But you can still dispute those bills or, in many cases, at least reduce what you owe, Allen said. First, ask the health care provider for an itemized bill that includes billing codes describing the care you received. If the provider is hesitant to give it to you, he said, explain that the Health Insurance Portability and Accountability Act, known as HIPAA, requires medical providers to share this information with the patients.
Once you have the itemized bill, check to see if the billing codes used by the provider, which are usually strings of numbers, accurately describe the care you received. (You can learn more about codes by searching for code numbers on Google with the phrase “medical billing code.”) Often medical providers charge for services they didn’t actually provide, or they charge more complex care than what was provided. , says Allen. If so, he said, dispute those charges and request a corrected bill by contacting the medical provider or doctor’s office directly.
You can also compare the amount the healthcare provider charges for each billing code with what insurance companies consider a reasonable amount to charge by looking at the codes on the hospitals’ websites or on the hospital’s website. non-profit organisation. Fair health consumer. When I did this, I saw that although my daughter’s ER doctor charged $17,000 for the stitches he sewed (and an additional $4,500 for the ER visit itself), the Average out-of-network cost for this type of stitch where she was treated is $2,983. In other words, he charged me more than five times the average off-network price. In this type of situation, you can dispute the charges as unfair and even sue the supplier in small claims court.
Another smart thing to do is find your insurance company’s Explanation of Benefits – the statement that summarizes the medical services billed to the company – because your medical provider should have tried to bill your insurance company. before billing you. You can call your insurance company to get your statement or you can access it online at the company’s website. If your medical provider didn’t bill your insurance company first — meaning there’s no explanation at all about benefits — don’t pay the bill you received, Nicole said. Broadhurst, a patient advocate and founder of Tennessee Health Advocates. Instead, call and ask the provider to bill your insurance.
Don’t give up the fight.
It is unfair, of course, that these charges should be imposed on the consumer, especially when so many billing problems reflect errors made by medical providers or insurance companies. “It takes a while, and it can be hassle,” Allen said. “And you have to be persistent.” But for people who have the time and resources, he added, it’s important to fight unfair medical bills. By doing so, we are not only helping ourselves, but also sending a message to the entire healthcare industry. “We all have to stand up and say, ‘Hey, what’s happening is not normal, and we’re not going to let you do this anymore,'” he said.
Researching my company’s benefit explanation helped me understand my daughter’s ridiculous ER bill. When I studied the statement, I saw that the doctor who sewed up my daughter’s stitches had tried to bill my insurance but with the wrong billing codes, so my insurance company denied the claim. The doctor should have resubmitted the claim to my insurance company with the corrected codes, but instead billed me directly.