How To Dispute an Incorrect Medical Bill or Denied Insurance Claim

Aisle between files stored on shelves
Lester Lefkowitz/ Stone/ Getty Images

If you have a claim that is wrong it can be a lengthy process to get the claim corrected. Additionally, you may need to fight with the insurance company if they have denied coverage for a service or procedure. You should begin each process with a notebook to record the results of each conversation you have with personnel. You should carefully check all of your medical bills to try to save money on your health care.

Call Your Insurance Company and the Hosptial 

Call the insurance company and the hospital regarding the dispute. If you are disputing an incorrect claim, then you need to request a complete copy of all services that were billed for. You also need to request that an inquiry be done on the claim. Do not be surprised if the staff is disbelieving that you did not receive the service.

Find Documentation About the Bill

Next, you need to collect the documentation to prove that you did not have the service done. The sooner you do this the better. You may need your doctor to write a statement regarding what was actually done. You should also note the name of your nurses and any other information that you may need.The papers you received when you checked out of the hospital and clinic may help too.

Take The Compalint to the Next Level

Wait for the results of the inquiry to come back. If they still claim that you received the service, you may need to refer it their supervisor.

Once you have worked through to the top level you will need to request a meeting in person to discuss the discrepancy. It rarely gets to this point. You may also need to contact a lawyer if this does not work. Keep your insurance informed during this entire process. If the claim is expensive, they may assign you a caseworker to work with on this.

Check Insurance Codes on the Doctor and Hospital Bills

If you are working to have a service covered when the coverage was denied, you will need to talk to both the doctor and the insurance agency. You may find that something was simply encoded incorrectly. This is a simple fix. It is often frustrating because you are dealing with two companies that have a lot of paperwork and bureaucracy to deal with. Document every phone call with the results of the call and the date.

Tips:

  1. To avoid confusion on getting your bills paid you should make sure that you get all necessary procedures preapproved. Often the doctor will do this, but you can call the insurance company to make sure that it has gone through. A quick phone call can save you a lot of money in the future. The day before the procedure, you should call and doublecheck that everything is approved by the insurance company. It is always good to check yourself so you are not hit with an unexpected bill if the claim is denied. 

  2. Sometimes a hospital is on the in-network list, but some of the doctors there are not. Anesthesiologists are notorious for this. You should contact your insurance company and the hospital beforehand to find out the options to help you pay the lowest amounts for these services. You will need to check to see if everyone involved in your procedure is pre-approved.

  1. You can work on paying less for your medical expenses, by shopping your procedures through your insurance company and by calling around. A simple phone call to your insurance company can help you save a lot of money. There may be specific deals that have a specific urgent care doctor set up as a primary care provider or you may not have to pay extra for an x-ray if you go to an independent urgent care insted of one connected to a hospital. 

  2. If you do not have medical insurance, you should shop around before you have anything done. You can also work out a payment plan with the hospital. If you can't afford health care, you should speak to the hospital before you have anything done. Many hospitals will lower the cost if you do not have insurance and may be willing to work out a payment plan with you. These deals vary by hosptial and it is worth calling several in your area to find the best deal, especially if you do not have insurance. 

Continue Reading...