How to Audit Your Medical Bills

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If you’ve read the news this week, you’ve heard about the Canadian woman who was charged nearly $1 million in medical bills when she unexpectedly gave birth to her baby in Hawaii. Jennifer Huculak and her husband Darren Kimmel were horrified after their insurance claim was denied by Saskatchewan Blue Cross, despite being told their international policy was accepted by the U.S. hospital. Much of their debt has now gone into collections, threatening their credit and limiting their financial choices.

Huculak and Kimmel’s story is unusual, but not uncommon. Medical debt is a primary cause of bankruptcy in the U.S. When you can’t pay your bills and your credit is in danger, what’s the next step? We suggest an audit. Questioning your bill’s validity and value is the first step in asserting your financial rights and protecting your credit score. Begin by:

Asking for an itemized copy. A bottom line is difficult to defend when an itemized bill is involved. Look for suspicious charges, including:

  • Non-procedural or medical-related items. Some hospitals are known for charging things like hospital bed rentals, surgical equipment and other reusable supplies. Unfortunately for them, these items cannot be billed to patients and should be removed from your invoice immediately.
  • Double billings. Were you charged for two doses of morphine and only given one? Compare charges to your medical records to verify or disprove items on your bill.
  • Unused items. Slippers, toiletries and over-the-counter medication can cost hundreds of dollars if the hospital supplies them. Dispute false claims (and bring your own slippers).
  • Mistaken identity. A fellow patient with a similar name or insurance number could be getting free treatment thanks to bad record-keeping. Ensure all medical treatments are yours. Don’t fall victim to mistaken identity.

Calling your physician. Hospital stays can be traumatic, and you probably don’t remember every procedure or medication ordered by your doctor. If you’re unsure of a charge, call your doctor and ask them to verify each item. Ask for a written copy of the original order to ensure accuracy. Hospitals cannot bill you for procedures not ordered by your doctor in writing, allowing this strategy to provide definitive answers.

Contacting your insurance provider. Insurers provide their customers with an Explanation of Benefits (EOB), detailing coverage, copays, and other expenses you are responsible for. If your bill doesn’t match your EOB, contact your provider and review your information. A clerical error or false reporting could explain a case of overcharging.

Hiring an auditor. If you can’t secure a fair bill, it’s time to take action. Request an internal audit from the hospital and consider hiring your own auditing service to secure a second opinion. The Medical Billing Advocates of America will help you find an auditor in your area. Escalating a case to the auditing phase usually uncovers errors and reduced costs.

Filing a formal complaint. Medical price gauging is despicable and in some cases, illegal. Assert your rights by filing a formal complaint with your state’s attorney general office. Creating a record of abuse will help to protect your credit from further unfair damage. Don’t wait to take a stand.