4 Reasons You Need To Look At Your Medical Bill

People dump all over health care when it comes to pricing and billing. Truth be told, the process of capturing charges should be easy... but it's not. The process of telling patients how much they might owe on their medical bill should be relatively easy... but it's not.

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It's relatively easy for someone to find this information and process it, but with all the people that come through, the number of charges there are to select from, and the constant changes that are often not reviewed by anyone, the process can get pretty complicated. Maybe not as much for physicians offices, and yet they don't always get things correct either. Trust me, I know; I went through this earlier today trying to get pricing and codes about possible procedures for my eye exam later this month.

Therefore, it becomes important for everyone to look at their medical bills just to see what's going on. I know, you're saying you don't understand any of it and wouldn't know what you were looking at. I'm going to help you here.

My main career is as a health care finance consultant. For decades I oversaw billing departments and revenue cycle issues. The main thing to know is that it's never billing's fault; all billing does is try to collect on what everyone else has done previously. By knowing this, hopefully you'll treat them better because they're pretty much learning the process as you are. Scary I know but that's how it goes.

With that said, let's look at 4 reasons why you need to look at your medical bill.

1. Duplicate charges. This happens more often than you would believe, especially with hospital bills. People are putting in charges and may not know it's been done already by someone else. Many hospitals have auditing processes that help to catch this, but many don't even look at the process until after the fact, which sometimes falls on billing if the insurance company catches it first.

2. Incorrect charges. This is a much different issue. I've seen men with hysterectomy charges on their bills and women with prostate charges on theirs. I've seen hospitals charge for 4 view x-rays when a person only had a 2 view x-ray. As it regards physician's offices, I've seen them bill for the wrong level of service; I deal with that one all the time, even as a patient.

3. Pricing. This is one of the most difficult areas for patients to understand, but trust me when I say you're not alone. There are no real standards for pricing, although there are recommendations for fairness that people like me try to employ. Things will cost more at large hospitals in larger cities than they will in rural or smaller hospitals because of overall costs of running a business. Still, every once in a while there's an amount that sticks out like a sore thumb, and when that happens, especially if you're a self pay patient, you need to check on it.

4. Insurance information. Hospitals and physicians offices try to get it correct all the time, but even if they copy your cards they might get things wrong. It's easy to transpose a number even if they're holding your card in front of them; get one digit wrong with a birth date and that bill's not being paid.

There's 4 things to look at; what can you do if you have an issue?

1. Before you call the billing office, if you have insurance call them first. Ask them why they either denied a claim or why they didn't pay the bill in full. If you learn it's because of your policy, there's no reason to call the hospital. If it's related to something the hospital did at least now you'll be calling with an idea of what the issue is.

2. If you call the hospital or physician because it's their fault, first tell them you're calling to check on the status of your medical bill, or if you got something from them ask them to tell you what the issue is. If they tell you anything other than what your insurance company said, call them on it by divulging your information. If they acknowledge the error and say they're working on it, make sure they take you out of self pay because it's not your problem until those errors are resolved.

Also, make sure to get the name of the person you're talking to as well as their direct phone number. One final thing; stay as calm as possible, because if you're yelling at the person you're talking to, even if they're trying to help you, they might make mistakes because you've mad them nervous and upset, almost as much as you; that will never help your situation.

3. You can always dispute the bill, but you have to tell them why. As I mentioned, I recently received an incorrect bill and I called to say I was disputing it because they had charged me for the wrong level of service. You might not have that kind of coding knowledge, but you can always ask for an itemized list of services and say you want an explanation of what you had done. You might be contacted by the department that performed the services, since billing people will never know any of that information, but at least you'll know.

4. If you have to, you might need to escalate the issue and take it to another level. For instance, in my situation I didn't get my code overturned. The doctor said I mentioned something off the cuff and he gave me a recommendation, and that's why my bill was higher. I didn't like it but I accepted it; can't win them all!

With that said, patients always have options. One, request the medical record, even if you have to pay for it. Two, compare what's in the medical record to what's on the bill; if you've been billed for a procedure that's not in the record, that's a major problem. Three, try to find someone with the proper knowledge to help you if needed.

These are quick tips to help you out. Most of the time, hospitals and physicians aren't intentionally trying to harm you financially, and if you go into an encounter with that mindset you'll get a lot accomplished.