Consumer IQ

How to Spot Medical Billing Errors in 5 Minutes

Most of us have received a medical bill with an error on it at some point in our lifetime. It’s bound to happen, with an estimated 50 to 80% of bills containing some kind of mistake. But how many of us have actually bothered to look for errors, let alone succeed in finding one?

It’s not easy. Medical bills can be pretty complex for a single sheet of paper. Most of us just grumble at the high cost, write our checks begrudgingly and then move on with our day. We never quite know whether what we paid was truly right or not.

How do you actually detect an error and what should you look for?

This stuff can be complicated and some errors require an expert’s eye, while others take only take a few minutes to spot. Really. Try these quick tips each time you get a new bill.

Find the discount.

If you’ve met your deductible, your health plan should be paying. It’s that simple. If you find you’re being billed for the full charge, there is probably something wrong.

Double check dates of service.

This is especially important for hospital stays. Sometimes patients are billed for more days than they actually spent in the hospital.

Look for duplicate charges.

If the same service name or CPT code appears twice on a bill, or you get more than one bill for what appears to be the exact same service, you might be getting charged twice.

Check the network discount.

If your plan has co-insurance (you pay a certain percent of the cost), you usually have to pay a higher percent for out-of-network providers than in-network. Look for the discounted or adjusted rate on your bill and then check what percent your insurance company applied. Sometimes the out-of-network discount is applied when the provider was actually in-network, which could make you responsible for 50% of the cost, rather than 80%.

Compare past bills.

If you got similar services from the same provider in the past, you might be able to spot an outlier. Tools like simplee.com allow you to compare bills at a glance, without having to save and sort through a pile of paper. One man recently saved over $900 when he noticed one bill where the wrong discount was applied.

Look-up the CPT code.

This is a five digit code, usually all numbers, but sometimes four numbers with a letter on the end. There is a code for every procedure you could get. For example, there is a code for a routine physical, one for a flu shot, an x-ray of the abdomen, etc. Make sure that the description of the code matches the service you received. If the description sounds inaccurate or more elaborate, that’s a red flag.

By being familiar with your health plan’s rules and regularly reviewing your bills, you’ll get more comfortable with how they look and what seems off. But most people don’t receive bills frequently enough to get that much experience.

If you are unsure, call the plan, contact your state’s Department of Insurance or the agency that regulates health plans. They may offer free consumer assistance with bills. And if you’re still in doubt? Consider a billing advocacy organization such as Medical Billing Advocates of America.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitterfacebook or email.