How to Dispute Medical Bills

Nicolas Cesare  | 

Health insurance is supposed to make life easier. Ideally, you get sick or suffer an injury and you know that your finances will still be in good health because your insurance company will help to cover the high cost of medical treatment.

However, what if your insurance company gets it wrong? What if your healthcare provider charges you for services you never received? What if you insurance refuses to cover something that you think they ought to? When insurance doesn’t come through, it’s up to you to fight back. If you lay down and take charges for medical services that you never received, you could end up in serious debt. Here’s what you need to know about challenging medical bills.

How to Challenge a Medical Bill

Before you ever reach the stage where you’re disputing healthcare-related charges, you will need to catch any mistakes first. Whenever you see your healthcare provider and your insurance is billed, you will receive an explanation of benefits (EOB) from your insurance company. This will go over all the services your insurance company thinks that you receive and what they will and won’t cover.

When you get your EOB, check it carefully and compare it to the bill from your service provider. Make sure that you’re only being billed for services you actually received. If you spot something that never happened or your insurance company isn’t covering what you expected them to, it’s time to take action and challenge the mistakes.

Talk to the Insurance Company and Your Providers

Sometimes these things are just an honest mistake. Your first step should always be to point out the errors to your insurance company or your healthcare provider, whoever is responsible here. They might just own up to and correct it, making it an easy fix for you to get your healthcare expenses back on track.

Ask for an Itemized Bill

If it looks like you’re going to have to take your dispute further make sure you have an itemized bill of all the services you’re alleged to have received. Getting the most detailed records possible following your hospital stay, doctor’s appointment, or ambulance ride will be crucial to the dispute ahead. Once you have the itemized bill, identity exactly which charges were made in error.

Recall Witnesses

Once you know exactly where the mistakes were made, it’s time to assemble your case. Try to recall anyone who was around when you received treatment such as doctors or nurses who worked with you frequently. Contact potential witnesses and find out if they are willing to support your claims about exactly which services you received and which ones you didn’t.

Submit a Formal Medical Bill Dispute

Once you’ve assembled all the evidence for you case (including your own testimony, a marked up itemized bill, and any support that you can get from witnesses to your treatment) it’s time to put all of that into a formal complaint. Contact the healthcare provider that made the error to learn about their exact procedures for medical bill disputes. You should also keep your insurance company in the loop — if they covered any services that were billed in error, they’ll want to know if those charges get overturned. Depending on the severity of the mistake, your insurance company may even offer help in challenging the medical bill.

Get Legal Assistance

Taking on a major hospital’s billing department by yourself is no easy task. If you find that you’re getting nowhere on your own, you can get help from a lawyer who specializes in medical bill negotiations. However, make sure you’re not going to be spending more on legal help than you’re being charged for the services you’re alleged to have received. Sometimes the financially sound thing to do is to accept the charges and move on.

How to Avoid Medical Bills Mistakes in the Future

Dealing with errors on a medical bill can be an exhausting process. It’s undoubtedly easier to avoid all this extra work and get the correct bill in the first place. Of course this isn’t always possible when your healthcare provider is the one who’s made the mistake, but there are some things that you can do to make sure that you’re not billed in error.

  • Know what services you’re receiving and why as you get them. Sometimes you can receive pointless X-rays or unnecessary drugs just because you didn’t stop to ask the rationale behind the treatment you were receiving. You should trust your doctors with your health, but that doesn’t mean that you can’t be curious. If you’re always asking questions, it will also be easier for your doctors and nurses to recall exactly what sort of treatment you received in case you need them as witnesses in a future medical bill dispute.
  • Make sure that your providers are using the right insurance codes in your billing. For example, insurance companies are required to cover preventative care at no cost to you. However, you need to make sure that the services you are receiving are being billed specifically as preventative care in order to receive the benefit. You can do this by looking up the insurance codes for the treatment that you intend to receive beforehand and comparing those to the codes that are used in your EOB and medical bill.

If your healthcare provider makes a mistake on your bill, that doesn’t mean that you have to deal with the fallout. You can challenge your medical bill and get it fixed so that you only pay for the healthcare services that you receive.


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Nick Cesare is a writer from Boise, ID. In his free time he enjoys rock climbing and making avocado toast.

This post was updated February 13, 2018. It was originally published January 2, 2018.