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Roughly 8 out of 10 medical bills contain errors (according to the Medical Billing Advocates of America). We want to help you streamline the process of correcting those errors to allow you to communicate directly with your insurance company or hospital. Use our customizable letters below to identify common billing errors and begin the process of correcting your medical bills.
It’s difficult to accurately review medical bills when you are viewing a summary of charges. Oftentimes, erroneous or inflated charges are hidden within summary statements and most often, they are paid in error. You have the right to request an itemized bill and a copy of your medical records in order to verify that the procedures you are being billed for were actually performed. Once received, you should review each individual charge to ensure that you are being billed for services that were rendered. If you come across something that seems out of place, contact the billing department to clarify.
In the case of a complex procedures, such as surgeries, hospitals often bill using bundled procedure codes. This should include operating room charges, supplies, and more; however medical facilities often make more money when they unbundle these items. It is quite common to receive double— or even triple billed items that are masked under separate line items. Beware of items such as “kit charges”, as these often do result in duplication.
Overcharges can result from incorrect time-keeping for surgical procedures, upcoded bills and more. Time-related errors are difficult to identify, but these result from incorrect calculations regarding how much time you spent in the surgery room. Operating room rates can run upwards of $200 per minute, resulting in an extra charge of $2,000 for a 10 minute clerical error. As a patient, you can always ask to reference the surgeon’s notes, which must include a start and stop time.
Denials are most often cause by a lack of documentation leading up to a medical procedure. Insurance companies require that the referring physician properly document his/her reasons for requesting any given procedure. Details must include the diagnosis, justification for reaching this conclusion, symptoms and details as to why this procedure was selected above other options. If your doctor simply failed to provide the necessary documentation, you can resubmit for approval with the aforementioned information.
Upcoding is a sneaky practice by which a doctor uses an incorrect procedure code, thus charging you for a procedure or care that was not rendered. You must look closely to identify these mis-charges, as they typically sound very similar to the actual service rendered. This egregious error is actually considered insurance fraud and it should be corrected immediately.
Price gouging is another unfortunate reality in the medical billing world. This is a scenario where a procedure will be billed to you at five to ten times the expected rate. Costs per procedure easy greatly from state to state, even from hospital to hospital within the same city. Although facilities will never admit to the calculations used to reach their final fees, these costs are oftentimes negotiable and you can request that your charges be reduced to the industry standard.