I went to the doctor for my yearly checkup a few months ago. Under the affordable care act of 2008 preventative care is covered. This would involve those annual checkups to keep the measles and the mumps away. To my surprise, I received a bill for $300 for tests performed. When I called the health insurance company to figure out the details, I found out that it all has to do with how the doctor coded it. We were able to correct it and figure out a way to not pay the bill, but how many American’s just pay the bill and move on?
If you have health insurance you should receive something called an Explanation of Benefits (EOB) in the mail. This document should provide details of services rendered, the date it happened, the amount the health provider charged the insurance company, the total amount not covered under each individual plan, and the total cost. While this will be specific to each individual plan and the deductibles, coverage, and copays involved, it is common for health providers to make a mistake. Here are some of the more common medical billing errors to watch out for when you receive your itemized bill and EOB statement:
- Duplicate charges: Carefully check for duplicate charges to make sure you were not billed twice for a single service or procedure. With an itemized bill, it should be much easier to spot.
- Canceled tests or procedures: You could have been charged for a test or procedure that ended up being canceled. Make sure this doesn’t happen by carefully reviewing your itemized medical bill. If you think you were wrongfully overbilled, collect all the necessary documents to prove that you did not receive the service, so you can dispute the charge.
- Incorrect patient information: Small errors such as incorrect name spellings or policy number misprints are common on medical bills. If your insurance ID number is wrong, it can lead to a claim denial or a full amount sent out by your health plan.
- Upcoding charge: A hospital could inflate a patient’s diagnosis to one that represents a more serious procedure, leading to a higher medical bill. For example, you could have received the lowest level of emergency room services but be billed at the highest level. This is an illegal, fraudulent practice, and you should ask your health care provider to correct the charge immediately.
- Unbundling of charges: This refers to the separation of charges that should have been billed under the same procedure code. This type of mistake can be tricky to identify unless you’re a certified medical bill coder, but you can reference the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services if you suspect such a mistake on your bill.
- Balance billing when in-network: This occurs when the health care provider bills you for charges other than co-payments, co-insurance or any other amount than what was assigned by your insurance company. Balance billing is often improper when the care was provided by an in-network hospital or physician. If you think you’ve been balance billed, compare the bill with your EOB to make sure. Balance billing is most common when you are treated out-of-network for non-emergency care, as doctors can set the rate to charge you and bill you for anything over the amount your insurance covers.
- Incorrect quantity: Make sure you weren’t charged extra for an incorrect quantity of items or medications. This mistake could be as simple as an extra “0” placed at the end of a number by the billing department.
- Operating room and anesthesia time: If you underwent surgery, check your medical records to see how long you were in the operating room or under anesthesia. Because patients are usually billed in 15-minute increments in these instances, mistakes here can add up quickly.
If you have questions regarding your Oklahoma health insurance, ECI is always here.