If that question made you wince as you said, “Too much,” you’re not alone. In fact, it’s estimated that the average price for medical care increases about 3.5% per year, every year.
The cost of all types of healthcare—doctor visits, diagnoses, and treatments, as well as the health insurance intended to cover those things—continues to climb, often leaving regular people on the hook for portions of their treatments.
Many of us sigh when we receive bills from our healthcare providers—but then we just shake our heads and pay those bills. We usually don’t stop to consider whether we’re being overcharged. Even if a price does seem too high, it’s difficult for a regular person to interpret the complex medical coding that appears on each bill.
The office staff at a busy healthcare facility is often entering codes quickly, so we want to make it clear that mistakes can happen. But not all mis-coded items are accidental. The complexity of medical coding can also make it easy for unscrupulous healthcare professionals and thieves to commit medical fraud. And it’s why getting in front of medical overbilling is the key to gaining control of your medical bills.
But what is medical overbilling, and how can you protect yourself from it?
What is medical overbilling?
In short, medical overbilling is a type of medical fraud that means you (or you and your insurance company) pay more than you should for healthcare visits and treatments.
Every medical visit or procedure has a corresponding medical billing code. This multiple-digit code tells your insurance company what service was performed, which makes it easy for them to determine how much of each treatment or procedure they’ll pay for and what the consumer (you) will pay for. Typically, the codes are entered at your doctor’s office or facility by your physician or someone on their staff.
There are several types of overbilling, but three of the most common varieties are:
- Upcoding: This is when you and your insurance are billed for a more expensive visit or treatment than you received. Often the codes have very similar structures and are easily dismissed by the layperson. As a result, the insurance company or consumer needs to pay a higher rate. An example of upcoding would be reporting an excised mole as 3cm when it was actually 2cm.
- Unbundling: If you have several services or procedures done at one time, your healthcare practitioner will usually send the bill to your insurance company in a bundle “for a reduced cost.” Unbundling, then, is when your practitioner sends the bill piecemeal: instead of receiving a reduced cost for the bundle, the insurance company (or you) will pay full price on each item.
- Misrepresentation: This umbrella covers several types of practitioner dishonesty. One example is a misrepresentation of service (you are billed for something you didn’t receive). Another might be a misrepresentation of provider (billing for the doctor, for example, instead of the nurse practitioner you saw). A third type is misrepresentation of dates (if you saw someone on July 3 but it was dated July 5).
How can I protect myself against medical overbilling?
As you can see, the complexity of medical billing makes it difficult to see if you might be a victim. And besides, why should you have to take coding classes to make sure your healthcare providers aren’t taking advantage of you?
At HealthLock, we realized regular people had almost no recourse when they were being overbilled. That’s why we decided to do something about it.
Our powerful AI bill auditing technology will review every bill and Explanation of Benefits you receive, making sure the treatments and procedures listed are correctly coded. We’ll flag the ones that could have overcharges and can even help you get your money back. In short, we’re here to help put control of your medical finances back in your hands—where it belongs.