Fight Medical Billing Errors

When Beverly Browning of Mesa, Arizona, checked into a hospital for a biopsy in 2003, she was thrilled the test was benign, but dismayed to receive a $9,500 bill. Her insurance company refused to pay, citing a pre-existing condition, and Browning was left to pick up the tab, though “I thought that was a lot of money for a 45-minute procedure,” she says. Browning, now 62, hired a medical billing advocate, a professional who works with patients to resolve billing errors and recoup their money. The  billing advocate, Cindy J. Holtzman of Medical Refund Service, Inc., in Marietta, Georgia., negotiated with the hospital, convincing them to lower the price by about $1,800. Holtzman then further negotiated with Browning’s insurance company, getting them to pick up most of the tab. Altogether, “I saved her about $7,500,” Holtzman says.

The American Medical Association announced in June that 20% of medical claims are processed inaccurately by health insurers, while the Salem, Virginia-based trade association, Medical Billing Advocates of America, finds the number of billing errors to be much higher. “Our best estimate is eight out of 10 hospital bills contain errors,” says MBAA Chief Operating Officer Christie Hudson. “We see them on a daily basis.”

While most billing errors are the result of an oversight, “about 3% of healthcare expenditures are fraudulent,” says Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, based in Washington, DC. Billing errors can be introduced at the medical provider’s office or by the insurer. In some cases, patients may receive bills for services that weren’t performed, or they may be double-charged or charged a higher-than-normal cost, Saccoccio says.

Protect yourself from billing errors by looking closely at any bills or statements listing services. If the statement lists “miscellaneous expenses,” or only provides a general summary of charges, ask for an itemized statement, Holtzman suggests. “I’ve seen a case where someone was charged $1,000 for a toothbrush,” Holtzman says. Also check the dates that services were rendered to make sure you actually received services on those days.

Even if your insurance company is footing the bill, you don’t want them paying for unrendered services since they could later use such charges as a basis for denying future claims.

For example, you might need a procedure in the future, but if you were already wrongly billed for it, your insurer might question the charge when you really need it. “If you see dates that you didn’t go to the doctor or if there are procedures that don’t look right, bring it to the attention of the insurance company,” Saccoccio says.

To determine whether a charge is reasonable, “call the doctor’s office or the hospital and get the procedure code. Then call your insurance office and ask what they allow for that procedure code to be charged,” says Hudson. Another way to check prices is via healthcare cost Web sites. You can then call the medical provider’s office and argue that the cost is unreasonable and ask if they can adjust the cost so it’s closer to that amount, Hudson adds.

You can probably handle many billing errors on your own by contacting your insurance company or the physician’s office, Hudson says.  If you’re not getting anywhere or if there is a large amount of money involved, a medical billing advocate might be worth the expense, which is typically 25% to 35% of the amount saved. Find one at BillAdvocates.com. The medical billing advocate signs an authorization form allowing him or her to work on the patient’s behalf, contacting everyone involved, from the insurance company to the physician’s office.