How to spot expensive errors on your medical bill, and when you should ask for an itemized bill
- If you're unsure about a charge on your medical bill, request an itemized bill.
- An itemized bill contains detailed descriptions that can help you argue unfair or incorrect charges.
- You can also negotiate charges by comparing what you were charged with the hospital's listed prices.
It's a common scenario: You've recently been released from the hospital or finished with a doctor's appointment.
Related Article Module: A quick and simple guide to reading your medical bills and Explanation of BenefitsYou're on the road to recovery, finally feeling like yourself, again. And then you get an outrageous medical bill in the mail. What do you do?
First and foremost: Don't pay it immediately. This might seem counterintuitive, but before you pay there are some steps you should consider taking like asking for an itemized bill, comparing charges, and speaking to an insurance agent.
Note: Not paying your medical bill immediately will not damage your credit score right away. It takes many months for collection agencies to become involved.
Hospital billing is like any other bill, people and computers make mistakes which can result in a bill that charges you more than you actually need to pay.
"We estimate about half of all medical bills have a mistake in them and we've never seen a mistake work out in a patient's favor," says Caitlin Donovan, health care policy expert at the National Patient Advocacy Foundation.
Here are expert-backed tips on what to do if you're unsure whether, or not, you're being overcharged for medical services.
Common mistakes on hospital bills
In order to spot a mistake, it helps to know what you're looking for. Here's a list of common mistakes on medical bills:
- Duplicate costs (i.e. you get charged twice for a procedure or medicine).
- You've been charged for a procedure, service, or medication you didn't receive. Use the Medicare code lookup to check that the codes on your explanation of benefits match the type of care you received. However, it can be a bit confusing. Sometimes a Google search can also help you find what certain codes mean.
- A procedure or medication price is inaccurate.
- Your insurance was supposed to cover something that it didn't.
- Your condition was misrepresented on the bill, also known as upcoding.
- You're missing your Explanation of Benefits (EOB).
But perhaps the most common mistake of them all is receiving a bill that hasn't gone through your insurance yet.
"The biggest source of mistakes, when you break that down, are bills that go straight to the patient before processing by the insurer. There are all sorts of reasons why that happens from the nefarious to the purely accidental," says Donovan.
Turns out, medical billing isn't as straightforward as paying the first bill a hospital invoices you for and may explain that whopping cost. So before you do anything else, firstmake sure your insurer has received and processed your bill. After that, if the cost still seems unreasonably high, start scanning for other errors or mistakes.
Can you negotiate a hospital bill?
Let's say you've found a mistake or your bill is more than you can pay. Can you negotiate a hospital bill?
If the bill is going to hurt you financially, it's worth arguing, says patient advocate AnnMarie Mcllwain, a seasoned medical billing and patient advocate with the Alliance of Professional Health Advocates.
If there are errors those are important to point out, but you may also find that you can negotiate the price of the bill, even if it doesn't have obvious mistakes.
Here are a few tips McIlwain recommends when arguing a hospital bill to save money.
1. Don't pay right away
If you're worried not paying immediately will affect your credit, don't be. "No bill can appear on your credit score for 180 days. Right off the bat you have six months," says Donovan.
Mcllwain recommends calling the hospital billing office number to let them know you're contesting a bill. Be sure and request that they put a hold on your case so it won't show up as debt and therefore will not affect your credit score.
It's also a good rule of thumb to document who you talk to and what they tell you.
2. Ask for an itemized bill
Related Article Module: A TikTok user's simple trick for lowering pricey hospital bills is going viralIt's important to note that you may not receive an itemized bill unless you ask for one. However, once you request it, the hospital is legally obligated to provide you with one.
You can either ask for an itemized bill after you receive your EOB or you can request one before you schedule a major operation, like a surgery, to get an idea of estimated upfront costs.
"Ask for an itemized bill. It's full of lots of detail. You might find you're being charged for days you weren't even there. Software and people are fallible," says Mcllwain.
Compared to an EOB, itemized bills give a more detailed description of all the services you received - including the medical billing codes on your EOB. Here's what an itemized bill may look like and how to read it:
3. Talk to your insurer
If you have health insurance, then reach out to an insurance agent who will help walk you through specific details of your bill and resolve any issues.
Important: Every medical bill will look different depending on several factors including where it's coming from, your health insurance, and the procedure or service you received.
If you don't have an insurance agent, there are still steps you can take to negotiate the bill with the healthcare institution billing you. It just may take more work on your part.
In either case, you should contact the hospital's billing department to let them know you're contesting their charge.
4. Compare the charges
Donovan and Mcllwain both recommend using the Healthcare Blue Book to see the cost of services and procedures in other hospitals near you. Another similar tool is FAIR Health.
Important: The Healthcare Blue Book provides a database of healthcare costs in various regions that you can compare with your bill. Their goal is to cut down on overpayment for medical procedures. The free version for consumers is being revised for 2021.
It's sort of like price comparing for cars, so it's best if you keep a log of average prices from other nearby hospitals. Once you have logged prices from neighboring medical facilities, you can use your own facility's chargemaster to compare the charges.
"Compare what they charge you to the chargemaster," says McIlwain "Increasingly, hospitals list a chargemaster link on their website where you can search what their typical charges are for certain procedures. If you see a discrepancy, use it during your negotiations."
If the cost of care at your hospital was consistent with the hospital's estimated price, you may still be able to negotiate the bill if you're being charged a lot more than you would have been at a neighboring hospital.
5. Put everything in writing
Mcllwain recommends documenting every phone call you have when negotiating a bill. Keep track of exactly what errors you're contesting, what you want to negotiate, and what your health insurance is meant to cover.
This means keeping all documents sent to you, highlighting areas that are inaccurate, and keeping a file of your health insurance policy. Some apps, like RexPay, can help you keep track of your bills as well.
6. Be patient
Donovan's organization estimates that it takes, on average, 16 calls to resolve a medical billing issue.
Sometimes these issues can take months or even years to resolve depending on how complicated the problem is.
Be patient and remember to try and remain calm on the phone even though you might be frustrated.
The representative you're calling is not who's responsible for the error, but they are there to help, says Mcllwain. Being nice and patient is often a faster, better way to get traction and resolve your issue.
7. Hire a medical billing advocate
If you find yourself in a tricky situation, it might be time to hire a medical billing or insurance advocate who can help you sort through and negotiate bills.
Medical billing advocates are specialists who can help field calls between hospitals and doctors and your insurance to resolve billing issues.
You can pay an hourly fee or a contingency fee depending on the advocate. Since they are independent contractors their prices may vary widely.
Insider's takeaway
It's important to keep track of your medical expenses and be thorough when paying a hospital bill as you may be getting overcharged.
If you can't pay your hospital bill or your appeal fails, you have some options. Some hospitals can help you set up a payment plan so you don't have to pay all at once. Some hospitals may offer internal financial aid as well.
Not-for-profit hospitals are legally obligated to adjust your bill if your income falls below specific guidelines. Payment policies are usually posted on each hospital's website, but be sure to read the fine print.
Additionally, you can apply for Medicaid if you are at or below the poverty line. Plus, there are many companies and charities that can offer debt-relief in the event that all else fails.
Medical Debt Relief Resources:
Donovan notes that there are some exceptional circumstances that may require more effort. If, for example, a hospital is charging ridiculous prices or is particularly aggressive, you may be able to reach out to your local congressperson or to the press. Sometimes a social media post will get a fast response from the hospital and your concern may get escalated to a higher priority.