How-to decipher your medical bills
Follow these easy steps to check your paperwork and avoid overpaying.
Don’t write a check, yet. Sometimes the doctor or hospital sends an invoice before receiving the full insurance payment, so the bill is more than you actually owe. Wait until your insurance statement comes in the mail to find out what you are responsible for.
Compare statements. When your EOB arrives in the mail, look at it next to the bill to uncover discrepancies. Check for these potential errors:
►Was your co-pay applied? If you paid at the doctor’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 (plus your co-pay or coinsurance) as payment in full. But many physicians 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 the other $350. Your insurance statement will state what your responsibility is. Give a copy of that to the doctor.
►Were you “up-coded”? If a doctor who removed a splinter from your foot bills the insurance company for surgery, your share might amount to hundreds of dollars. If charges seem stratospheric, look up the CPT code on the American Medical Association website. If the description doesn’t match the procedure, call the provider—and your insurer—and ask for a correction.
Maintain meticulous records. Before you send in a claim or pay your bill, make a copy of the invoice and claim form. File this paperwork away with your insurance EOB. If you are ever involved in a dispute, you will be in better standing if you have complete paperwork, including any notes you took at your appointments. Also, if your medical expenses exceed 7.5 percent of your adjusted gross income in any year and you itemize, you should be able to deduct them when you file your federal income tax. Save your sanity by listing your history and monitoring your medications and appointments in one place—these sites can help:
►Online storage: These sites each offer free record consolidation and medication management: healthvault.com, google.com/health and healthmanager.mayoclinic.com. You can give your doctor printouts or online access.
►Offline storage: Download a blank template to your hard drive, then print and carry the paper copy with you. At office.microsoft.com, click on “Templates,” then select “Healthcare” and choose “My Health Record.”