How to make sense of a medical bill
How to review your medical bill for inaccuracies
Medical bills can be really confusing. Anyone who has had a healthcare experience is probably familiar with receiving several documents from different providers and insurance companies, and struggling to understand whether they are correct.
Often, the more acute the healthcare experience, the more complicated the billing. On top of this, many medical bills contain errors.
Industry groups estimate as many as 80 percent of medical bills contain inaccuracies. In these instances, consumers often end up overpaying. Some people have even argued medical bills are overly complicated on purpose to keep most consumers from noticing when they have been overbilled.
The whole process can cause a lot of anxiety, especially after a medical scenario. So how can consumers ensure their bills are correct?
Below are some tips to help consumers feel more comfortable reviewing their medical bills.
Medical bill versus Explanation of Benefits
The first thing consumers typically have questions about are the many different documents that arrive in the mail. Some outline charges and what the consumer owes, but then say, “This is not a bill.” What is it, then?
For a medical experience, you will typically receive both a medical bill and what’s called an Explanation of Benefits (EOB). Generally, but not always, you will receive the EOB first. This document comes from your health insurance company, and it outlines the services performed, what the doctor or hospital charged, what your insurance company paid, and what you owe as the remainder. It will typically say in one or more places on the document, “This is not a bill.”
So what do you do with it? Keep it. When you do receive a medical bill, you will want to ensure the EOB and the bill match up.
Medical bills will typically show the same information as the EOB, but they will also provide instructions on how to pay the amount the consumer owes. This is the actual “bill” for the services.
It is a good practice to cross-reference the EOB and the bill to make sure all the services you had performed were properly documented with your insurer and to make sure you weren’t charged for any services you didn’t receive. However, that can sometimes be difficult to do without an itemized bill.
Providers generally don’t send an itemized bill, but you can ask for a list of charges outlining which services were performed.
These services may be represented in medical, diagnostic or disease codes. These numerical codes are used to determine your bill and file claims with insurers.
You can inspect the itemized list of services to ensure that you did in fact receive all the services listed there. It is not uncommon to find inaccuracies. If you are not sure if a service was performed, call the billing department for your provider and ask to have any services you are unsure about explained.
Typically a price will be listed alongside any services you had performed. While pricing in healthcare is notoriously opaque, it can often be beneficial to research the average price for any service you received. Consumers can use tools like Healthcare Bluebook to search online for fair prices for common healthcare services.
Again, this isn’t a sure thing – but if you are concerned you are being overbilled, it can be worthwhile to call the provider’s billing department and double check that the services and prices are accurate.
Medical bills can be confusing, even for consumers who work in the healthcare industry. But by carefully reviewing your bills, you can have more confidence that the charges are accurate.
This column was originally published in The Tennessean.
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