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    How To Dispute Medical Bills: We’ll Walk You Through The Steps!

    Jose Sanz - 2019-01-20 14:16:13

    Medical treatment is often essential and can even be a matter of life or death. Essential medical bills can oftentimes be a major financial burden - but not paying them can have a very negative effect on your credit

    Unpaid bills can lower your credit score and reduce your chances of being approved for credit. Moreover, when approved for credit, it might mean much higher APRs as a result.

    To make matters worse, the reason your medical bills are so high could be an error made by the hospital or healthcare provider - and you shouldn’t have to pay for their mistakes.

    Have you received a bill recently that seems excessive?  There are steps you can take to dispute it before it falls into arrears.

    What To Be Aware Of Before Disputing?

    We need to make it clear from the beginning that disputing medical bills is not the easiest process - but it certainly can be done.

    You’ll need to be prepared to spend a fair amount of time contacting your healthcare provider and health insurance company before you dispute your bill. You can do this both by phone and by email.

    There will also be a certain amount of negotiation involved in the process if you’re hoping to get your bill reduced, so get ready to negotiate and advocate for yourself.

    Your doctor can be a valuable ally in the process of working  with your health insurer and healthcare provider to dispute your bill.

    It’s worth mentioning your planned dispute to your primary care physician and asking them if they’d be willing to provide written testimony about your medical history if necessary.

    Now that we’ve covered the groundwork, let’s take a look at the process of disputing your medical bill in more detail.

    The Step-By-Step Process to Dispute Your Medical Bill

    A bill that looks suspiciously high is always worth investigating. There are seven steps you’ll want to follow to increase your chances of success.

    Gather your medical bills and request an Explanation of Benefits (EOB)

    The amount your healthcare provider will charge you directly  is usually the excess amount that your health insurance won’t cover.

    Sometimes a billing error occurs on a long medical bill and you end up being charged more than you should be. Here’s how to spot it.

    • Contact your health insurance provider and ask them to send you the EOB (Explanation of Benefits) for the medical bill you’re planning to dispute.
    • The EOB will list all the services, charges, and procedures that the medical provider charged your health insurance for, how much of each charge was covered by your insurance, and how much excess you are liable to pay.
    • You’ll want to compare each amount on the EOB to your medical bill - and if the amounts don’t match exactly, make a note of each discrepancy.

    Request a detailed medical bill

    Some bills only contain a summary of services rendered and the total you’re being charged.  That means you won’t be able to compare the bill to your EOB in enough detail to pick up possible errors.

    Here’s how to resolve this issue.

    • Ask your healthcare provider to send you a detailed, line-by-line bill that lists all the expenses they are charging you for.
    • You’ll see that each item has a code called a CPT code next to it on the statement - this code tells you what specific service you’re being charged for (including medical consultations, theater equipment, blood tests, or the cost of your hospital stay).
    • If you notice one or more CPT codes that correspond to services you didn’t receive (like a surgery if you only had a consultation) take careful note of the code and amount.
    • If the amount billed for any item doesn’t match your insurer’s EOB, take note of that too.

    Contact your medical provider

    At this stage you’ve identified possible errors that you’d like to dispute. The next step is to contact the healthcare provider that sent you the bill.

    Dealing with customer service representatives in the disputes department can be challenging, and you’ll need to be patient as you explain your situation, the errors you’ve picked up, and your reason for disputing the bill.

    • Don’t be discouraged if the first person you speak with can’t or won’t adjust your bill. Ask to speak to their supervisor (or even their supervisor’s supervisor).
    • Keep trying until you reach someone who has the authority to make a decision with regards to your bill.
    • You can ask the representative you speak with to tell you what’s involved in the dispute process. Don’t hesitate to ask when you can expect to hear back from them with a decision on the item(s) you’re disputing.
    • It’s ideal to receive confirmation in writing that payment of your bill will be suspended while the provider investigates your dispute.

    Ask your insurer to dispute the bill

    Your health insurance company shares the responsibility of paying your medical bills and they will be keen to avoid paying unnecessary amounts just as you are. You can use this fact to your advantage.

    • After you’ve disputed your bill with your healthcare provider you can contact your medical insurance company and report the error(s) to them too.
    • Your insurer may launch their own investigation into the billing error and contact the healthcare provider independently to make sure that the mistake is rectified.

    Still having trouble? Contact the patient advocate

    Many healthcare providers, especially hospitals, have a dedicated patient advocate whose job is to deal with patient disputes and resolve them on the hospital’s behalf.

    There are times when contacting the healthcare provider and your health insurer don’t produce the desired results.

    This is when a patient advocate can be a powerful ally.

    They may also have the authority to add a discount to your bill, especially if you’re experiencing financial difficulties.

    Negotiate

    Whether you’re dealing with the healthcare provider, your insurer, or a patient advocate, you’ll need to negotiate carefully to get your bill reduced.

    Your doctor can provide a letter to help support your claim and encourage your insurer to cover your expenses. This document should outline your medical history and give reasons why your medical procedure was necessary.

    Get in touch with your State Insurance Commissioner

    The State Insurance Commissioner may be able to assist you if the strategies above don’t yield the desired results. 

    Your commissioner is a consumer advocate and regulator of the insurance industry and has the power to investigate irregular billing and other issues.

    The process can be paperwork intensive.  You’ll want to make sure you have all the relevant documentation ready, with copies of important documents ready to be submitted to the commissioner.

    Bottom Line

    Disputing an error on your medical bills can save you from the stress of having your bill go into arrears and collection - and it can save your credit score from being damaged too.

    While the dispute process can be long, it’s definitely worthwhile. Following the steps above will help you increase your chances of success.