How to Understand Your Medical Bill

1.

Check your Doctor's bill. Have you been billed for the services actually delivered to you on the date of the visit printed on the statement. Also, check and verify that the bill has been submitted to your insurance company.

2.

Examine, in detail, your insurance company's statement. Have any services been denied. If so, is there an explanation? If there is an explanation, call your Doctor's office to see if this can be rectified in a way that you don't have to pay out of your pocket.

3.

Do you feel you have been billed excessively. Ask your insurance company for the CPT (Current Procedural Terminology) codes of the services rendered. Check the AMA CPT website to find out the regular amount Medicare pays for that service in your geographical area. Your insurance company should pay something equal or a percentage (90\% to 130\%) of that amount.

4.

If the payment is low and your share of the co payment is higher than it is as stated in your insurance policy, dispute it with a copy of the payments for that CPT code. If you feel the Doctor has billed for more than the service you received, call the doctor's office and voice your disagreement and request that it be corrected

5.

DO NOT BE IN A HURRY TO PAY OUT OF YOUR OWN POCKET! GETTING REFUNDS ARE A HEADACHE!
Wait till all disputes are resolved to your satisfaction. Keep track of phone calls, e-mails, faxes and letters sent out in the course of resolving the issue. Be polite,informed, and above all persistent in trying to get the issue resolved. Do not be bullied by statements like 'we will send you to collection'. You have a right to have your reasonable queries answered to your satisfaction.

6.

"Fair Pay for a Fair Service" - should be your watchword.

Tips and Warnings

  • Examine every detail of your bills and EOB's. Do not assume that company which provides you the health insurance,the doctor's office and the insurance company will sort out things. They do not care about your difficulties. They care about their own until you make them aware of yours.
  • Remember - 'THE SQUEAKY WHEEL GETS THE GREASE'.
  • Bills are processed by computers at your insurance company. Computers process information fed into them. Most people feeding information into those computers are at the bottom of the totem pole in that organization and not the smart kids in the room.
  • Do not be surprised if they have made errors. You won't find out unless you pour over the information sent out to you
  • 1)When a person gets a medical bill - WAIT! before you pay anything.
    2)Let your insurance company deal with it. this will be done if you assigned your benefits to the Physician, Hospital, Lab or Procedure facility.
    3) When the insurance company pays your doctor or service provider, they will send you an EOB(Explanation of Benefits)
    4) Check the EOB in detail
    5) If there is a balance to pay from your own pocket, make certain that you have received the services you have actually been billed for (and paid for by the Insurance company)
    6)If you feel you have been overcharge or would like to question an item in the EOB, call or write to the insurance company for further details.
    7) EOB's sent to patients (like yourself) generally do not have precise information on the kind of services you have received. They just state doctor visit or ER visit. When you request details, the insurance company will provide the code the provider has used to bill their services.
    8) Doctor's services are condensed into CPT (current Procedural Terminology) codes. Google CPT codes. You will get the web site of the American Medical Association CPT website. if you follow the form there and type in the CPT code - you will find what Medicare pays for that code in your area. Your insurance company may pay the same amount or a percentage of that, say 90\% to 130\%.
    9)If you are satisfied with the explanation, go ahead and pay the balance due. If not satisfied dispute that service/payment with a copy of the CPT code and fees.