Dispute Incorrect Medical Bills or Denied Insurance

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If you have an incorrect health insurance claim, it can be a lengthy process to get the details corrected. Additionally, you may need to deal with the insurance company if they have denied coverage for a service or procedure. Here's how to dispute an incorrect medical bill or denied insurance claim.

Key Takeaways

  • If you receive an incorrect medical bill, the first step to take is to call the insurance company and the hospital.
  • Next, gather the documentation needed to prove that the bill was in error. The more information you have, the stronger your case is.
  • If needed, continue to escalate your issue until you're speaking with someone who can help you.
  • Remember that getting preapproved and staying in network can help prevent complicated medical billing issues.

Call Your Insurance Company and the Hospital 

Start off by calling 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 the services that were billed for.

Be sure to ask for an itemized bill so that you can see each service that you are being billed for.

Gather Documentation

Next, you need to collect the documentation to prove that the medical bill was in error. The sooner you do that, the better. You may need your doctor to write a statement regarding which services you had and which you did not. 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.

Escalate Your Complaint

Wait for the results of the inquiry to come back. If they still claim that you received the service, and won't remove the error from your bill, you may need to refer it to their supervisor. Once you have worked through to the top level, you will need to request a meeting in person to discuss the discrepancy.

The worst-case scenario is that you may also need to contact a lawyer if these first efforts do not work. Keep your insurance company informed during this entire process. If the claim is expensive, it 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 after it has been initially denied, you will need to talk to both the doctor and the insurance agency.

Regarding medical billing errors, you may find that something was simply coded incorrectly, which is a simple fix.

It is often frustrating because you are dealing with two companies that have a lot of paperwork and bureaucracy. Document every phone call with the results and the date.

Avoid Disputes by Getting Preapproved and Using In-Network Providers

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 double-check that everything is approved by the insurance company. It is always good to check so that you will not be hit with an unexpected bill if the claim is denied. 

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 whether everyone involved in your procedure is preapproved.

Shop Around

You can work on paying less for your medical expenses by shopping around for your procedures through your insurance company and by calling around and doing your research. Although that may seem like a lot of work, it is less expensive than going without health insurance. 

Keep in mind that you may have to pay extra if you go to an independent urgent care facility instead of one connected to a hospital.

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.

Frequently Asked Questions (FAQs)

How do I dispute incorrect medical bills on my credit report?

You should dispute information on your credit reports directly with the credit bureaus, which you can do by phone or mail or online. You can also reach out to the original billing or collections agency to see whether it will remove the item for you, which may expedite the process.

Who qualifies for assistance with medical bills?

If you need assistance paying your medical bills, you may be eligible for a variety of assistance programs, including Medicaid, Supplemental Security Income (SSI), Extra Help, and many different charities and organizations. Some medical providers have their own financial assistance programs, too. Qualification criteria vary by program, so start by reaching out to your medical provider and insurance carrier for more information about your assistance options.

What happens if you don't pay medical bills?

If you fail to pay your medical bills, they will eventually go to collections and end up on your credit report. However, this process takes longer than with other types of credit. Credit bureaus must generally give you 180 days before putting medical bills on your report, so you will have enough time to work out a payment plan. Once that period has passed, though, it will have a negative impact on your credit and stay on your report for seven years.