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Medical Billing Errors – What to do?

Medical billing errors are very common. Estimates put the rate of medical billing error somewhere between 30-80%. Unfortunately, identifying mistakes on a bill and successfully contesting them can be a complicated process. While billing errors are generally not the basis for a lawsuit, there are many steps consumers can take themselves in this situation.  So, what steps can you take to protect yourself?

1. Don’t delay! There are time limits for disputing a bill, so be sure to review your bill promptly, and notify your healthcare provider of a dispute as soon as possible. Written notice of a dispute may delay the bill from being sent to a collection agency.

2. Get an itemized bill and a copy of your medical records. Ask for an itemized statement. Without all the details, it is not possible to identify the item(s) that need to be disputed. The statement should show every item you received, any care that was provided, and every procedure that was performed. Ask for your medical records as well, so you can check your bill against what is recorded in your medical records.

3. Keep a records of your contacts. Be sure to record every contact you have with the healthcare provider(s) and insurance company(ies). When you make a phone call, note the following: the date and time of the call, the person, or people, with whom you who spoke, and what was said. Get an email address for the billing department, so the communications are in writing. If you send a letter via the United States Postal Service, save a copy and note the date it is sent. (You might consider sending it via certified mail with return receipt requested.)

4. Phone call. If it is a simple mistake, you can sometimes remedy the problem with a friendly phone call to the doctor’s office. You should, however, followup with a fax or email to get it in writing. Thank them for helping you with the problem, and ask for a written copy of the revised bill.

5. Write a dispute letter. If it isn’t resolved via the phone, write a dispute letter. Start the letter by providing the essential details, such as your account information. Be specific about which charges you are disputing and why. Make sure to save a copy of the letter and note the date you mailed it. You should consider sending it via certified mail, return receipt requested; it’s more expensive, but it will provide proof that the letter was both sent and received.

6. Be persistent and follow up. If you do not hear back within a few business days, email them again or give them a call to confirm that they received your communication.

7. Don’t be afraid to ask for a discount. Oftentimes, a discount can be negotiated. You might not get a discount, but it doesn’t hurt to ask.

8. Make a complaint. If you believe that you are being treated unfairly you can file a compliant about a doctor with the Texas Medical Board at http://www.tmb.state.tx.us/page/place-a-complaint or a healthcare facility with Texas Health and Human Services at http://www.dshs.texas.gov/facilities/complaints.aspx?terms=hospital%20complaint#complaints. Complaints about improper claims denials against insurance companies can be filed with the Texas Department of Insurance at http://www.tdi.texas.gov/CONSUMER/complfrm.html

9. Medical Billing Advocate. If you don’t feel you can do this on your own, you can consider seeking out the assistance of a Medical Billing Advocate. Advocates charge either an hour rate or take their fee as a percentage of what is recovered. You can find some billing advocates at the following sites www.Claims.org and www.Billadvocates.com.

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Rosen & Spears is a plaintiff law firm which seeks to protect the rights of healthcare consumers and their loved ones through medical malpractice, nursing home neglect, financial abuse of seniors, and other types of claims. For more information, please contact us.

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About the author

Rosen & Spears is a plaintiff law firm which seeks to protect the rights of healthcare consumers and their loved ones through medical malpractice, nursing home neglect, financial abuse of seniors, and other types of claims. For more information, please contact us