Resolving Insurance Issues

Man calculating bills

It’s never fun to get bills in the mail. It can be additionally frustrating when they’re medical bills for a procedure you thought was covered.

Health benefits can be confusing to sort through, and alarmingly, insurance billing errors are not uncommon. Depending on the source, it’s estimated that between 7% and 80% of medical bills contain errors.

If you receive a bill that you think is incorrect, start by asking the provider to explain the exact charges submitted to your insurance carrier. For example, if you went to your primary care provider (PCP) for what you thought was a routine preventive visit but see additional charges, call your PCP’s office and ask what those charges were for. You can also check the bill against the Explanation of Benefits (EOB) that your insurer is required to send you after your medical provider has filed a claim. An EOB will detail exactly what your medical insurance covers and what it has paid toward this claim.

If you see discrepancies between your bill and your EOB, talk to your doctor’s office, explain the discrepancies, and ask them to review and fix the charges. If your insurance provider has not covered something they are supposed to, you should also contact them to review your case. You may need to file an appeal – make sure to do this as soon as possible to avoid your bill going to collections. See HERE for a more detailed, step-by-step outline.

You may not have to do this on your own. Check to see whether your employer provides access to third-party vendors like Health Advocate or Alight. These companies will help you review your benefits and dispute charges you think were made in error.

What to Do if Your Medical Bill Has Mistakes (webmd.com)
This simple form can keep you from overpaying for medical care (cnbc.com)