How to Fight Insurance Company on Medical Bill

Errors or overcharges on medical bills are unfortunately commonplace. If you suspect something might be amiss with your bill, begin by asking for an itemized copy and carefully reviewing each charge individually.

Keep careful records of every interaction with providers and insurance companies, including names of each person spoken with, telephone numbers used, and an overview of what was discussed.

1. Review the Bill

Medical bills can be extremely complex and confusing to comprehend, often including numerous charges for different procedures and treatments that you might not cover by your insurance plan. Furthermore, they sometimes contain errors which result in patients being charged for services they did not receive or paying more than should have. Luckily there are steps you can take to help navigate these complex bills more easily while fighting inaccurate charges and fee increases.

First step to successful billing: review it carefully! Be mindful to pay close attention to each charge: procedure type, provider name and date of service are important details that could indicate errors on a billing statement – such as an incorrect name or address being listed or charges not paid by your insurance provider. Also be wary of any erroneous or excessively priced charges you find, making a list and then reaching out to billing department to dispute those items if necessary.

Whenever speaking with the billing department, be sure to remain calm and polite. Explain any errors on your bill that you found and request an itemized list of each charge; additionally, request copies of records related to each service or treatment listed on your bill as well.

Review your explanation of benefits (EOB). This document should outline why your insurer denied your claim and how you can appeal it – this can be extremely useful when fighting back against an insurance company regarding medical bills.

If the reason for your denial was an administrative error at an insurance company, contacting customer service should help quickly resolve this matter. They should explain what procedures need to be followed for filing an appeal and when this should occur. Make sure to take detailed notes during all conversations, and follow up in writing on any requests made during these calls.

2. Contact the Doctor

Medical bills can be confusing and frustrating to understand, especially when they contain errors from billing offices or your insurance provider. You have rights and a lot of power to fight back and get things resolved; here are some steps that will help.

At first, carefully review any medical bills or procedures bills carefully, especially those related to hospital visits and procedures. Get an itemized bill copy so that you can go line by line to check all charges are correct; look out for double charges, incorrect codes and calculations and miscalculations.

If there are any discrepancies, contact the billing office and request that they recode and rebill your insurer accordingly. Likewise, compare your insurer’s explanation of benefits (EOB) with what was listed on your medical bill to verify if their amounts match up.

Reach out to your physician or hospital and explain that their bill doesn’t seem accurate; perhaps they will reduce it or negotiate a payment plan specifically tailored for you. In such an instance, be sure to keep all documents from both providers and insurers safe in an easily accessible place.

Many providers also provide patient advocates, which are available to reduce your costs, expedite resolution of issues quickly, and more. These representatives tend to reside in hospitals and large medical networks such as HMOs.

If you are still having issues resolving your bill, reach out to your state insurance commissioner. Every state has an agency dedicated to handling insurance complaints and disputes; these departments can give advice on how and what documentation may be necessary when filing a complaint, as well as refer you to legal services that specialize in medical billing disputes. Furthermore, if your health insurance has denied one or more claims on which you believe coverage should have been granted, appealing with them provides another chance for them to review and assess them more thoroughly before ruling in your favor.

3. Contact Your Insurance Company

Each health insurance provider has different rules and regulations. When seeking out medical billing assistance from your insurer, contact their customer service department and ask to speak to someone with extensive experience specializing in medical billing. Often these staffers will have even more expertise than any of your insurer’s managers themselves! If your bill is complex enough, you may need to call several times and speak to different people; keep track of who spoke with whom when; record dates/times as well as conversations summaries so they will come in handy should a complaint need be lodged against them or with state insurance commissioner or Consumer Financial Protection Bureau (CFPB).

If you have coverage and receive a medical bill that your health plan deems covered, and it includes services your plan has covered, correct any incorrect charges from providers as soon as possible and pay. In addition, reach out directly to providers to request itemized billing statements so you can ensure no unnecessary or duplicate services are charged for. You should be able to find their billing office contact information on any Explanation of Benefits statements or bills you receive.

Your insurer should send an explanation of benefits with each bill that your health care provider submits, to help explain why he/she wants you to cover an expense or procedure. As sometimes happens with medical providers submitting bills incorrectly to insurance companies, this could cause claims being denied or not being fully covered.

One common error healthcare providers make is assigning incorrect CPT codes (the code system used by medical billing professionals) for services you received, leading to unnecessary extra charges or being billed for services you did not need. You should review your list of CPT codes against your Explanation of Benefits to identify any charges which are incorrect or unnecessary.

If an insurance claims processor denies your claim, you have certain legal rights to contest their decision by appealing it as detailed in their denial letter. Additional medical records or letters from doctors proving why you believe it should be covered should be submitted as supporting documentation for their decision to reconsider their decision.

4. Contact Your State Insurance Commissioner

Insurance regulation at the state level is intensely monitored by your state’s insurance commissioner, who serves as your advocate. Should an out-of-network medical bill arise unexpectedly or your health insurer refuses to cover something, your state insurance commissioner could be the solution.

When disputing medical bills, it’s important to keep time and patience in mind. On average, Patient Advocate Foundation case managers require 22 calls on average in order to resolve a single medical billing dispute – with collections agencies often employing questionable practices or violating laws making matters even more challenging.

Medical billing disputes are among the top consumer complaints received by the Consumer Financial Protection Bureau, but you can take steps to safeguard yourself. Start by asking your medical provider if they will stop collecting payment while working together to dispute it; and if that does not produce resolution, reach out to a medical billing attorney who will represent your interests in court.

Interested in hiring an attorney who specializes in medical billing disputes? Start by conducting a quick Google search to see what others have had to say about their experiences, then arrange for a consultation session to discuss your case and determine the most effective strategy – be sure to bring all relevant documentation and proof with you for this meeting! Additionally, keep up-to-date on changes happening within your state laws by consulting our map below and finding your state’s insurance commissioner’s contact info!