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Medical Bills Aren’t Scary – Here’s How You Can Read (And Check) Yours!

Most people do not understand their medical bills. After you have filed your health insurance claims, you are issued medical bills and your health insurance billing statement. Understanding your bill and the billing errors that can occur as well as methods on how to negotiate your bill or to check it are useful.

Understanding the EOB

The EOB is the explanation of benefits, which is a summary of the charges your medical provider has billed your health insurance provider for, and also what they did with the claim. Your explanation of benefits is not a medical bill. This is a document that describes all the medical costs of your medical care and tells you how they will be split between your health insurer and yourself. It can be helpful for you to ask your medical service provider for an itemized list of services that were issued to you and to compare it to your EOB, and also to ask the service provider for confirmation on the amount that was covered by your insurance.

Medical Billing Errors

A study conducted on medical billing revealed that hospital bills amounting to $10K or more usually had an average f $1300 of medical billing errors. Experts reveal that it is likely that 80% of medical bills contain errors. For this reason, it is important that you know how to check your bill and identify errors. There are thousands of billing codes used, and it has increased from 24 000 billing codes to about 175 000 billing codes in the last couple of years. Here are a couple of coding errors that may occur when your medical bill is being processed.

Bundling Errors

It is common for groups of services and supplies to be bundled up altogether and given one code. However, should the wrong code be used, or if a code outside of the bundle code is used, the individual code may end up being denied by your health insurer, leaving you to pay an amount that would otherwise be paid by the insurer.

Upcoding Errors

These coding errors take place when the wrong code is simply used for a procedure or a service. An example of an upcoding error is when a code for a branded medication is used instead of the code for a generic of the medication. Or, in another example, if a person happens to be billed for a more severe procedure or treatment than they were treated for, like being coded for a broken ankle when it was actually a sprain.

Down-coding Errors

This is the opposite of what occurs in upcoding. In this instance, you are again billed for the wrong treatment, but in this case, you may have, for example, been billed for a sprain when you actually had a broken bone. This is termed down-coding and is another form of incorrect billing that could lead to your coverage being denied.

How to Know If You Are Being Overcharged

In the event that you are being overcharged on your medical bill, it can be difficult to figure it out on your own but it can go a long way to compare your bills to the costs that Medicare would normally charge. Check Medicare’s cost list or their physician fees on their website and compare your medical bill to this. If you know a figure of what the procedure or treatment should cost, then you are in a better position to negotiate a reduction or a better price. It is also a good idea to look for obvious errors like looking at the dates and codes to see that your bill does not have any duplicates. Also, be aware of the laws around balance billing. Balance billing is when a service provider bills patients for the balance after the insurer has paid an amount. Some states have laws against this, so look for such billing in your medical bill and check the legislation In your state.

If you are still finding it difficult to understand your medical bill or if there are elements of your bill that are unclear to you, you may ask the healthcare provider if they have patient advocates or even sometimes medical billing advocates who can assist you to review your medical bills Don’t ever be afraid to ask for help.

 

 

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