News 2 I-Team: Spotting medical bill errors

Healthcare costs keep rising. Deductibles are higher than ever, and healthcare experts say medical bills are often full of errors.

The I-Team started our investigation into billing errors in October of 2015 after a Lowcountry man showed us his errant bills.

I-Team investigator Rebecca Collett started closely monitoring her family’s bills following the story.  In three bills for routine lab tests in the last year, providers charged the Colletts $702 in out-of-pocket expenses.   After a closer look at the bills, Rebecca found she actually only owed $12.75.

On two bills, insurance wasn’t paying any of the charges for routine pregnancy labs.  The provider charged the Colletts $224 and $203. The problem was the bill wasn’t charged under the correct insurance policy number.   After the insurance was updated, the actual out-of-pocket cost for the $224 bill was $12.  Of the $203 bill, the actual out-of-pocket was 75 cents.

Spotting the issue with the insurance policy number wasn't hard.  On those lab bills, the information was on the front of the bill.  Finding errors isn’t always that easy.

On a bill from a local hospital for labs, the hospital showed the bill was filed with the correct insurance carrier.  One the phone, a patient advocate confirmed the bill was filed with the insurance carrier, but the Colletts still owed hundreds of dollars.  The hospital allows patients to set up payment plans for large bills.  It would be more than a year and several more calls to the hospital before an error on that bill was caught.

It turns out the hospital had the wrong policy number. It took a call to the hospital and confirmation of the policy and group numbers to catch the errors.  So while the bill was filed with the correct carrier, it wasn’t filed under the right account.

 

The most common errors

Health insurance expert, Shelli Quenga, says you should wait to get an Explanation of Benefits from your insurance company before ever paying bills or setting up payment plans.

The EOB never came for the Colletts hospital charges, which was a good indication it wasn’t filed correctly.

Patient advocates estimate 80 percent of medical bills contain errors.

The most common errors include:

  • - wrong insurance or patient information
  • -duplicate charges for the same service
  • -bills for cancelled treatments
  • -incorrect quantities of medication
  • -balanced billing- where the provider tries to collect more money from you than they agreed to with your insurance company.

The EOB from your insurance company will explain the exact charges you owe and what the provider agreed to bill.

“That really dictates how much you really need to pay because your insurance company has negotiated a contract about how much you pay,” Quenga explained.

Once you have the statement from the doctor and the EOB double check the following to check for errors:

Was the date of the service correct?

Are the patient and doctor names correct?

Is the insurance policy number right?

And what was the appointment for?

Finally, you can request an itemized bill from your provider.

One bill from the birth of the Colletts’ first son revealed several charges for services never received.  These sorts of errors will drive up the cost to patients and insurance companies.

“You've got to be vigilant,” Quenga said.  “It really begins with having an understanding of how your insurance works.”

 

Steps to spot errors

Understand what your insurance covers and what your portion will be before heading to the doctor. It’s important to understand your copay as well as what procedures and checks are covered at 100 percent.

Compare the bill from the provider with the Explanation of Benefits from your insurance carrier.  You only owe what your insurance says you owe.  Any extra charges are usually the providers balance billing you, which breaks their contract with your insurance company.

Request an itemized bill or receipt from your provider to make sure you weren’t charge for services or medication you didn’t actually receive.  Those charges drive up the cost to your insurance company and could be passed onto you through deductibles and coinsurance costs.

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