Dealing with Medical Billing Issues


Due to the complex nature of today’s medical billing industry, it’s difficult for many consumers to know exactly what they will end up having to pay for medical services or treatments. Fortunately, there are some things you can do to make it easier to deal with any medical billing issues that may arise.

Understand what your insurance does and does not cover
Your first step in tracking a medical billing issue is to find out exactly what your insurance does and does not cover. Review your health plan’s coverage brochure or contact your insurer to find out about your health insurance plan’s coverage exclusions or limitations, expenses that are fully or partially covered by your plan, and the ramifications of using an out-of-network provider.

Another helpful tool is an explanation of benefits (EOB). Once a medical claim is processed by your health insurance provider, you should receive an EOB. The EOB will provide you with the dates and type of services provided, the amount billed by the medical provider to the insurance company, what the insurance company paid to the provider, and the amount that wasn’t covered. Review your EOB and compare it to your medical bills. If you find any discrepancies, contact your medical provider’s billing department.

Keep an eye out for common billing errors
Unfortunately, errors are a common occurrence in the medical billing industry. As a result, it’s always important to request an itemized bill. Check your itemized bill to make sure all your identifying information, dates of service, and insurance information are correct.

In addition, be alert for common billing errors, such as:

  • Being billed separately for services that are already covered under previously bundled fees
  • Being billed for extra time in the operating room or more anesthesia
  • Being billed for a more expensive charge than necessary (also known as “upcoding”)
  • Charges for canceled procedures
  • Charges for duplicate procedures
  • Incorrectly coded procedures

If you find an error on your bill, contact the billing department of the medical provider to request a corrected insurance claim and/or bill. Be prepared to explain the mistake to the billing representative and provide copies of billing records that illustrate the billing error.

Don’t be afraid to negotiate
If you have a large medical bill, it may be worthwhile to negotiate with your medical provider. Depending on the amount you owe, you may be able to lower your balance or arrange a payment plan that spreads out the amount you owe over a period of time.

Consider getting professional help
Some medical billing issues may be too difficult to resolve on your own. If you are unable to determine what you owe or negotiate a resolution with a billing department, consider enlisting the services of a medical billing advocate. Medical billing advocates are typically paid an hourly rate. For more information on medical billing advocates, visit the Medical Billing Advocates of America website at

 Prepared by Broadridge Investor Communication Solutions, Inc. Copyright 2016.


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