If you have received a medical bill that you were not expecting, or one that seemed much higher than you thought it would be, your initial reaction might be to panic about how you are going to pay the bill. However, it might be that the bill has been sent to you in error.
Yes, everyone knows how expensive medical care is, but if you have a healthcare plan you may actually be covered for the treatment you received. Or it could be that the medical billing codes entered were incorrect. According to the good folk at Find-A-Code.com, it is always worth taking some time to go through your Explanation of Benefits (EOB) and compare it to the medical bill that you have received. Doing this will give you some idea as to whether you are right to raise a dispute.
What is the Explanation of Benefits?
Your EOB document details the treatment you have received and explains how and where you are covered by your healthcare plan. You will see information about the procedures that were carried out, how much the healthcare provider charged for this procedure, the discount that the insurance company has negotiated, how much the insurance company is paying to the provider, and the amount that is owed by you. The EOB will also include an explanation of any procedures that are not covered.
Comparing your EOB to the bill might give you some indication as to why your bill is higher than expected. For example, you might find that you have been billed for the wrong procedure, or that the plan discount has not been applied. Or you may find that you were wrongly billed for preventative care services such as a colonoscopy or flu shot (both of which should be fully covered as per the Affordable Care Act).
How to Dispute Your Bill
If you believe you have been billed incorrectly, it is a good idea to make a note of where you think the error occurred before you contact the billing department at the medical provider. You should then explain that you have found an error and ask what the process is for raising a dispute. You should also ask that the due date of the bill be put on hold or extended while the dispute is ongoing.
It is likely that the person you speak to will explain what you need to do to raise the dispute. It might be that you will need to submit it in writing, or that they can take the details over the phone. It is a good idea to get as much information as you can at this time, such as the name of the person you are speaking to and their ID number if appropriate. Write all this information down as well as the time and date of the call. Ask for information about when you are likely to hear back and get confirmation about whether the entire bill will be placed on hold or just the specific part that is being disputed. You may need to settle the rest of the bill before the dispute has been resolved.
Mistakes can unfortunately happen from time to time when it comes to medical billing and coding. It is therefore important that you check your EOB when it arrives and compare it to your medial bill. If you think a mistake has been made, you should contact the medical provider’s billing department to highlight the error. If you cannot get the issue resolved, you may need to seek legal advice.