How to Fight and Conquer Discrepancies in Medical Bills
Medical bills are unfortunately a part of our life, no matter your plan, coverage or deductible. Whether you’ve just had a checkup, a baby – or something in between – chances are you’re going to end up with a medical bill. But what do you do if those services are incorrectly billed and processed? Here’s some tips on how to get your bill settled correctly and make the most of it financially.
When our second daughter was born via c-section, we hit our $6,000 deductible really quickly. We’d paid various other medical items throughout the year, helping us to hit our deductible before the end of the calendar year. However, thanks to discrepancies between the hospital, our insurance, and my husband’s company’s third party benefits firm, we were being billed an additional $3k out of pocket.
You can only imagine my frustration and need to knock some heads together at the run around I got from the hospital, insurance, and third party benefits company. Thankfully I’d kept good records of what bills I’d paid and when, knowing that this calendar year would be an expensive one for medical bills.
Not to mention, his old company switched insurance like some people switch spouses – it was a yearly event to a brand new insurance company, coverage plan, and possibly third party benefits manager. Talk about having to reinvent the wheel every year (and learn to navigate through all the ins and outs again and again!).
I learned a lot of tips and tricks with my dealings with two births, tons of medical bills, and multiple insurance companies. Here’s a step-by-step guide on how to fight medical bills when they’ve been billed incorrectly:
Gather all of your medical bills and insurance paperwork.
You’ll need all of your medical bills and additional paperwork so that you can easily review and compare all of the information on the bills to your coverage. Paperwork needed will include:
- All bills from doctor’s office/hospital
- All insurance EOBs (explanation of benefits, also called claims)
- Review all checking accounts and credit cards that you’ve made any medical payments with. Make a list of these payments on a separate sheet of paper.
- Any other letters, emails or correspondence from the insurance, doctor’s office/hospital, or third party benefits company (if applicable)
Review your insurance coverage and numbers.
If you don’t already know or understand your insurance coverage and how it works, now’s the time to jump on it. Check your insurance’s website or HealthCare.gov to learn the terminology.
You need to know and understand how much your deductible is, what percentage your coninsurance coverage is, and what’s considered in or out of network for your plan, just to name some of the broader pieces.
Also make sure that if you have an HSA (health savings account) or HRA (health reimbursement account) through your employer, that you understand the rules and restrictions. How to file for reimbursements, what the restrictions are on claims or services, and amounts available are going to vary based on the plan your company offers.
It can be difficult and frustrating to sort through. If you don’t understand your coverage or have questions, make sure to call and ask your insurance or third party benefits provider. Keep calling until you understand exactly what’s covered and what you owe. No question is too dumb! If you don’t understand your coverage, it’s up to you to find someone who can explain it in a way that is easy to understand.
Go over your medical bills with a fine toothed comb. Twice.
Next, you’ll want to review each and every bill for errors. Check to make sure that:
- The charges are for services actually rendered
- There’s nothing questionable listed on the bill
- That the claim was submitted to your insurance AND processed by them. This is important! If it hasn’t been processed yet, you shouldn’t be paying it.
Occasionally – and frustratingly – you’ll receive a bill before it’s been properly processed through your insurance company. This was the case with my second c-section. I received a bill for the ultrasound and paid it on time, like a financially responsible adult.
Turns out it wasn’t processed correctly through the third party benefits provider, so they had no record of it. When we pinpointed the missing payment, the provider said – well, you shouldn’t pay a bill that hasn’t been processed! Seriously?
Lesson learned: Always keep track of what medical bills you’ve paid throughout the year, along with the paperwork. You never know when you’ll have to go back and dig them up to dispute something!
Compare what you’re being billed to the insurance claims.
Make sure that the numbers match up. To do so, review the EOBs/claims. You should have a claim for each bill you receive. Match them up by service date and provider so you know you’re looking at the correct items.
On the EOB/claim, there’s always a column that says, “What your provider may bill you”, or something to that effect. Make sure that the number matches what you’re being billed on the actual bill. If it doesn’t match, or is higher – that’s a red flag that you’ve been billed prior to the office filing the claim with the insurance, or that there’s a discrepancy somewhere between the insurance and doctor’s office.
What do I do if the medical claim doesn’t match the medical bill I received?
If you find a discrepancy between your medical bill and the EOB/claim, there are several points of contact you can follow through with in order to straighten it out:
- Start by contacting the doctor’s office. Talk to them about the numbers on your claim versus what’s being billed. You can ask them to reprocess the claim with the insurance company, or give them your insurance company’s contact information and ask them to speak with them directly.
- Next, try the insurance company. If you can’t get a decent resolution with the doctor’s office, contact the insurance company and explain the situation. Give them the doctor’s number or fax and ask them to reach out on your behalf.
- Contact your third party benefits provider (if you have one). They are the middleman between your company and insurance. Generally, they’ll be the ones that deal with your HRA and HSA. If there’s a discrepancy on HSA/HRA payment, this will be the place to reach out to.
- Talk to your company’s HR. In our case, as a last ditch effort, I reached out to my husband’s company’s HR manager. She was able to bridge the gap between the insurance and third party benefits provider in order to clear up the discrepancies in billing and HSA.
It will take several calls and some time to straighten this out, so be patient. Also, there’s a chance that it might take a bit of time, and the bill could get sent to collections. If so, call and explain the situation, and ask them to put in a request to pull the bill from collections. While it might only be a two week reprieve, it’s better than having to deal with yet another company in the process!
Also, make sure to keep meticulous notes on all of your phone conversations concerning the bills. Write down who you talked to, what was discussed, the date, and what the next steps are. You’ll be thankful to have those notes all in one spot to whip out if needed!
What if i can’t pay my hospital bill?
Now that the dust has settled and everything’s sorted out, you have a final bill sitting in front of you. But what happens if you can’t pay your hospital bill?
There are several options you can try to help with getting medical bills paid or forgiven:
- Ask to for a discount. Some medical facilities will give you a discount if you pay it all at once, or with cash.
- Ask for a payment plan. If you couldn’t possibly scrap together the entire bill, ask for a payment plan. Often they’d rather get $50 a month than nothing, and it doesn’t hurt to ask!
- Ask if they have a sliding scale on bills. Some hospitals and doctor’s offices have a sliding scale they can use to base what you owe of of the income you make. You have to fill out forms and send in paycheck stubs proving what you make and what your debt is, but it’s worth it if it means getting some of the debt removed.
- Ask for debt forgiveness. Try writing a letter to the hospital asking for debt forgiveness. Like the sliding scale, if you can prove a hardship, it’s worth asking for forgiveness on the debt. Some facilities have charity programs that help out with these types of requests.
How to Get Medical Bills Forgiven
If you just can’t pay the mounting medical bills, there are additional resources out there that can help you with medical bill debt forgiveness. Besides trying to negotiate with the hospital or medical facility, you can also reach out to your insurance company. While it might be a long shot, it’s worth a try.
There are also charities available that can help with medical debt forgiveness. There are several out there that you can find via Google, but be very cautious and make sure they’re legit before pursuing any involvement with them. Some that I’ve found are:
- RIP Medical Debt
- The HealthWell Foundation
You can also check with the hospital, your church, or community see what other charities they know of that can help you out.
One last option is to try crowdfunding, such as starting a GoFundMe fundraiser. This is one way to ask family and friends for help. You can explain your situation, and even if they can’t make a donation, they can easily share your fundraiser on social media for others to see.
Don’t forget to keep track of all of your medical payments in a calendar year. If the amount paid out (including mileage to and from appointments) and greater than 7.5% of your net income, you can write off those expenses if you do itemized deductions. This has come in handy for us the years that we had our daughters, and every little bit helps!
Medical bill discrepancies can be a pain, but they’re not completely unmanageable. With the right paperwork, knowledge and ability to follow through, you can fight and conquer your medical debt.
A forty-ish web designer/developer by day, a budget & financial fanatic by night. I’m a mom, wife, avid reader, and DIY enthusiast who’s tracking our journey to debt freedom. Read More