You’ve made all the right moves to get your insurer’s approval for treatment so you won’t have to fight for coverage later. So imagine your dismay when you receive a surprise bill from the insurance company. Don’t pay it. Wait until you get the explanation of benefits to find out why your claim was denied.
These forms can be difficult to decipher; ask the insurer for a translation. The doctor may have billed with the wrong tax ID, or you may have used an old insurance card. In such cases, an appeal usually isn’t necessary, says Patrick Shea, a claims specialist and director of MedicalClaimsHelp.org, in Green Bay, Wisconsin. “You can get the errors reprocessed with a phone call.”
Coding mistakes also can cause problems. The provider’s office may have input the wrong code for the procedure or the diagnosis. “Sometimes the doctor can resubmit it with a different diagnosis and procedure code, and the charge will be paid,” said Kathleen Hogue, a medical billing specialist in Twinsburg, Ohio.
To spot mistakes from the start, get an itemized bill that breaks down each cost separately, especially for complex procedures and hospital stays. “Anytime you receive a bill from a facility, you should ask for a detailed, itemized bill to know exactly what you’re being charged for,” said Pat Palmer, founder of Medical Billing Advocates of America, in Roanoke, Virginia. You may have been charged for services you didn’t receive, in which case you can usually fix the error with a phone call or by providing the medical records.
Kim Jacobs of Lakeville, Minnesota, had both authorization issues and clerical errors. Two years ago, she underwent an outpatient procedure recommended by her gynecologist. She had been told by the doctor’s office that the procedure was authorized, so she was surprised to receive a bill for nearly $10,000. “The doctor’s office said they got the approval, and you don’t think to double-check it,” she said. Her doctor has since written letters to the insurer explaining why the procedure was medically necessary, in hopes of overturning the denial.
In the meantime, Jacobs contacted Palmer and her colleagues for help. They asked the hospital for an itemized bill and successfully disputed several of the charges, bringing the bill down by nearly $4,000. Disputing errors on the bill is a good strategy for knocking down the cost while you’re undergoing the more complicated process of appealing. Jacobs continues to pursue her appeal with help from Palmer and her colleagues.
Kimberly Lankford is a contributing editor to Kiplinger’s Personal Finance magazine. Send your questions and comments to firstname.lastname@example.org. And for more on this and similar money topics, visit Kiplinger.com.