Medical billing errors can cost your family big—and they're more common than you think. Here's what to look for on your medical bills to prevent overpaying on health care.
And you thought exam gowns were scary! Consider this: Odds are, there's a mistake in that medical bill you just opened. According to a NerdWallet analysis of 2013 hospital audits by Medicare, 49 percent of bills contained errors, and some medical centers messed up on more than 80 percent of claims to Medicare. Those flubs matter to consumers more than ever, because greater health insurance cost-sharing and higher deductibles mean that a mistake can take a chomp out of your wallet. What's more, billing errors can be tough to spot and tougher to fix. Disputes can drag on, and if you don't take the right steps, your account could be put into collections. Ensure a clean bill of health with these steps.
What You Can Do to Prevent Medical Billing Errors
Don't pay your doctor's bill until you receive an explanation of benefits (EOB) form from your insurer. Both statements tell you the amount being charged for your procedures, the amount your insurer is paying and what you owe. The totals should match—and if they don't, it's time to do some digging. (Keep in mind: Sometimes the doctor or hospital will send an invoice before receiving the full insurance payment, so the bill is for more than you actually owe. Wait until your insurance statement comes to find out what you're responsible for.)
Get an Itemized List
Some bills might list only a total amount owed, even if you underwent more than one procedure. If charges are lumped together in broad categories—"lab tests," say—call the billing department of your provider or hospital to request an itemized bill so you can see every single service for which you're being asked to pay. That makes it easier to spot errors.
Check the CPT Codes
Doctors use current procedural terminology (CPT) codes to categorize treatments and procedures. You can find those numerical codes on your EOB; google the digits to find out what they stand for.
Know Before You Go
Once you've scheduled a procedure, phone your provider and ask how much she will charge, along with which CPT codes she'll be submitting to your insurer. Then go to your insurer's website to see what your plan will cover. Another handy source: guroo.com, which gives a range of prices in your area for more than 70 nonemergency procedures.
If you're going to be hospitalized, call the billing department to ask what the room-and-board fee will be. Also, find out if each of the people who will be treating you (doctor, radiologist, anesthesiologist) participates in your plan.
Don't have the time—or the patience—to scan your bills for errors? Go to billadvocates.com or claims.org and find an expert to do it for you. Advocates usually get an hourly rate (starting at around $50) or work on commission (about 30 percent of what you end up saving). Considering the amount of money you might owe otherwise, that could end up being a pretty sweet deal.