Confused by Medical Billing Processes and Procedures? Here’s How to Read Your Medical Bills

Confused by Medical Billing Processes and Procedures? Here’s How to Read Your Medical Bills

1000 667 Jennifer Nelson

So, you spent an evening in an emergency department nursing a cup of something from a vending machine and trying to keep out of the path of coughing patients, running children and busy hospital staff. As if that wasn’t stressful enough, now you’re staring down the medical bill that arrived in your mailbox, adding insult to injury — literally.

Can’t make heads or tails of medical billing processes and procedures? You’re not alone. A 2016 survey found that 72% of respondents had received a medical bill they didn’t understand. Worse, bills written in medical jargon and other unfamiliar terms may as well be written in code. In fact, they generally are.

But it’s imperative that you scrutinize the bill anyway. A recent Consumer Reports survey of 1,000 insured adults who had received a medical bill found that 2 out of 3 reported having at least one billing issue, such as an error or a higher-than-expected charge.

That could easily be you — so it’s worth taking the time to learn how reading medical bills works.

How to Read a Medical Bill

Whether you’re deciphering medical expenses via a paper bill or a provider’s online portal, start by verifying that the basic facts — names, addresses, insurance information, dates of care — are correct. A clerical error like the wrong policy number or a misspelled name can be the tip of the iceberg that signals more billing issues under the surface.

Next, make sure you’re viewing the complete itemized bill. To see just what you’re being charged for, you’ll need the line-by-line listing, not just the final tally. Ask for an itemized bill if you don’t receive one.

Finally, you’ll probably need a couple of references to help you decipher the codes that represent all of your charges, since the abbreviations in your bill might not always be obvious. A medical dictionary will clarify any technical terms you come across, an ICD code reference will explain the universal codes set by the World Health Organization and a CPT code reference will translate the codes hospitals, providers and insurers use for diagnoses and procedures.

Strategies for Making Sure the Bill Is Right

Once armed with your resources, pore over your bill looking for errors. Ask yourself:

  • Does the bill reflect my experience? For example, confirm that the length of your stay is correct, as well as your room category (private or semiprivate) and any timed charges, like those for the use of an operating room or an anesthesiologist.
  • Did I get what I’m being charged for? Be sure you received any and all medications and supplies you see listed on your bill.
  • Are there any other errors? Look for duplicate charges and double-check that you’re not being charged for balance billing, the leftover balance after your insurance pays. Make sure the insurance reimbursement you receive is accurate, and of course — as much as you might not want to do it — take our your calculator and confirm that all the math adds up correctly.

If you don’t understand a charge, you can’t identify what it’s for or you think it’s a mistake, remember that you have the right to have the bill explained to you. Call the 800 number listed on the bill and have someone walk you through any disputes.

How to Negotiate a Bill

If you’ve followed those steps and you’re satisfied that your bill is technically correct, it might still be too high for you to pay. This is where a little research comes in handy. You can look up the cost of procedures in your area and dispute the charges or negotiate the price down.

The most important thing when negotiating a medical bill is to act quickly. Any delay risks putting your bill in someone else’s hands — such as a collection agency — where you have less leverage. Ask as many questions as you need to fully understand the charges or pricing. The worst that can happen is that they say no. If you’re stuck, try:

  • Citing the high cost. Mention that a specific item or overall bill seems high and ask if it can be reduced. Be prepared to offer the amount you would like to pay for a specific item or overall bill and tell the representative where you got your numbers. Offer to send a letter requesting to pay a lower amount.
  • Asking if you qualify for any discounts. This could include a discount for paying the entire bill up front or for paying in cash. Also be sure to request information about resources like charity and financial assistance programs or an affordable payment plan.
  • Moving on to your next steps. If you have no luck lowering the bill and want to pursue it further, ask about an appeal process.

Navigating your way through medical billing processes and procedures can be a slog, especially if you’re still recovering from an injury or illness. But with the right resources at your fingertips you can not only understand your bill but also ensure you’re paying the fairest price possible for your health care.

Jennifer Nelson

Jennifer Nelson is an award winning health, health IT, and personal finance writer.

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