I'm counseling a friend on how to challenge a hospital bill. Up to 80% of hospital bills have errors - ALWAYS dispute (whether it's an emergency procedure or planned pregnancy).
Some recommended steps: 📝
1) Ask your insurer for a medical bill AND explanation of benefits. These forms include information about your deductible, co-pay, co-insurance, etc.
If a procedure is not covered, the explanation of benefits should explain why.
2) Check that your explanation of benefits matches your bill. EXACTLY matches. Sometimes plan discounts aren't applied or multiple bills combine into one.
These shenanigans often lead to errors and are a sign you need to contact the insurer or hospital/facility.
3. Request a detailed line-item bill. You can get it from the hospital or ask your insurance company to get it on your behalf.
It should show dates/times, descriptions, total prices, insurance adjustment, and medical billing/CPT codes.
4. Most people have a shit ton of CPT codes, particularly for a hospital stay. Google CPT Billing Code. Make sure EVERY CPT code on your bill occurred in the facility.
One digit off can be a 15x bill increase 🤯 Also note if the CPT code was for something medically unnecessary.
5. Call the hospital/facility's medical billing office. All hospitals should have a customer service line or at least an online form to submit a dispute.
This is a must. Yes it's annoying, yes it takes time but I've found these folks are lovely and can potentially fix the issue.
6. These agents put in a request and research the issue. Importantly, they will put your bill on hold (!!!) while they research the issue.
This typically takes 4-6 weeks. Make sure you document your communications and follow up based on the timeline given.
7. Also file an appeal with your insurance company. If you're covered, using your insurance as an advocate is a great way to make progress on disputing the medical bill.
This is an area of alignment with you and your insurer. THEY want a cheaper bill too.
8. Depending on the hospital, there might be an in-house patient advocate that could help you reduce your bill, help expedite resolution of errors, etc.
They also have connections to resources that can also help if you can't afford your medical bills.
9. Legal recourse is an option but I wouldn't recommend it unless the bill is exorbitant.
But seriously, hospital billing depts can be your greatest champions. I've heard of instances where agents will say that they'll reduce your bill 20% if you pay today.
10. I can't stress this enough: follow up! document! You have to be active in these situations to resolve them. We shouldn't have to (but this isn't a thread for ranting about our healthcare system) but it's damn worth it.
If you ever need help, I'm your girl.
You can follow @singareddynm.