How to Check Medical Bills for Accuracy

Medical bills often appear complex, leading many individuals to pay them without a thorough review. Errors in medical billing are widespread, making it prudent for consumers to scrutinize every statement. Reports indicate that up to 80% of medical bills contain errors. This means many patients may be overcharged, highlighting the importance of understanding and checking these financial documents. Reviewing medical bills can prevent unnecessary expenses and ensure financial accuracy.

Collecting Your Medical Records

The first step in checking medical bills for accuracy involves gathering all relevant financial and medical documents. Request an itemized bill from the healthcare provider’s billing department. This document provides a detailed, line-by-line breakdown of every service, procedure, medication, and supply provided during your care, along with associated billing codes and costs. An itemized bill offers the transparency needed to verify individual charges.

Next, obtain your Explanation of Benefits (EOB) from your health insurance company. An EOB is a statement explaining what medical services your insurer has covered on your behalf. It outlines the cost of care, any discounts applied, the amount paid by your health plan, and your responsible portion. Accessing your EOB is possible through your insurer’s online portal or via mail. Possessing both the itemized bill and the EOB is essential for a comprehensive cross-check of all charges and payments.

Understanding Billing Statements

Deciphering medical bills and EOBs requires familiarity with common healthcare financial terms. A “deductible” is the amount you must pay out-of-pocket for covered services before your insurance begins to pay. A “co-pay” is a fixed amount you pay for a covered healthcare service, while “co-insurance” represents a percentage of the cost of a covered service you pay after meeting your deductible. The “out-of-pocket maximum” is the most you will have to pay for covered services in a plan year.

The “allowed amount” refers to the maximum amount an insurance plan will pay for a covered healthcare service, which may be less than the “billed amount,” or the total charge from the provider. Medical bills frequently include procedure codes, such as Current Procedural Technology (CPT) codes and International Classification of Diseases, Tenth Revision (ICD-10) codes. CPT codes describe medical, surgical, and diagnostic services and procedures performed. ICD-10 codes identify diagnoses and health conditions. These codes provide a comprehensive picture for the payer.

Verify the dates of service and the names of providers and facilities on the bill. These details should align with your personal records of when and where you received care. Comparing the services listed on your itemized bill with the entries on your EOB ensures both documents reflect the same care. This confirms that services billed correspond to services rendered and that your insurer processed the claim as expected.

Recognizing Billing Discrepancies

Once you understand your medical bills and EOBs, you can identify potential discrepancies. One common error is duplicate charges, where the same service or item appears multiple times. Review each line item to ensure you are not billed more than once for a single procedure or supply. Another frequent issue involves charges for services not actually received, such as tests, medications, or procedures that were ordered but canceled or never provided.

More complex errors include “upcoding” and “unbundling.” Upcoding occurs when a provider bills for a more complex or expensive service than performed, often using an inaccurate CPT code. For instance, a routine office visit might be billed as an extended consultation. Unbundling involves separately charging for services typically grouped under a single comprehensive code. These practices can artificially inflate the total cost of care.

Beyond service-related issues, look for incorrect patient or insurance information, such as misspelled names, wrong birth dates, or inaccurate policy numbers. Verify that the dates of service on your bill accurately match the dates you received care, as discrepancies can indicate an error. Also, check for charges from providers you did not see or for services performed by a different provider than listed.

Disputing Inaccurate Charges

After identifying discrepancies, contact the healthcare provider’s billing department. Before calling, gather all relevant documentation, including your itemized bill, EOB, and any personal notes detailing the errors. Clearly explain the specific discrepancies and request a bill review. Many billing issues can be resolved directly with the provider through this initial contact.

Throughout the dispute, maintain meticulous records of all communications. Note the date and time of each call, the name and title of the person you spoke with, and a summary of the conversation, including any agreements or next steps. This documentation is invaluable if the issue requires further escalation.

If the provider does not resolve the issue, contact your health insurance company. Your insurer has an internal appeals process, which you must initiate within a set timeframe, often 180 days from the notice of a denied claim. The insurance company is required to complete its internal review within 60 days for services already received. If internal appeals are unsuccessful, you may have options for an external review. This involves an independent third party reviewing your case. You can also contact your state’s Department of Insurance or consumer protection agencies for guidance.