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How to Audit Your Medical Bills

The information provided on this website does not, and is not intended to, act as legal, financial or credit advice. See Lexington Law’s editorial disclosure for more information.

Medical issues are challenging to deal with on their own, but then come the medical bills. Unfortunately, medical bills are the leading cause of bankruptcy in the United States. Medical bills can often be astronomically high, causing many people to fall into debt when trying to pay them off.

However, many Americans don’t realize that they should always be reviewing their medical bills to verify the charges are valid. This is especially true for people who are worried about paying their bills. An audit from Equifax found that hospital bills exceeding $10,000 had, on average, $1,300 in incorrect charges.

You may not need to check your bill thoroughly if you had just a simple consultation, but there are more likely to be errors if you had a more complicated visit, such as a surgery. Keep reading for a comprehensive guide and tips on how to audit your medical bills.

What to Do When Reviewing Your Medical Bills

Take these steps when auditing your medical bills:

Ask for an Itemized Copy

Your medical provider will likely send you a summarized version of your medical bill. This is a condensed version of your statement that groups charges into categories, so it doesn’t provide you the level of detail and insight you need to review your bill thoroughly.

If you receive a summary bill, reach out to the relevant parties and get the itemized version instead. You have the right to ask for an itemized bill, either from the billing department at the medical facility or online. Please note that even a small procedure can result in a multipage statement, so you’ll have a lot of reviewing to do.

Once you have the copy, review it for any suspicious items. This can include:

  • Double billings: Does a line item show up twice when you don’t think it should? For example, two doses of morphine when you’re sure you were only given one. You can compare charges to your medical records to verify or disprove items on your bill.
  • Non-procedural or non-medical-related items: Some hospitals have been caught trying to charge for things like hospital bed rentals, surgical equipment and other reusable supplies. Hospitals aren’t legally allowed to bill these items to patients, and you can dispute these charges immediately.
  • Unused items: Items such as slippers, toiletries and over-the-counter medication can cost hundreds of dollars if the hospital supplies them. For example, a simple over-the-counter painkiller, such as Tylenol, can cost as much as $15 for one pill. Dispute any false claims and, if you can remember to do so, bring your own slippers.
  • Mistaken identity: Mistakes happen on medical bills from time to time. A fellow patient with a similar name or insurance number could have all their medical treatments added to your invoice. Don’t fall victim to mistaken identity, and make sure your charges match your treatment.
  • Refused treatments: At some point during your medical care, you may have refused certain medications or treatments. If you did, make sure they don’t appear on your final bill.
  • Other: Watch out for any other charges that seem incorrect in any way, such as incorrect medication names or dosages, incorrect dates, the wrong name or address, wrong insurance information, wrong surgery minutes, incorrect room classification, and so on.

If there are any codes or words on your bill that you don’t understand, take the time to look them up. You should be able to find explanations online. Some useful resources include this Medical Dictionary, the Medicare code lookup tool and this ICD code reference tool. An ICD code ensures you were billed for the correct diagnosis.

Check Your EOB and Medical Records

Next, check your Explanation of Benefits (EOB) and your medical records. Compare these to a copy of your medical bill. You can get your EOB from your insurance provider. Your EOB will automatically come via mail or email and show what portion of the charges are being paid by the insurance provider. The statement will say “Not a bill” at the top.

You can get your medical records from your health provider. You will likely have to fill out a form requesting a copy of your medical records, and you may be charged a processing fee for the request. The cost can vary for each provider, but states usually limit how much a provider can charge. Ask up front what that fee will be.

Talk to Your Physician

Hospital stays are often traumatic, and it’s unlikely you remember every procedure or medication ordered by the doctor. It’s entirely within your rights to call your doctor and ask them to verify each item. Another sound strategy is to ask for a written copy of the original order. Hospitals can’t bill you for procedures not ordered by your doctor in writing. Compare the written copy of the original order to your medical bill and dispute anything that doesn’t match.

Keep Records of Everything

Keep records of everything, including receipts, dates of services and payments, healthcare visits and provider names. This will help you avoid confusion as you sort through all the details. It will also make any disputes easier as you have all your proof organized. Additionally, if you end up in small claims courts, records will be necessary for your lawsuit.

Hire an Auditor

If you have tried to dispute your bill to no avail, it’s time to take action. You can request an internal audit from the hospital and consider hiring your own auditing service to secure a second opinion. Escalating things to this stage usually uncovers errors in the billing and results in reduced costs.

What Should You Do Next?

Challenge the Charges in Question

The first step in challenging your medical charges is to contact the medical facility’s billing department and try to speak to someone who may reduce your expenses.

Many Americans don’t realize that medical charges are negotiable. Even if you can’t have items removed, you can ask for them to be reduced. Hospitals can ultimately charge whatever they want for medical costs, but you can compare your fees to what is considered standard. Use the FairHealth tool for comparison. If your charges are double or triple the standard, bring this up in negotiations.

You can also file an appeal with your insurance company.

Work With a Patient Advocate

If challenging the charges on your own doesn’t result in anything, you may consider hiring a patient advocate. An advocate will negotiate on your behalf, and they have the experience to garner results. Usually, advocates only charge you if they’re successful in getting a reduction in your bill, and their charges are typically a percentage of what you saved on the bill.

File a Formal Complaint

Some cases of medical price gouging are downright illegal. If you believe yours to be an unlawful situation, you have every right to file a formal complaint with your state’s attorney general’s office. Creating a record of abuse can also help protect your credit from further unfair damage.

Protect Your Credit

When your medical debt is sent to collections, you have a period of 180 days before it appears on your credit report. This means you have some time to work things out before your credit is impacted.

Ultimately, you need to make sure you take care of your bills in one way or another. Negotiate what you can, pay what you can and communicate with billing staff so they know what you’re doing. This can delay them from sending the billing to collections. Even if the medical debt isn’t fair, it can end up being sent to collections and ruining your credit.

Be proactive in auditing your medical bills quickly and acting as soon as you suspect anything is wrong. If you’ve already had medical bills show up on your credit report, you can still work to improve your credit score. Consider using credit repair services from Lexington Law. We’ll help you address any unfair and unverified negative items on your credit report. Get your credit score back on track today.

Reviewed by John Heath, Directing Attorney of Lexington Law Firm. Written by Lexington Law.

Born and raised in Salt Lake City, John Heath earned his BA from the University of Utah and his Juris Doctor from Ohio Northern University. John has been the Directing Attorney of Lexington Law Firm since 2004. The firm focuses primarily on consumer credit report repair, but also practices family law, criminal law, general consumer litigation and collection defense on behalf of consumer debtors. John is admitted to practice law in Utah, Colorado, Washington D. C., Georgia, Texas and New York.

Note: Articles have only been reviewed by the indicated attorney, not written by them. The information provided on this website does not, and is not intended to, act as legal, financial or credit advice; instead, it is for general informational purposes only. Use of, and access to, this website or any of the links or resources contained within the site do not create an attorney-client or fiduciary relationship between the reader, user, or browser and website owner, authors, reviewers, contributors, contributing firms, or their respective agents or employers.

Source: lexingtonlaw.com