10 Tips for Resolving Medical Billing Errors

Over the course of the last year I’ve identified two medical billing mistakes that would have cost our family over $1000.

One of the mistakes was a $1000 administrative error and the other mistake was an incorrect coding of a medical procedure resulting in an over charge of approximately $200.

Fortunately, I was able to identify and dispute the issues which led to a positive resolution.  What is concerning to me is the possibility of past issues I’ve readily agreed to pay which could have been errors.  So now I really start paying attention anytime I’m asked to pay any amount of medical expense out of pocket.

It was not easy to get the above errors corrected, so I’m going to share 10 things you can do to stay on top of such issues and see them through to resolution for your benefit.

1. Review coding: Medical administrators are responsible for coding procedures for insurances purposes.  If you’re asked to pay for a medical expense out of pocket, ask for the medical codes being filed to your insurance.  Contact your insurance company and make sure your insurance is covering the procedure appropriately and the correct codes are being used.

2. Plan ahead: For some procedures and health services you are able to plan ahead.  Contact the service provider and ask for the procedure name or code that will be used.   Contact your insurance provider and find out your insurance coverage beforehand to avoid monetary surprises of the bad kind.

3. Be persistent and follow up regularly: If you encounter an issue, put it on your calendar to make a weekly call to all parties involved.  I’ve found for disputes, there are multiple people who have to get involved with both the medical and insurance organizations.  Don’t accept, “We’ll call you back in two weeks.”

4. Own the issue: Don’t expect someone else to solve the problem for you.  You may say, “It’s their mistake, they need to fix it.”  Let me tell you that no one will own the issue like you will.  Of course, once in a while you’ll come across someone who is willing to go the extra mile for you in customer service, but don’t always count on that.  You must own the problem to resolution.

5. Take good notes: One mistake I made in the case of the $1000 over billing was that my notes turned into chicken scratch on a piece of paper.  They were tough to read later.  I’m usually a more organized person, but trying to make calls during work hours made it more difficult to stay on top of matters and document appropriately.

Consider using a spreadsheet to capture the following:  date and time of call, whom spoken with, organization, what was discussed, action items on your side or their side, other parties mentioned, i.e., “I have to follow up with my boss, Bill, to review what we discussed”, and a direct call back number.

6. Connect parties: If you’re direct in saying you can facilitate the discussion between multiple parties, you may have a better chance of getting it resolved quickly versus the follow up call falling to a long list of calls to be made later in the week.  I was lucky as my insurance provider would put me on hold and contact the medical provider’s office immediately.  I thought this was pretty good service.  A better step may have been to include me in the discussion.

7. Stay aware: Watch bills as they come in the mail, especially, after a hospital procedure or delivery of a baby.  I think we received bills for up to 3 months after our son was born last year.  Don’t assume you owe them anything.  Match bills up to insurance statements, make sure they align and then follow tip 1.

8.  Know your insurance: I feel pretty silly about this one, but the overcharge of $100 was because I didn’t know my insurance well enough.  I was told I needed to pay $100 towards my deductible, when I really didn’t have a deductible for that particular service.

After much hassle between the insurance company and provider, I got it resolved.  Once you sign up for medical insurance, understand your coverage!  Having this information handy will allow you to quickly question or contest requests for out of pocket payments while at the place of service.

9.  Remain calm: this should go without saying (I have to remind myself often), but don’t let yourself get heated.  You’ll do nothing but help someone become demotivated to work with you.  Remain calm and if you don’t like the results, see tip 10,

10.  Don’t be afraid to escalate: If you’re not seeing the results you want, ask to speak to a supervisor.  Make sure you have your facts and call record handy.  Tell the supervisor you’re not satisfied with the lack of progress and simply state the facts.  Again, capture the details of the call and next steps.  Don’t hesitate to contact the supervisor directly if you haven’t heard anything after two business days.

Also, as nice as some people might be, they simply don’t have the knowledge or experience to get what you need accomplished.  Don’t be afraid to escalate in these matters as well.  You’re the one stuck with the bill!

To wrap up, here is one more bonus bit of advice:  get your resolution in writing.  If your bill is reduced or dismissed, ask that a new statement be sent immediately stating such.

Do you have any advice you would like to share based on past experience?  What have you done that has led to the quickest resolution and least amount of pain?

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