How to Dispute Health Insurance Errors

Board care for elderly can cause medical bills to pile up.

Photo used under Creative Commons from attercop311.

With the possibility of multiple bills being generated from a single visit – along with discrepancies in the diagnosis and treatment necessary – there’s no wonder that medical bills sometimes have errors. In fact, a recent study conducted by the American Medical Association revealed that even with the recent improvements in billing accuracy, a full 10% of bills paid by private insurance companies do, indeed, have errors. Added to that is the fact that next year, in 2014, a much greater number of Americans will have health insurance coverage under the Affordable Care Act, thereby increasing the possibility of errors.

There are ways consumers can dispute any health insurance billing errors they find. The following are just a few suggestions to set things right and possibly save yourself quite a bit of out-of-pocket expense in the process.

First, make sure your insurance provider has the most accurate and up-to-date information about you. Though it sounds entirely too simple, such discrepancies as your date of birth, the spelling of your name or whether or not you regularly utilize your middle initial on your paperwork can create problems. A great example of how this can happen is when a person is admitted to the hospital. A hospital patient can be seen and tested in a number of different departments, and unfortunately, all the departments create separate billing for the work performed. Thus, it can be tricky to keep up with all of this and to remember it all at the time your bill is actually received. It is always best if you have a friend, family member or other patient advocate available to double-check the information while you’re being seen at the hospital.

Second, review your bill. Generally, your bills come with an explanation of benefits – read them over and be sure you understand them fully. This statement will indicate what services are being paid for by your insurer and which ones are not. This is a great way to get a clear, concise explanation if your insurer doesn’t cover a particular service.

Third, be sure you have a good understanding of your insurance benefits. Have a working knowledge of your deductible and your co-pays. If you have to be referred to a doctor outside the network, understand what percentages are covered for these types of visits. In the case of pricey specialists, you should know that insurance companies often work with average “industry standard” costs for certain services and often will not bend if your specialist charges significantly more than the average.

Fourth, after reviewing your bill and truly understanding your benefits, don’t be afraid to ask questions if you do not understand. Challenge the charges if you deem it necessary. Be sure you keep detailed records of who you spoke with and their responses. Keep a copy of anything you fax, mail or email to your insurer.

Fifth, check the medical coding information. Much of the medical billing information you receive works off of specific coding from your doctor’s office, submitted directly to the insurance company. In certain cases, you may need to go back to the doctor’s office to request a “run-down” of the medical codes associated with your visit. Compare this information to your bill. If there is, indeed, a discrepancy, you can go back to the doctor’s office and ask that the information be corrected and resubmitted. A simple error in coding the diagnosis can make a huge difference in the payment of services associated with that visit.

Sixth, get agreements in writing. Promises are no good without written confirmation, preferably via email.

Finally, if the dispute process seems entirely too consuming, you may consider getting a medical billing advocate to help. A growing number of consumer advocate services and software programs are now available to assist in detecting and disputing medical billing errors.