What to Do If You Receive a Surprise Medical Bill

When we welcomed our third daughter into our family last year, I initially took heart in knowing that we’d already met the deductible on our health care plan. But my complication-free delivery did not seem to jibe with the size of the hospital bill I received.

Our situation isn’t unusual: 57 percent of Americans have been surprised by their medical bills, according to a University of Chicago study. Unfortunately, there’s rarely an easy solution to figuring out if you’ve been billed correctly. In my case, it’s more than a year later, and our insurance company is still processing our corrected claim.

Although it’s taken patience and persistence, I’ve learned a lot about steps you can take to advocate for yourself and make sure you’re being billed correctly. Here’s what to do if you receive a surprise medical bill.

REQUEST AN ITEMIZED BILL

Although I had a complication-free delivery with no epidural or pain medication needed, the final bill came to an eye-popping $13,000. My patient responsibility came to $1,234; on top of that I owed my obstetrician about $1,000.

My foggy postpartum brain was tempted to just pay the bill and move on, but my gut told me something was off. Some intensive digging revealed that I was correct: I’d been overcharged by close to $700 — not altogether surprising considering up to 80 percent of medical bills can contain errors, according to some industry estimates.

Patient advocate and author Adria Gross says common medical billing errors include duplicate charges or incorrect coding. “When this stuff happens, you have to fight it,” she says.

When my bill came in with just a flat figure instead of an explanation of services, I called the medical billing department and requested an itemized bill. What the hospital emailed me was a list of service codes and prices, and the descriptions were complicated and abbreviated. So I had a hospital billing agent go through the bill line by line with me to explain each charge. (If your bill includes five-digit procedure codes, I discovered you can also enter them into this database run by the Centers for Medicare & Medicaid Services, which will translate them into plain English.)

I eventually spotted three charges totaling $672 for services I had not received: pain medication, a catheter and a flu shot in the delivery room.

STAY ON TOP OF YOUR INSURANCE COMPANY

After I pointed out the incorrect charges, my hospital submitted an amended claim. But my insurance company improperly processed it as a duplicate claim, which caused yet another delay. Gross says claims can get denied for several different reasons. “For instance, if your bill has a wrong diagnosis code, it’s going to bounce back,” Gross says. Other common causes include incomplete information on the claim or the insurance company deeming the services as medically unnecessary.

To help you get through what can be a lengthy process, keep detailed notes of your correspondences with your insurance provider. For each call, jot down the date and time, the name of the representative you spoke with and any other important details. 

If your claim gets denied, consider filing an appeal. You can do this by asking for an internal appeal, where the insurance company conducts a comprehensive review of the decision. Alternatively, you’re within your rights to appeal your case to an independent third party for external review. This will essentially take the resolution out of the insurance company’s hands.

WATCH FOR BALANCE BILLING

Another thing to look out for is balance billing. This is when a medical provider charges you for outstanding fees after your insurance provider has already paid its portion, and after you’ve already covered your deductible, coinsurance or copay. Many states have laws in place to prevent in-network providers from doing this, but out-of-network providers are permitted to. It’s also possible to get a balance bill if you go to an in-network hospital but receive care from an out-of-network doctor — I found this out the hard way when my older daughter split her chin open and needed stitches.

If balance billing is illegal in your state and you receive a surprise bill from an in-network provider, address it immediately with your doctor or hospital and your insurance company. Then contact your state’s insurance department and medical board to file a complaint. If you have a self-funded medical plan through your employer, Gross suggests reaching out to the Department of Labor.

UNDERSTAND ALL YOUR REPAYMENT OPTIONS

After all your due diligence, you may find you legitimately owe a big bill. If you can’t pay it all at once, reach out to your hospital to see if they offer in-house payment plans. Even though I’m still waiting for my insurance company to reduce my delivery bill, I’m still going to have to pay a portion of the total. My hospital allowed me to transfer the balance to a third-party credit partner with virtually no interest.

Currently, I’m paying $60 a month toward the bill while I wait for the insurance to fix things. The agreement is that they will apply these payments to the amount I owe and when my claim finally does get resolved, they’ll reduce my balance.

You may have more options than you think for covering a big medical bill. If you’re able to pay it all at once, the hospital may give you a discount if you pay with a debit card, health savings account or flexible spending account. If you’re experiencing financial hardship, it’s worth inquiring with your hospital about financial assistance or payment programs, particularly if you received care at a nonprofit hospital. If taking on debt is your only viable option, keep in mind there are personal loan providers who focus on medical bills — just be sure to shop around for the best interest rates.

The last thing anyone wants to do while recovering from a major medical event is figure out a complex hospital bill; it certainly wasn’t fun to do while I was recovering from childbirth. But think of it as one more way to look out for you and your family — you could save yourself some significant money in the long run.