Am I Being Billed Correctly?

“This bill can’t be right.”

“I wasn’t expecting it to cost this much.”

"Why am I getting billed for that?"

"Why isn't my insurance paying for this?"

If you’ve ever opened a medical bill and felt confused, frustrated, or blindsided you are not alone. Healthcare is complicated, but if your medical bill seems "off" or you suspect there may be an error, you are probably right.

Billing errors happen constantly. Medical billing is layered, automated, and often processed in stages. Things get miscoded. Claims process incorrectly. Adjustments happen after the fact. You can literally get a college degree in medical coding.

Don’t panic over the first bill.

Very often, the first statement you receive isn’t the final version. I'm not talking about the letters that say "this is not a bill." I am talking about the actual bill that comes 30 or more days after your medical procedure.

Sometimes the insurance company is still processing the claim. Sometimes the provider still needs to fix their mistakes, sometimes claims get denied before they are approved.

A lot of strange-looking charges correct themselves after everything finishes processing and a second statement is issued. That doesn’t mean you should ignore the bill forever, but it does mean that you shouldn't rust to write a check the same day you open it.

**9 out of 10 billing issues my customers bring to me get fixed just by waiting for the second bill.**

Never pay a bill that you believe is wrong.

I know the instinct is to just get it over with. But once the provider has your money, it becomes much harder to get it refunded. Once the provider is no longer trying to collect your balance, their urgency to fix the issue tends to drop. It is always easier to correct a mistake before payment is made.

Reference your Summary of Benefits

If something feels off, the next step is to compare your bill to your plan's Summary of Benefits. That document outlines what your plan is supposed to charge for things like outpatient surgery, imaging, or specialist visits. If the bill doesn’t line up with how your plan says it should process, that’s a red flag.

You should also look at your Explanation of Benefits (EOB) from the insurance company. The EOB will show what was billed, what was allowed, what insurance paid, and what you actually owe. If the provider is billing you more than what the EOB says is your responsibility, something needs to be corrected.

Out of network charges: 

Maybe you chose an in-network hospital, but the anesthesiologist or radiologist was billed as out-of-network. If that happens, challenge it. Tell them you did not knowingly choose an out-of-network provider and you expect the claim to be processed appropriately. These situations can often be adjusted — but only if you speak up

Let me take a look: 

If you’re unsure about your bill, ask me for my opinion. 

Simply text or email me a picture of the bill. I can usually tell pretty quickly whether the amount you are being charged makes sense or if something needs to be escalated.

If there truly is a billing error, I can often get it resolved by reaching out to my carrier representative directly.

Sometimes it just takes the right person asking the right question to get an issue resolved. If a bill doesn’t make sense, don’t assume you’re stuck with it. Slow down, review it carefully, and if you need a second set of eyes, I’m here to help!

Bonus:

If you ever need to call your providers billing staff don't be fooled or intimidated. Just because they say "that's the way things are" doesn't mean it's true and proper. Just because they are using complicated lingo doesn't mean that they know any more than you. Just because they seem nice and helpful and friendly doesn't mean that they have your best interests in mind.

Remember, if you think something is wrong you are probably right.