• Joshua Schainbaum

Were You Overcharged for Medical Care?

When you shop for groceries, clothes, gas, or eat at a restaurant - you review your bills for accuracy before we pay.   

But when it comes to healthcare bills, for some strange reason most of us assume that the charges are accurate.  Unfortunately, with healthcare costs high enough to wipe out savings - even if you have health insurance - everyone needs to know how to read their medical bills, and check them for accuracy. It's not just the financial cost you need to worry about.  Inaccuracies in medical bills can show up on medical records - and could potentially lead to dangerous misdiagnosis or treatment at a future date.   Medical billing is complicated, and bills often contain mistakes.  - The American Medical Association found that 7% percent of all claims paid by insurance contained an error. -  Companies that work on behalf of hospitals to fix claims denied by insurance companies estimate 30% of denied claims are coding errors. -  Patient advocacy groups estimate as high as 50% of medical bills have errors.  (I have trouble believing that figure, but something between 7% and 50% is very plausible.) Most medical bills can be influenced by dozens of people.  -  A mistake entering your information by any one of them can simply be passed down the line. -  Any mistake can cause problems - from inflated bills to outright rejection of your claim when submitted to your insurance company.

It only takes ONE mistake on YOUR bill to create a nightmare.  Some errors are simple human error or clerical errors.  Some are outright fraud.

We always provide our clients with a professional medical bill negotiator service to help sort out any medical or dental bills over $400.   But anyone can sort out common medical billing errors with enough time and effort.   Here are some common medical billing errors:

Duplicate Billing =  procedures or services are billed multiple times, one of the most common billing errors. For example, both a doctor and a nurse may have indicated that a particular medication was given to you without realizing that the other had already billed for the service. Or, a medication was billed both when prescribed and administered. 

Lack of Medical Necessity = the care provider fails to provide the coder with enough information about your diagnosis. The wrong code could be used in your bill.  Errors like this can cause your insurance company to deny your claim because of “lack of medical necessity.”  That means you would be solely responsible to pay your care provider directly.

Upcoding = a medical billing code is changed to one which represents a more severe diagnosis or treatment. If intentional, this is illegal. It can cause your bill to be inflated. It can also create dangerous inaccuracies in your medical records.  Common examples include coding for a name-brand medication when a generic was used, or coding a regular office visit as inpatient care.

Unbundling = charges that are normally grouped under a single billing code are instead listed separately. This can inflate your bill because the items would normally be charged at a package rate. A common example is multiple medical tests which should fall under the same code, but instead are billed separately.

Mismatched Treatment/Diagnosis Codes = a medical biller upcodes your diagnosis, but leaves your treatment code alone.  Your health insurance company will typically reject the claim due to the mismatch.  But that's not made clear to you.  Not only will your claim be rejected, the bill is inflated by the upcoding. Incorrect Patient Information = any misspelling of your name or a typo in your insurance ID can lead to your insurance company rejecting the claim.  Errors in age, gender or birth date so that the claims do not match up to what's on file with your insurance company.   These are actually very common errors. Please keep us in mind if anyone you care about needs help with individual or family Health Insurance.  I will take good care of them with high-quality, custom-tailored solutions, and remarkable service. 


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