How to Make Sure Your Medical Bills Are Right
Ask these 7 questions about every medical bill to make sure you don’t pay more than you owe.
Surprises can be great. Surprisingly high medical bills? Not so much. And unless you’re an expert in billing codes, it can feel impossible to sort out whether what you owe is correct or not.
Fortunately, there are a few fairly simple things you can do to make sure your medical bill is right before you pay it. And it’s worth your time and effort because mistakes are common: An estimated 80% of medical bills contain some kind of error. Not all of them are the kind that cost you money or are hard to fix. But it still makes sense to double-check your bill.
Here are 7 questions to ask about every medical bill, no matter what the total.
Question #1: Does this bill match my “Explanation of Benefits” from my insurance company?
If you follow just 1 tip, it should be this: Never pay a medical bill until after you get an explanation of benefits (EOB) from your insurance company, says Caitlin Donovan. She’s a senior director of public relations for the National Patient Advocate Foundation. “That’s the big packet from your insurer explaining your benefits that says ‘This is not a bill.’”
An EOB breaks out 3 key pieces of information:
- What the medical provider charged.
- What your insurance paid.
- What you’re expected to owe.
Without an EOB, there’s no guarantee that your medical provider billed your insurer first before sending you a bill. Which means you might not owe nearly as much as you think.
Once you get the EOB, compare it to the medical bill. “If they’re not the same, something is wrong. You need to investigate further,” Donovan says. Call your healthcare provider’s billing department. Ask them to review the bill with you. You may also need to contact your insurance company if it’s not an easy fix.
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Question #2: Do I need an itemized bill?
Legally, you’re entitled to an itemized bill. That’s a bill that breaks down your total healthcare cost into single items. In most cases, you probably don’t need it, Donovan says. “Itemized bills can get really complicated. There are thousands and thousands of medical billing codes now,” she says. “It’s much better to wait for the EOB and compare that.”
There are a few exceptions, like if you owe a large sum of money. You may want to compare your bill to your medical records to make sure there are no needless charges. Or you may need the itemized bill as proof of an error, Donovan says.
Question #3: Are the dates and providers correct?
A simple way to quickly check whether your medical bill is correct: See if it has the right dates, the right providers, and the right procedures. Does something seem off? Call the medical provider’s billing department with questions.
Question #4: Did I get billed for an out-of-network provider when I shouldn’t have?
A top way to save money on medical expenses is to make sure you’re using an in-network  provider. That’s a provider who is under contract with your insurance plan and has agreed to charge discounted rates. By the same token, using an out-of-network provider “is the biggest source of large bills,” Donovan says. Their rates might be higher. And your insurance company may not cover out-of-network bills at all.
Unfortunately, it can sometimes be tough to know whether you’re getting care from an in-network provider. For example, you might have used an in-network hospital for a surgery but the anesthesiologist that day was out-of-network. If it appears a provider was mistakenly charged as out-of-network, call the provider to confirm they are in network. Then tell your insurance company. If the company doesn’t agree to cover the cost, think about hiring a medical billing advocate. They can be expensive — some charge $100 or more per hour, or they take a percentage of the money they save you. But if you have a large or complex bill, it could be worth the cost. Or reach out to an organization like the National Patient Advocate Foundation for free support.
Question #5: Can I negotiate the balance?
Believe it or not, medical bills are very negotiable, Donovan says. She suggests asking for a discount. In exchange, you might offer to pay in cash or pay a certain amount of the bill right away. You can even negotiate down the cost of certain procedures after the fact.
To do that, it helps to know what other hospitals or doctors are charging. Hospitals are now required to post the prices they’ve negotiated with insurers for 300 common medical procedures. You can use sites like Healthcare Bluebook and Clear Health Costs to compare healthcare costs in your area. “We’re in a place now where addressing a hospital bill is very similar to buying a car,” Donovan says.
And don’t forget to ask about financial aid. Most medical providers have financial aid programs. But they often won’t offer the aid to you unless you ask, Donovan says.
Question #6: Should I ask for a payment plan?
If you have a large bill, or a bill you can’t afford, then it can make a lot of sense to ask for a payment plan. “Hospitals are expecting to hear from you,” Donovan says. “They’re not going to be surprised to find out that you can’t afford to pay a $30,000 bill up front.” Some medical providers will even offer no-interest payment plans if you ask.
The key to getting on a payment plan that works for you is to know 2 figures:
- The amount you can afford to pay now.
- The amount you can afford every month to pay off your bill.
Make sure you truly can make the monthly payment you suggest. That way your bill won’t wind up in debt collection.
Question #7: Does my company offer health advocacy help?
If you have health insurance through your employer, there’s a chance it may offer patient advocacy support. Often it’s in the form of a digital health management app like Wellframe. These smartphone apps can connect you with people within your health plan who can help you solve medical billing problems. They can also help you stop future ones from happening. To find out if you have a digital health management app, talk to your human resources department.
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