Medical Billing Errors on the Rise

According to a recent survey by the Employee Benefit Research Institute, 60% of Americans say they are paying increasingly more of their medical bills out of pocket, despite the fact that many of those surveyed were covered by health insurance. This increase in self-payment is putting tremendous stress on middle-class families, more than one-third of which reported having trouble covering basic necessities to EBRI.

EBRI President Dallas Salisbury reported, "These results show the impact of rising healthcare costs is widespread and growing."


So how do you combat having to pay for medical services you never received?

The best way is simply to keep a watchful eye on those detailed (and confusing) bills you receive from the hospital or clinic. If you notice that you have been charged for a service never rendered, you must contact the billing company or main office as soon as possible. Most insurers and healthcare providers will gladly fix any issues, though some do enforce a deadline, and if you catch the error once the deadline has passed, it becomes much harder for you to pay only for the services you actually received.

Another common mistake found in medical bills is coding error. Most patient services are listed according to specific numbers or codes which identify them. Like all abbreviation systems, medical billing is certainly not without its fair share of mistakes. If you do receive a bill that does not indicate what the listed codes stand for, be sure to contact the billing office or your doctor's office to make sure you know what you were charged for.

Deciphering your medical bill or health insurance policy isn't always as easy and lucid a task as it should be. Paula Fryland, manager of the national healthcare group at PNC Financial Services Group Inc., reports that a recent company study found that one-third of Americans have difficulty understanding their explanations of health benefits.

The study also found that one-quarter of consumers believed that their insurers had rejected legitimate claims, prompting 20% of such consumers to pay claim charges out of pocket. Many cited fear of damage to their credit scores as an important factor in settling claims quickly. But there is a silver lining: more than half of those who pursued the claims through their insurers were able to get all or most of their claims paid off.

If your health plan comes with a high deductible, you can expect to take a hit if your insurer does not apply the discounted group rate to charges acquired within the deductible. Insurers typically establish group rates in tandem with healthcare providers, so it might behoove you to convey your concerns to your doctor. Deductible rates for such plans can range from $1,000 to more than $10,000.

Here are some other quick tips for keeping medical bills accurate and low:

• Review your EOB (explanation of benefits) before you get a bill.
  
  
• Check that the name, address, insurance group, and identification numbers on the bill are correct. If this data is wrong, it may be that you received another patient's EOB or even that someone is fraudulently using your benefits without your knowledge.
  
  
• Check to make sure that the name of the healthcare provider, the services for which you were billed, and the date(s) of your visit correspond to the facts.
  
  
• Keep track of the contributions you have made toward your annual deductible.
  
  
• If you visit a healthcare provider in your established network, be sure you get credit for it. HMOs can force you to pay the full price of a procedure if you are serviced by a professional outside their established network.
  
  
• If you notice something inconsistent or incomprehensible in your EOB, contact your insurer through their toll-free help line.