Welcome to the Informed Consumer, providing the latest tips and tools to assist consumers in making informed decisions, from the Fairfax County Consumer Affairs Branch.

Today’s topic: Medical Billing.

Medical billing mistakes and overcharges can mean that you’re billed more than you really owe. Without some helpful tips, it may be hard to determine how much you owe, because things like billing codes and unfamiliar terminology codes make it difficult to decipher most medical bills. The following tips should help you spot and address common medical billing problems.

Before You Are Billed

• Read your insurance plan documents and become familiar with your plan. The plan documents will spell out your coverage and responsibilities. For example:

  • How much time do you have to notify your insurance provider if you visit the emergency room

  • Does the plan require that you obtain pre-approval prior to a scheduled hospital admission?

  • What is the cost to you if you visit a medical provider who doesn’t participate in your plan?

  • What is the maximum lifetime medical benefit you may receive? 

• Keep a log to list and date your medical visits, tests, and prescriptions. Later, your notes will refresh your memory and help you double-check the accuracy of the bills you receive.    
• Before a hospitalization, contact the hospital’s billing department and ask what the room-and-board charge covers. Avoid additional fees by bringing some items, like slippers and tissues, from home and declining those provided by the hospital. Obtaining pre-approval to bring your own prescriptions to the hospital will save even more.

Once the Bills Arrive

• Review your statements and bills promptly. Typically, you’ll first receive an explanation of benefits (EOB) form from your insurance company, and then separate bills from each of your medical providers. If your hospital has sent a summary bill, contact its billing department and ask for an itemized bill; you should receive it within 30 days of the request. 
• Review the “explanation of benefits” form to learn the total cost for a visit or procedure, the amount the insurance company will pay, and the amount you may be billed by a provider. Double-check your medical bills with the EOB to make sure you’re paying no more than the amount stated on the EOB. 

Review your medical bills for common problems:

• Verify your name and insurance information. A simple typo that changes the group insurance number can result in higher billings to you. Make sure hospital billings include your correct hospital patient number.
• Confirm you’ve been billed for the correct procedure. Errors can easily arise if the billing department enters the wrong billing code, or makes some other clerical mistake. Make sure you’re not charged for tests or procedures that were never performed.
• Look for duplicate charges on items like medication, lab work, or other fees. There shouldn’t be two entries for a single medical test.
• Look for terms like “kit,” “tray,” and “room fees,” which indicate that the provider is charging one “bundled” fee for multiple items. Bundled billings increase the risk that you may be charged twice for the same item.  For example, assume a hospital room-and-board fee covers the cost of a nurse handing the patient his or her medication. If the hospital also charges an “oral medication fee,” then it is billing the patient twice for the same service. If you have questions about what’s included in a bundled fee or bill, contact your provider or the medical facility.
• Request your anesthesia records if you’ve had a surgical procedure and question the amount of Operating Room, or OR, time that’s been billed. 
• Facilities typically bill for OR time by the minute, which can make errors in billing the OR time very expensive. Because your anesthesia records state the time your surgery began and ended, they can be used to determine the correct OR time. Confirm you’ve not been separately billed for items often included in OR fees, such as gloves and linens.  
• If you’ve been hospitalized, check your bill to make sure you’ve been billed for the right type of room and for the right number of days. For example, you shouldn’t be charged a private-room rate if you stayed in a semi-private room, and you shouldn’t be charged for the last day if your insurance plan prohibits it.

If You Find a Problem

• Call the provider, explain the billing problem, and ask that it be corrected. During the call, write down the date, the name and title of each person you speak with, and what was discussed or decided. When you receive a corrected bill, check it to confirm that the problem has been resolved as agreed upon.
• Contact your insurance company if your medical provider does not agree to correct the billing. Explain that you’ve attempted to resolve the issue with the medical provider, but have been unable to do so. Again, during the call, write down the date, the name and title of each person you speak with, and what was discussed or decided.  
• If the problem is not resolved prior to the bill due date, pay that portion of the bill that is not in dispute. 
• During a billing dispute, some providers may report the unpaid portion of a bill as a delinquent account. Check your credit reports; if the disputed portion has been reported as delinquent, write a concise, explanatory “statement of dispute” and request that the consumer reporting companies add it to your credit report. More information about credit reports and credit reporting agencies is available from the U.S. Federal Trade Commission at www.ftc.gov .   

Thanks for listening to the Informed Consumer. For more information on this topic or if you feel that you’ve been a victim of a scam, please contact the Consumer Affairs Branch at 703-222-8435 or visit our web site at https://www.fairfaxcounty.gov/cableconsumer/csd/consumer. Informed Consumer is produced by the Fairfax County, Virginia, government.