Medical billing errors can cost your family big—and they're more common than you think. Here's what to look for on your medical bills to prevent overpaying on health care.
How to Read a Medical Bill for Errors
Are there obvious errors?
A misspelled name, incorrect insurance policy number, the wrong procedure code—any of these things can lead to your claim being denied. Also, check for "phantom" services that weren't performed (such as tests that ended up being canceled) and duplicate charges (being billed twice for a single procedure). If you spot an error, ask your doctor to resubmit the bill.
Was your co-pay applied?
If you paid at the MD's office, check to see if that amount was deducted from the bill.
Were you "balance billed"?
An in-network doctor's agreement with the insurance company usually requires that she accept the insurer's check—along with your co-pay or coinsurance—as payment in full, but some doctors might try to bill you for the rest. (Say the doctor billed $600 for a procedure but the insurer paid only $250. By law, the doctor can't charge you for the other $350.) Your insurance statement will confirm what your responsibility is; give a copy of that to your doctor.
Are there unbundled fees?
This means being billed item by item for things that should have been grouped together as part of a lower-priced package. Take, for example, the fee for delivering a baby: lab tests, IVs, the delivery itself and postnatal care are charges that should be bundled. Scan your bill for words such as kit and tray (each of these terms covers charges for multiple items).
Were you "up-coded"?
If a doctor removes a splinter from your foot and bills the insurance company for surgery, your share might amount to hundreds of dollars. If charges seem unreasonable, google the CPT code. If the description of the procedure doesn't jibe with what you had done, call your provider and your insurer and ask for a correction.
Does the timing seem off?
If you stayed in the hospital overnight, double-check the room-and-board charges. Although many plans don't allow hospitals to bill you for the day you were discharged, some hospitals do. And look for the time you were admitted: If you went to the ER at, say, 10 p.m. but weren't admitted to the hospital until after midnight, you shouldn't be billed for the previous day.