What percentage of medical bills have errors, and what can you do about it?

Hospital and doctor bills often have incorrect charges.  Studies have found that 10% of medical bills contain errors!  Medical bills may be completely incorrect but still result in the bill getting sent to a collection agency.

Almost everyone has received an inaccurate bill or a bill incorrectly denied by insurance. Sometimes the bills are sent months later, which can cause confusion and make it difficult to track what was paid.  Many people have paid bills they really aren’t sure they owed!

Bizarrely enough, the billing system also hurts doctors and hospital systems. The administrative expenses for billing is twice as high in the United States as in many other countries, and is the cause of approximately 20% of the entire healthcare expenditure.

Why so many medical billing errors? The main reason is that our healthcare system is a patchwork of different systems and multiple doctors or groups billing for the same treatment. For example, when a patient has a surgery, they will get separate bills from the hospital, surgeon, anesthesiologist, radiology, etc.

The second reason is that each procedure performed requires a “code”. If the code is entered incorrectly, it can result in denial of insurance coverage. The current system has over 150,000 medical codes. Despite all of the regulations and coding details, it is also frustrating that the cost of each procedure can vary by 300% or more.

So what can you do to protect yourself?

1. Whenever possible, check before you receive healthcare that the doctor or hospital are covered by your insurance.
2. Keep a file with all of your medical bills. Save them for at least two years in case a very late “revised” bill arrives. And those pesky “Explanation of Benefits” statements that you get? Save those too, they can help later in some cases.
3. Remember that booklet (Member Handbook) they send out when you join a new insurance plan? Always keep those, as they can have information included about what is covered and how you can dispute a claim.
4. Read every bill to be sure it appears correct, but also request an “itemized statement” from every visit or procedure. This will help if there is a dispute later, and also is required if there is a submission for Health Savings Account (HSA).
5. If you find an error on your bill, call as early as possible to discuss with the provider’s office. You may have to set aside a chunk of time for these calls as they can be very time consuming.  When you call, be sure you have the bill in front of you and the itemized statement if possible. If the first person is not helpful, ask for their supervisor.
6. If you get a denial of coverage from your insurer, you have a right to ask for an appeal.
7. If you still cannot get help, it may require escalation to an insurance commissioner or to Medicare administrator.