Are Medical Billing Errors Making You Sick?

 By Catherine Powell

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It should come as no surprise that the United States ranks highest  for healthcare costs in the world.  In 2022, healthcare spending hit an all time high of $4.3 trillion, which averages out to nearly $13,000 per person. That's nearly twice as much as that of other developed countries.  Three reasons our costs are so much higher include inadequate industry regulation, soaring drug costs, and billing fraud.  If all this isn't bad enough, another factor that makes healthcare less and less affordable for the average American has to do with billing errors totaling $54 billion in 2020 alone.  If you're sick and tired of being overcharged for services you may or may not have received, or you're worried sick about getting treated for fear of being overcharged, here's what you need to know.

Do you know your rights?

Depending on whether the healthcare plan you enrolled in is an HMO, a PPO, Medicare, or Medicaid, trying to access health providers that are in-network can be confusing at times.  Some patients have found themselves caught between their doctor and their insurer when it comes to getting the treatment they need in a timely manner.  This problem sometimes can be multiplied by the number of providers they are seeing.  Make one wrong move and you can find yourself receiving bills for services rendered that you thought were covered by insurance but were not.  or, you could receive a bill for a service you never received.  (I know the latter to be true because I recently went to the ER to get a few stitches only to be hit with a bill for $173 for a TDAP injection I neither asked for nor received.)

Up until January 2022, there was little protection for the public when it came to healthcare gouging.  It literally took an act of Congress called the No Surprises Act to keep the American public from being hit with unexpected bills from emergency services or healthcare providers that policyholders didn't realize were out of network.  Since that time there's been a way for patients to dispute surprise charges, provided they total $400 or more. Click here to visit the End Surprise Medical Bills website.

Diligence is the first line of defense. 

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Like it or not, all too many medical bills are charged in error.  Others are mailed by scam artists hoping to cash in for little more than the cost of a postage stamp.  Before you write a check or write down your credit card number on a bill for medical services, make sure you really owe something.  Sometimes all it takes is a phone call to a provider to discover that you were billed in error. (This happens more frequently than you realize.)  If you're sure that the service or item you're being billed for wasn't legitimate, insist on having the bill itemized or explained to you in plain English.  Also, make sure the bill has the correct name and insurance information on it.  If anything on the bill is incorrect, you could have been billed for someone else's treatment.  If you still haven't resolved the situation to your satisfaction, ask to speak to a supervisor, or drive to the provider's place of business to sort out the problem in person.  If necessary, insist on initiating a 3-way call between you, the provider and your insurer.

Billing errors happen for a variety of reasons.  Some occur due to the complexity of the medical reporting system where one wrong letter or digit can mean the difference between being correctly billed or being charged for something you didn't receive.  Another problem is a lack of communication between federal healthcare plans like Medicare and state-backed plans like Medicaid.  Retirees with dual coverage comprise 10% of unpaid medical debt in this country even though most should owe little or nothing for treatment.   

How to avoid being scammed.

Since medical fraud is rampant, make sure you speak directly to a provider you know and trust about any billing errors.  Never get duped into calling an unfamiliar phone number printed on a suspicious bill.  It will undoubtedly lead to a phone room operated by con artists who will try to convince you to make a payment.  Even if the person on the phone seems to know your medical condition, don't fall for this trick since scammers can easily buy medical histories on the dark web.

How can you avoid being overcharged for medical treatment?

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First and foremost, make sure you understand what is and isn't covered by your health plan.  Some plans allow patients to make appointments with providers in-network on their own, while others require patients to get a referral from their primary care physician before being treated.  If a procedure or therapy is recommended by a provider, request an estimate of benefits that will show you what is covered by your insurance and what costs you will be required to pay.  Understand your plan's limits and deductibles.  Make sure you know which providers are considered in-network.  Get to know your plan's list of benefits.

Regardless of how the error occurred, if you receive an erroneous bill, you need to take the matter seriously.  Ignoring a medical won't make it go away,  Far from it.  Not only will you receive more bills in the mail, failure to pay could result in more dire consequences should the matter go to collections.  Never agree to make a partial payment, since this could be construed as accepting responsibility for the erroneous item.

What can you do if the bill goes to collection?

Bill collectors are only permitted to contact you about debts you owe.  By law they aren't allowed to call you about debts you don't owe or someone else's debts.  They aren't permitted to harass you day and night. You have the right to tell them to stop contacting you.  That's the good news.  The bad news is that collection agencies can place a black mark on your credit report, or they can sue you in court.  If they prevail in court, it could lead to your wages being garnished or a lien being placed on your home.  If you receive notice of pending litigation, discuss the matter with an attorney.  Better still is to try to resolve any billing error with the medical provider that created it in the first place.  While this might entail spending hours on the phone or taking the time to visit the provider in person, it will be worth it to resolve the issue before it reaches the collection stage.

Catherine Powell is the owner of A Plus All Florida, Insurance in Orange Park, Florida.  To find out more about saving money on all your insurance needs, check out her website at http://aplusallfloridainsuranceinc.com