How to Dispute Surprise Medical Bills
But you can still contest these bills or, in many cases, at least reduce what you owe, Allen said. First, ask the medical provider for an itemized bill that includes billing codes describing the care you received. If the provider is hesitant to give it to you, he said, explain that the Health Insurance Portability and Accountability Act, known as HIPAA, requires medical providers to share this information with patients.
Once you have the itemized bill, check whether the billing codes the provider used, which are usually strings of numbers, accurately describe the care you received. (You can learn about the codes by Googling the code numbers along with the phrase “medical billing code.”) Often, medical providers bill for services they didn’t actually provide, or they bill for care that is more complex than what was delivered, Allen said. If that’s the case, he said, contest those charges and ask for a corrected bill by contacting the medical provider or the physician’s office directly.
You can also compare the amount of money the medical provider charged for each billing code with what insurance companies say is a reasonable amount to charge by looking up the codes on hospital websites or on the website of the nonprofit organization Fair Health Consumer. When I did this, I saw that although my daughter’s E.R. doctor charged $17,000 for the stitches he had sewed (and another $4,500 for the E.R. visit itself), the average out-of-network cost for these kinds of stitches where she was treated is $2,983. In other words, he charged me more than five times the average out-of-network price. In this type of situation, you can contest the charges as being unfair and even take the provider to small-claims court.
Another smart thing to do is to track down your insurance company’s explanation of benefits — the statement that summarizes the medical services billed to the company — because your medical provider should have tried billing your insurance company before billing you. You can call your insurance company to get your statement, or you may be able to access it online on the company’s website. If your medical provider didn’t bill your insurance company first — meaning there’s no explanation of benefits at all — don’t pay the bill you received, said Nicole Broadhurst, a patient advocate and the founder of Tennessee Health Advocates. Instead, call and ask the provider to bill your insurance.
Don’t give up the fight.
It’s unfair, of course, that these burdens are placed on the consumer, especially when so many billing issues reflect mistakes made by medical providers or insurance companies. “It does take a certain amount of time, and it can take some hassle,” Allen said. “And you have to be persistent.” But for people who have the time and resources, he added, it’s important to fight unfair medical bills. In doing so, we not only help ourselves, but we also send a message to the broader health care industry. “We all need to stand up and say, ‘Hey, what’s been happening is not right, and we’re not going to let you do this anymore,’” he said.
Tracking down my company’s explanation of benefits helped me understand my daughter’s ridiculous E.R. bill. When I studied the statement, I saw that the doctor who sewed my daughter’s stitches had tried billing my insurance but with the wrong billing codes, so my insurance company rejected the claim. The doctor should have resubmitted the claim to my insurance company with the corrected codes, but instead he billed me directly.