I know I’m not alone in receiving medical bills and wondering what the heck is going on. I might be in a better position than many because of my background, but like you I’ll get bills that have things on them that I have to question.

Doctor greating patient
Creative Commons License Vic via Compfight

There’s a right way and a wrong way to ask questions about things on your medical bill. If you go into it screaming like a maniac, people will tune you out and your experience will be horrible. No one has to listen to you screaming and cursing, and since you’re looking for information or assistance you won’t get it with those attitudes.

Instead, here’s how to get the information you need and at least put pressure on the other side, even if you don’t end up getting everything you’re hoping for.

1. Circle these things on your bill so that when you do call up you know exactly what information to give the person you’re talking to: account number; date of service; the charges you’re concerned about; or the payment amount showing that you might think isn’t high enough from your insurance company.

2. Ask them to explain the items you have an issue with. If it’s a charge issue the person you’re talking to might not know how to address it, since most billing people don’t have access to either the medical records or a charge sheet to know why a certain procedure was selected. They should be very good at explaining payment issues however.

3. Ask them for the CPT/HCPCS code of the service performed. They have to tell you this because it’s part of your patient’s rights. Why do you want this information? Because you might have to contact your insurance company to find out why they didn’t cover something and having that CPT code will give you some leverage and make them think you know more than you might know. It also wouldn’t hurt you to look up the CPT/HCPCS code once you have it to be better informed later on.

4. If you’re told there is no CPT/HCPCS code and it’s not a supply item they’re either lying, inept, or they’re not allowed to charge you for the item. Any medication without a code is considered a take home medication; you’re not supposed to be billed for that unless they told you while you were having services done that it wouldn’t be covered and asked if you wanted to pay for it.

Some supply items don’t have codes, but any items that must be used to perform a procedure that aren’t specialty items are considered as routine charges, and you might be able to challenge those charges and get them off your bill. Any services that show up on your bill must have a CPT/HCPCS code or else insurance companies will ignore them, and if they ignore them you can ignore them as well.

5. If you’re unsatisfied with the answers you get tell them you’re disputing your bill . They may take your request by phone but these days most offices will ask you to send your request in writing. If you do this, make sure your letter is as short and direct as possible and, for added protection, send it by registered mail.

In most states, once you disputed your bill they can’t send you another bill until it’s resolved or send you to collection, and if they do you can call them up and complain about it. That’s why sending it registered mail works best because you’ll have a signature of someone who signed for it.

Sometimes even after doing all of this you’ll find that they were correct and no changes will be made. At least you will have taken steps to find out the truth. And if you’re dissatisfied you can always ask for arbitration or go to your state’s insurance commission. Or find an expert online who might be able to offer you some guidance for a small fee.
 

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