By Teri Dreher Frykenberg, RN.
Estimates suggest that up to 80 percent of medical bills contain at least one error. That’s why I always recommend that people not pay a medical or hospital bill until they have received an itemized bill and carefully reviewed it.
There are a lot of reasons for mistakes in medical billings, which can cause you to incur a bigger-than-expected bill or your insurance to be denied.
Some common types of medical billing errors include:
- Incorrect diagnostic codes: For example, an administrator might enter the wrong code, indicating that a patient had an X-ray on both legs when only one leg was imaged.
- Typos: A typo can cause a single saline drip to be registered as many more.
- Incomplete or incorrect information: Information for a patient or provider might be entered incorrectly or incompletely.
- Duplicate billing: The same service might be billed for more than once.
When you receive an unexpectedly large medical bill, the first thing to do is take a deep breath, ask for an itemized bill (which you are legally entitled to), and review it for errors. If you think there are errors – or the bill is just too big for you to handle – the worst thing to do is to ignore it.
Instead, challenge it. A study just published in JAMA Health Forum found that it’s worthwhile.
Erin Duffy, a research scientist at the University of Southern California’s Shaeffer Center for Health Policy and Economics, surveyed a cross-section of health consumers and found that one in five – fully 20 percent – reported that their household had received a medical bill that they could not afford or didn’t agree with.
Most of them didn’t reach out to the health-care provider because they didn’t think it would make a difference. But, she wrote, “the experiences of those who did reach out provide evidence to the contrary.”
“Most respondents who reached out reported at least one form of financial relief, bill corrections, or better understanding of the bill,” she wrote. “These findings suggest that patients benefit from reaching out to the billing office on receiving a problematic bill, and those who do not reach out may be missing financially advantageous opportunities.”
The study found few differences in the households reporting problem bills – the residents had different levels of income and education. But these factors did affect a person’s willingness to call about their medical bill.
“Those who were uninsured, Medicare insured, and less educated were less likely to reach out to the billing office,” Duffy reported. “These differences in self-advocacy may be widening the gap in financial burden of health care between those with higher and lower socioeconomic status.”
Self-advocacy is not easy, and challenging a medical bill can be time-consuming and frustrating. Some of the people in Duffy’s study said they had spent five hours or more contesting a bill, and quite a few said they didn’t feel the people in charge were respectful to them.
But if the outcome is a reduced bill or a payment plan, it can be worth the effort. It’s estimated that Americans are carrying more than $200 billion in medical debt, the majority of it by people who owe $10,000 or more. While the three major credit agencies no longer include medical debts under $500 on credit reports, it can still impact credit scores if the health organization reports it to the credit agencies.
Tellingly, only 3.5 percent of the respondents sought help from an advocacy organization to contact the billing office, Duffy said. The time burden plus the fact that many of the people surveyed didn’t reach out at all indicates “there may be an unmet need for formal assistance navigating bills,” she wrote.
Patient advocates are one source of such formal assistance. They navigate the intricacies of the health-care system itself and its mind-boggling billing systems, too. A medically trained patient advocate can look at an itemized medical bill and spot duplications and inconsistencies that a lay advocate may miss.
To avoid mistakes and misunderstandings, understand your health insurance coverage; ask questions when you don’t. Know what your deductibles, coinsurance, copays and out-of-pocket maximums are. Ask why your doctor is ordering certain tests or procedures. Call your insurer in advance to find out how much you’ll be asked to pay. Always document the answers you receive, who you spoke to, and when. Get promises in writing. And if you’re uninsured, be upfront about it.
After all that, if you still receive a bill you think has errors, advocate for yourself and you may save yourself some money.
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Teri Dreher Frykenberg, RN, is a patient advocate and founder of www.NurseAdvocateEntrepeneur. She is the author of How to Be a Healthcare Advocate for Yourself & Your Loved Ones (Amazon). She would be happy to offer a free consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com
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Tags: credit report, debt, medical bills
