“According to the New York Life Insurance Company, the average medical bill has $600 worth of errors. This not only comes out of the insurance company's pocket, it comes out of your pocket, either in cash or in increased premiums.”
Despite the best efforts of personnel in billing departments working for hospitals, doctors, or medical institutions, errors in billing do occur. There are several reasons for billing errors. Some are human error and others are just errors of the system. The eight most common billing errors according to MSN Money Central (resources) are duplicate billing, number of days in the hospital, incorrect room charges, operating room time, up-coding (charging more for the same item, i.e. generic vs. name brand), keystroke errors, and services never rendered
To determine if an error was made you may wish to dispute the debt so that an itemized statement of charges can be sent to you. In some cases you can simply do this yourself, in others you may want professionals such as DDS to require a validation of debt to ensure all of the charges are 100% legal, verified, and collectible.
If you do this yourself you will need to research whom to send a letter to, send the letter certified mail (preferably via a notary), write up the letter, and if you wish to be thorough a Debt Collectors Disclosure Statement. The more laws you invoke that allow you to ask for aspects of verification the greater chance you will find out if they are doing something incorrect, fraudulent, sold the debt, wrote it off, or are doing anything that may invalidate the debt. At a minimum you should:
1. Require the billing company to provide you with an itemized statement with the dates on it for each service you were provided for which you are being billed. You may also ask them to include answers to a debt collector’s disclosure statement if you have one. In your notice to them include a copy of the bill, showing the billing period since different companies take various time frames to process your request for verification. If it is an insurance company you are dealing with the processing date could differ from the actual date of treatment.
2. When the itemized bill is returned pay close attention to each line item. There should be a transaction listed for each charge, even if insurance has paid all or a portion of the bill. If you have no insurance filed, you will need to focus on the items listed as billed. Any medical codes listed next to charges should have a description of what each code means, if it does not you should write back and request a sheet with the codes and a deciphering of what they mean.
****NOTE: If the billing company does not send you an itemized statement, or does not respond within thirty days then you should send them a notice that they may be in violation of the Fair Debt Collection Practices Act, and that failure to provide the requested verification for the debt may invalidate it, and their capacity to collect it.
3. Record each charge you are disputing on a separate piece of paper linking it to the date of service in question. Pay attention to large charges like x-rays or lipid panels if you did know you didn't have these services performed; these are the first you will want to include in your dispute as they are easy to spot. Next look for the smaller items like dosages of medicine.
4. Inspect more closely any panels for which you are billed. These might be duplicated if they are charged separately then as a bundle. For instance, you will not typically have two EKGs done on the same visit, so make sure you aren't charged for one EKG then charged again for one under a bundle such as "cardiac screening tests."
5. Write a letter to dispute all charges in question to the medical billing company. Indicate your findings, and request that the billing company send you a corrected billing statement.
6. Write a separate letter to your insurance company detailing the incorrect information you found, and include a copy of the dispute you sent to the billing company. Your insurance agent should pursue this matter with the medical billing company since they were probably paid twice for something, or paid for services that were never rendered at all.
Next time you enter the hospital, or visit a doctor you should:
Keep track of your care, write in a notebook if possible how many times your blood gets drawn every day? All testa such as an MRI or a CAT scan, ask them specifically what the test is. If you cannot keep track of basic services, it would be a good idea for a family member to try to keep up with it.
Ask questions. Ask the doctor or nurse what kind of test you are being given and why, why your blood has to be drawn twice a day, etc. Doctors are usually very willing to help the patient take part in or understand the care they are receiving. Make sure you jot these questions and answers in your notebook.
Always ask for an itemized bill. You may meet some resistance on this, "it’s out of our control" usually means, "you'll get what you get next month in the mail." Don't hesitate to call the hospital's administration to request the itemized bill if it doesn't come that way.
Check the room rate and number of days you were charged for the room if in a hospital. Hospitals have different rates for private, semi-private, two-person, and four-person rooms. Make sure they match what you actually had.
Check the equipment usage rates. Were you on oxygen? For how long? Was the equipment removed from the room during your stay (after you didn't need it). Is that reflected in the bill?
Being billed for drugs that were not administered and tests that weren't performed are very common mistakes. You are also billed for general supply items that are in your room when you get there. You are billed for what is not there when you check out. If there inventory is inaccurate or something was borrowed for another patient, if it is not replaced, you will be billed for it.