The Ultimate Guide to a Disputing Medical Bill

When it comes to medical bills, negotiating with billing departments can take up an incredible amount of time. The process can be very frustrating as well. Studies show that a typical case can likely take up about 22 calls to find a solution. Regardless of whether your dispute will take that long to resolve or not, it would help if you prepared for a long battle whenever raising a dispute. 

You should know that the billing system, when it comes to medical bills, is incredibly complicated.

Several CPT codes are reused to represent medical procedures, and some issues might arise from any area. Problems may happen with the CPT codes. A duplicate charge might have happened, or you may have been charged a lot because the doctor is out of network with the insurance plans. Sometimes, by mistake or even deliberately, your insurance claim may be denied by your insurance company.

There are a wide number of problems that can happen. It doesn't matter what kind of problem you face; you should keep in mind the below recommendations so that you can avoid being charged more or charged wrongly. They can also help you reverse any wrongfully denied insurance claim.

1. Getting a Bill That Is Itemized:

This is the first tip to negotiating with billing departments at hospitals. Most of the time, hospitals and other medical establishments tend to give you a summarized bill. You'll find that those bills only contain mention of the sum that is due from your end. If you want to make sure that you get a bill with all the charges listed in it, you should ask for a bill with all the details of the procedures and their charges listed. 

You should be able to see every single procedure you were charged for. Even those who are involved in the billing process agree. This is the first thing you should check to ensure that you're not being charged wrongly. 

You should look out for your detailed bill whether you're being charged for services you haven't received. You might also be charged mistakenly or otherwise for medicines you haven't received or even for hospital facilities that you haven't used. You should compare this bill with the explanation of benefits, or as it is also known, EOB. Your insurance company should be able to provide you with one. If you're a recipient of Medicare, you should check what our Medicare summary notice says. 

2. Having a Chat with the Medical Service Provider:

In case you're able to find charges that you don't understand, you should take it up with your doctor. You should point out the discrepancies and ask your doctor to review them.

If in case you are arguing against a charge that you've been asked to pay, you should ask the doctor's office that they don't send the bill off for collections at the time you're disputing the issue. You'll be able to do this with the help of a simple phone call. In case the issue that you have is complex and requires time to come to a resolution, what you should do is get it in writing from the provider that they will not send the bill off to be collected until you're satisfied.

3. Getting In Touch with the Insurance Company:

If you find that there's something in the bill that should get covered in the insurance, but the insurance doesn't pay it, then you should give a call to the customer care of your insurance company and ask them about the conditions that need to be met for them to pay for those charges. It may have happened that some details were either missed by the insurance company or were not provided in the first place. Those details might have been crucial for establishing that those services were necessary.

It sometimes happens because the doctor's office entered the wrong CPT codes. In that case, you should ask the insurer that they correct the mistake. Insurance companies nowadays are providing these services that are value-added in nature. Several insurance companies have nowadays started to provide services related to claims resolution.

4. Taking Notes:

Right from the beginning, when you start making the phone calls, make sure that you note down all the details of the calls somewhere. Those details should include the date and time when those calls were made, the person you spoke with, and what information they gave you. That way, you'd be able to keep a record of who provided you what information. Often, you'll find that the person you spoke with is actually from an offshore call center and is neither equipped nor authorized to make changes to your bill. If you can't resolve this with them, you should ask to speak with a supervisor. 

These are some of the steps that need to be taken to ensure that you pay exactly the right amount for your medical bills. You can seek the assistance of ClaimMedic for any help regarding a billing dispute.