Dealing with Medical Billing Issues

Dealing with Medical Billing IssuesIt’s a common occurrence these days–you receive a sky-high medical bill in the mail. Maybe the bill is for medical services or treatments that you thought were covered by your insurance. Or perhaps you have difficulty understanding exactly which medical procedures you’re being charged for, or what the medical billing codes on your hospital bill mean.

The fact is, due to the complex nature of today’s medical billing industry, it’s difficult for many consumers to know exactly what they will end up having to pay for medical services or treatments. Fortunately, there are some things you can do to make it easier to deal with any medical billing issues that may arise.


Understand what your insurance does and does not cover

Your first step in tackling a medical billing issue is to find out exactly what your insurance does and does not cover. Review your health plan’s coverage brochure or contact your insurer to find out about your health insurance plan’s coverage exclusions or limitations, expenses that are fully or partially covered by your plan, and the ramifications of using an out-of-network provider.

Another helpful tool is an explanation of benefits (EOB). Once a medical claim is processed by your health insurance provider, you should receive an EOB. The EOB will provide you with a variety of information, such as the dates and type of services provided, the amount that was billed by the medical provider to the insurance company, what the insurance company paid to the provider, and the amount that wasn’t covered and for which you are responsible. Review your EOB and compare it to your medical bills. If you find any discrepancies, contact your medical provider’s billing department.


Keep an eye out for common billing errors

Unfortunately, errors are a common occurrence in the medical billing industry. As a result, it’s always important to request an itemized bill, as opposed to just a summary of charges, from your medical provider. An itemized bill is critical when it comes to identifying billing errors because it will detail each medical procedure for which you are being charged.

Once you’ve received your itemized bill, check to make sure that all of your identifying information (e.g., address, date of birth), dates of service, and insurance information are correct.

In addition, be alert for common billing errors, such as:

  • Being billed separately for services that are already covered under previously bundled fees
  • Being billed for extra time in the operating room or more anesthesia
  • Being billed for a more expensive charge than necessary (also known as “upcoding”)
  • Charges for canceled procedures
  • Charges for duplicate procedures
  • Incorrectly coded procedures

If you find an error on your bill, contact the billing department of the medical provider to request a corrected insurance claim and/or bill. Be prepared to explain the mistake to the billing representative and provide copies of billing records that illustrate the billing error.


Don’t be afraid to negotiate

If it turns out that you do owe money, it’s important to know that medical bills may be negotiable. If you have a large medical bill, it may be worthwhile to negotiate with your medical provider. Depending on the amount you owe, you may be able to lower your balance or arrange a payment plan that spreads out the amount you owe over a period of time.


Consider getting professional help

Some medical billing issues may be too difficult to resolve on your own. If you are unable to determine what you owe or negotiate a resolution with a billing department, consider enlisting the services of a medical billing advocate.

Medical billing advocates are typically paid an hourly rate. They can be extremely effective in helping you deal with a variety of medical billing issues, such as identifying billing errors and/or assisting you with negotiating a lower balance. For more information on medical billing advocates, visit the Medical Billing Advocates of America website at



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