Dealing with medical billing errors and fraud can be overwhelming and time-consuming, but if you have the time and determination, you can potentially save money and ensure your medical records remain accurate.
A quick note: resolving these issues can take a significant amount of time and determination. In fact, nearly half of patients spend up to a month fixing incorrect medical bills.1 We’ve even heard horror stories of some taking as long as a year!
But if you’re the do-it-yourself type, we’re here to help. Since we’ve been investigating and negotiating medical bills for members for well over a decade, we asked our expert negotiators for some tips to help you get started:
- Review your bill thoroughly: The first step is to carefully review your medical bill. If it is not itemized, request an itemized invoice. Ensure that each service, medication and test listed is accurate and that the Current Procedural Terminology (CPT) code corresponds to your treatment. Mistakes can often arise from simple clerical errors, so it’s essential to identify any discrepancies.
- Gather your documentation: Collect all relevant documents, including medical records, insurance policy details, and any communications you’ve had with the healthcare provider or insurance company. Having this information readily available will strengthen your case when you communicate with them.
- Understand what is and is not covered by your insurance: Log in to your insurance company’s portal and locate your policy to determine what is covered by your current plan. If you don’t understand something, contact your insurance company to get clarification.
- Reach out to your provider and/or insurance company to discuss the billing issue: Contact either your insurance company or the billing department of the provider depending on where you think the error originates. Politely discuss the issue and present your evidence. You may need to make your case over several calls, emails and faxes. If you are appealing a claim denial, your insurance company may require you to put together a case.
- Stick with it: Unfortunately, you are on their timeline, so be patient and follow up consistently. In many cases, you may need to follow up frequently during business hours (in their timezone), so we recommend keeping a calendar of important dates along with detailed notes of who you talked to last and what was said. Try to get things in writing as often as possible.
The medical system is complex, but by following these five tips you can increase your chances of resolving the issue successfully. Of course, our experts are here to save you time, money and hassle by doing the work for you. And remember, you only pay a portion of shared savings if we successfully save you money.
Keep in mind, if you do decide to do it on your own, persistence pays off.
Zelis. “Healthcare Financial Journey: Reducing friction for healthcare consumer.” 2023.