If you’ve ever spotted a mistake while skimming a bill from your doctor’s office or hospital, you’re not alone. In fact, it’d almost be weirder if you hadn’t.
It’s estimated that anywhere from 49 to 80 percent of medical bills contain errors. Worse? Many people don’t bother to challenge them, figuring they don’t have the time or familiarity with medical insurance required to win.
Fortunately, spotting—and reversing—these sometimes costly mistakes isn’t rocket science. You just have to know what you’re looking for. Here are some of the most common billing errors, plus what to do if it happens to you.
Duplicate billing occurs when one provider bills twice for the same service, or when two providers bill for the same service. (For example, if a doctor and nurse both note that a blood test was given to you, the billing department might issue two separate bills.)
Your best bet is to reach out directly to your medical provider and ask for a corrected bill, says Adria Goldman Gross, author of “Solved! Curing Your Medical Insurance Problems” and founder of MedWise Insurance Advocacy. “Even if you’re being charged by an outside billing company, [which is increasingly common], call the doctor” first and ask them to communicate with their vendor on your behalf, she adds.
Medical coders translate physician notes into codes indicating the reason for your visit, procedures performed and diagnoses received. Miscoding, or worse, upcoding—indicating a more severe diagnosis or an inpatient treatment instead of a regular office visit, for example—can result in an inflated bill.
If you suspect that’s the case, do your homework before requesting an amended bill. Gross recommends double-checking the codes yourself, paying attention to CPT (current procedural terminology) and ICD-10 (which refers to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes in particular.
It may seem far-fetched, but Gross says receiving bills for bogus services happens more often than you’d think. And it often goes unnoticed, since many patients don’t examine their explanations of benefits (EOBs) and bills closely.
This is another case where your best recourse is to call the doctor’s office to make them aware of the mistake. If, for some reason, they’re unwilling to correct it, the next step is to report them to your insurance company (which may take action against them) and/or your state’s division of consumer affairs.
Balance billing is when you’re charged an outstanding balance after you’ve paid your deductible, copay or coinsurance and your insurance kicked in its portion, as well.
Generally, this is illegal if your provider is in-network (though it varies by state) and performed a covered service. However, it’s typically allowed if you’ve seen an out-of-network provider, even at an in-network facility. (This is most common in emergency rooms. While the hospital itself may be in-network, some medical personnel may not be. Patients who sought treatment at an in-network hospital ER got an unanticipated out-of-network bill 22 percent of the time, according to one 2016 study in The New England Journal of Medicine.)
If you’ve been balanced billed by an in-network provider who won’t revise the bill, report it to your insurance company to intervene on your behalf. They may be violating the terms of their contract and could face fines and other penalties. You can also report the provider to your state medical board.
If you’ve been legally balance billed, it’s time to put your negotiating skills to good use. You may be able to get a portion of your bill forgiven by offering to pay some upfront immediately or setting up a payment plan.