What to Do When You’re Questioning a Medical Bill

Understanding your medical bill can often be a challenge. While some bills can feel straightforward, like a bill for a visit to your doctor’s office, and others much more complex, like a surgical bill, it’s important to review all of the charges. It doesn’t happen often, but it is possible that you could receive an incorrect bill, and we’re here to give you some quick tips for what to do when you’re questioning a medical bill. 

Understanding Your Medical Bill

Each provider issues bills differently, but there are some key phrases and terms that are consistent across billing systems. Billed charges refer to the full amount of the charges based on the visit or procedure that you and/or your insurance company will be responsible for. An adjustment is an amount that your healthcare provider has agreed not to charge, usually determined during the insurance reviews. Insurance adjustments are the fees and costs that your insurance company covers on your behalf. 

When you receive a bill, the first step is to review the bill to see if any adjustments have been made by your insurance company. If they have not, it’s a good idea to call your doctor’s office and confirm that the medical claim has been submitted to your insurance company. There are a variety of reasons that a medical provider wouldn’t submit a claim, and you may inquire as to why your medical provider did not submit information to insurance. Regardless of the reason, if they have not submitted the claim to insurance, you can ask that they submit a claim for the services provided. 

If you have already received an Explanation of Benefits (EOB) statement that matches your bill amount, then you owe the amount listed on the bill. You likely received your EOB in the mail, and you may have an electronic copy available in your online account with your insurance provider. The EOB is a detailed explanation of the costs, coverage, and your responsibility for payments.

After reviewing your charges, ensuring the bill has been submitted to insurance, and receiving an EOB, if you still have questions about your bill, call your doctor’s office and ask them to review the details of the bill with you.  

What to Do if Your Medical Claim is Denied

If you receive notice that your medical claim is denied, a good first step is to contact your insurance company to determine why they denied the claim. A denial could be as simple as a mistake on your paperwork or more complicated, like the insurance company needed more details or information from your provider to properly process the claim. 

Next, contact your doctor’s office and ask them to re-submit the claim to your insurance company with proper documentation, if necessary. If your claim remains denied after you complete the proper steps, you have the option to appeal the denied claim decision. You may challenge Medicare’s decision on what they agree to cover, and it’s possible that your appeal can be expedited. It’s easy to be overwhelmed by the appeals process, but it can also be worth your time and effort. You can read here for additional information about appealing a denied Medicare claim.

If you find the process confusing or overwhelming, give our team of licensed Client Advisors a call at 1-877-222-1942 for assistance!

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