Review the Accuracy of Medical Bills

I’ve been fortunate that my last few trips to a doctor were regular check-ups. I have, when I was younger, gone for more serious reasons like a fractured bone or some other “minor” issue (as opposed to something more serious and systemic). One of the big lessons I have from those experiences was that you really need to review your bills, or those Explanation of Benefits (EOB), forms because you never know when you’ll find an error.

One of the trickiest jobs in the world has to be medical billing. Think about how long it takes for you to understand your health insurance coverage, now picture a poor medical biller who has to deal with a dozen different insurance plans every single day. The amount of training and practice that requires must be astounding, even given all the technological help they get. Medical coding errors have to be expected. The biller isn’t doing it intentionally (it’s not like they’re paid based on that), they’re just doing their job.

Let’s say your insurance gets charged for a more expensive procedure (or a more expensive wrong procedure) but you don’t pay anything out of pocket (beyond your deductible). Since it “cost” you nothing, is it worth challenging the bill and telling your insurance about the error? Yes. Most health insurance plans have a cap as to how much they will reimburse, both annually and lifetime, so it’s important that the billing is accurate. If you are billed for a $5,000 procedure when you only had a $500 one, that’s $4500 from your lifetime/annual cap that you can’t use anymore. Those are medical services you may need one day that you will have to pay for out of pocket because of a medical billing error.

So the next time you get one of those EOBs, double check it. It’s in everyone’s best interests to keep medical costs down and force medical billers to be on top of their game.

2 Responses to “Review the Accuracy of Medical Bills”

  1. Pat Chiappa Says:

    For the first time ever I had a few medical things happen (none serious) in the last year or so and I was more than a little shocked at the carelessness all around.

    You say to read the EOB’s because the medical biller might have made an error – how about the doctor coding a procedure wrong – twice. I kept calling her and it was finally done correctly. Savings – $240

    I had another doc tell me to ‘shop around’ for a certain procedure, which I hadn’t really considered. By doing that I saved 60% of the cost – and I didn’t have to travel out of town to get it done. Savings – $600 (yes, $600!)

    In another instance I requested a refund from a dentist for what I called a shoddy bridge – she complied, but sent the refund back to the insurance company. I no longer was employed and not covered by the insurance. I wrote an explanation and had a few conversations and they agreed to pay my new dentist the refunded money from the old dentist. Savings – $1,400.

    My point, and I think yours too – is to not only check everything but also to ask lots of questions. Everyone is in a rush and mistakes happen and the only person looking out for you and your money is you.

  2. Bre Says:

    Thanks for posting this! I work in medical billing and am no longer surprised how much that people don’t know about their health care coverage. I’m thrilled to see such a thoughtful and down to earth article on real-life predicaments that happen far too often.