When Candice Fleszar was documenting contractions and medications during the birth of her daughter, she wasn’t thinking about her medical bills. Still, her attention to detail ended up saving her some money anyway.
“Look at the itemized bill. It might surprise you,” says the 46-year-old mother of four from Lowell, Michigan. On it, she found a charge for saline which was ordered but never delivered in time for the birth. Fleszar contacted the billing department, provided her documentation and the charge was removed.
[Read: 8 Ways to Get Help Paying (or Cutting) Medical Bills and Drug Costs.]
However, not every billing dispute gets resolved so smoothly. Michelle Riddle, owner of Complete Dignity Healthcare Advocacy in Gilbert, Arizona, works regularly with clients on claims issues. She had one client who went in for surgery and ended up not needing a particular procedure. “They had the products [for the procedure] in the operating room in case they needed them, and the patient was charged for the products,” Riddle says. When the hospital refused to amend the bill, Riddle had to take her client’s case to court to get the charges removed.
To avoid overpaying for your medical care, follow these six steps.
Step 1: Gather service information upfront. Erin Durkin, director of financial planning for EP Wealth Advisors, says one key to avoiding medical bill discrepancies and surprises is to understand upfront the expected costs. It’s something she wishes she had done when she needed a brace after surgery. “They charged me $400 for that brace,” Durkin says. “I looked up the cost online and saw that this specific brace retailed for $60.” If she had researched in advance, she may have been able to provide her own brace at a lower cost, but since it was furnished through her health care provider, she was stuck with the $400 charge.
Fleszar also learned the hard way the importance of asking extra questions upfront. When her daughter was referred to a specialist in the same office as her pediatrician, she assumed all providers at that location worked within the same network. Instead, the specialist was out-of-network and charged significantly more. “It was a ridiculous amount,” Fleszar says. “We raised a stink about it but ended up paying it.”
Step 2: Document your care. Keeping careful records of your own is essential to backing up claims of overcharging. Riddle says facilities will automatically bill based upon a doctor’s orders. “If your order [for medication] says morning, noon and night, you’re going to be charged for morning, noon and night,” Riddle says. That’s even if you end up declining the medicine at some point. Oftentimes, the only way to dispute a charge in this case is if you have kept your own documentation of what medicines you received and when.
[Read: How to Negotiate Your Medical Bills.]
Step 3: Request an itemized bill. Most medical providers send out what Riddle calls a “bottom line invoice” which only has the total amount due. Instead of simply paying that, consumers should request an itemized bill to compare to their records.
Several procedures could be completed within a single visit and those will each be coded separately. If anything is unclear, contact the provider’s office for more information. “A legitimate office will not hesitate to explain their charges and answer a patient’s questions,” says Frank Scafidi, director of public affairs for the National Insurance Crime Bureau.
Step 4: Compare your bill to your chart and insurance explanation of benefits. The next step is to compare your bill to your explanation of benefits from your insurance company or your medical chart. Explanations of benefits are sent automatically by insurers, but there may be a charge for requesting a chart.
Once received, people should confirm the bill’s services match what is on the chart. Consumers should also watch for any instances of double-billing on explanations of benefits, which may occur when a physician gets paid by a hospital but also bills a patient directly. Riddle recalls one instance in which she got a surgeon’s bill reduced from $13,000 to $95 because the hospital had already paid him.
[See: 10 Medical Services Medicare Doesn’t Cover.]
Step 5: Notify the biller of discrepancies. Any errors or overcharges should be first brought to the attention of the health care provider’s billing department. The office may then audit the bill, and you should be prepared to provide documentation or evidence supporting your claim. “In my experience, there’s going to be a little pushback,” Riddle says. She’s found some health care providers seem to stall on making corrections. “It’s almost like [they think], if we can drag it out long enough maybe the patient will give up and pay.”
Step 6: Get help if needed. If the company declines to correct the bill, patients may need to find an ally. First, contact the insurance company to see if they can offer assistance. Other options may include filing a complaint with a state medical board or hiring an attorney. “We have to be our own advocates, and that’s not easy with our busy lives,” Fleszar says.
Another possibility is hiring a patient advocate who works with billing disputes. “When you have an advocate on your side, you have someone who knows the laws and your rights,” Riddle says. For those who take the time to dispute a medical charge, the reward can be significant savings on medical costs.
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How to Review (and Dispute) Your Medical Bills originally appeared on usnews.com
