What to Do When Your Insurance & Hospital Do Battle

When you’re in recovery from a hospital visit — whether it’s a major surgery, a visit to the emergency room or just a routine procedure — the last thing you want to worry about is paying your medical bills. Although the doctors may have stitched you up, sometimes they don’t quite stick to procedure when it comes to filing your bills with your insurance company.

Here’s how to avoid a misfiled medical bill or one that contains errors.

Pay Attention

As with any other billing statements, be sure to read medical bills line-by-line to see what you’re paying for. Sarah O’Leary, CEO of ExHale Healthcare Advocates in Los Angeles, says that experts in the field have estimated that up to 40% of medical bills contain errors. Staying in the habit of diligently reading your bills ensures that you’ll be aware when an incorrect bill comes through.

It Doesn’t Hurt to Check

Even if you’re not sure that a charge is incorrect, it can never hurt to ask. “One of the biggest problems we have is that we trust our doctor, our hospital, and we give that trust away to our insurance companies,” says O’Leary. “We assume that they’re acting 100% in our best interests.” But that isn’t always the case. Even something as simple as an incorrect medical bill code or computer model can lead to mistakes, and just because you’ve already received treatment doesn’t mean you’re liable. “Everything can be negotiated,” she says. “Even if you’ve already received the health benefit, had tests run or an operation, and you have the bills in front of you — those bills can be negotiated down significantly.”

State Your Case

Once you’ve found that you’ve been incorrectly billed, inform both your healthcare provider and insurance company that you’re not responsible for the charge. If the hospital submitted the paperwork on time, ask that they provide proof to your insurance company. If they didn’t file it appropriately, you’re not at fault and be sure they know you’re not liable for the charges. In either case, open a dialogue with both institutions, because whichever company is in the wrong is responsible for the bill.

Keep a Paper Trail

Throughout all your contact with both the hospital and the insurance company, keep a record of everything. Whenever you talk to any representative of either company, take note of their name and position. If you’re disputing the bill through a written claim, send it by certified mail so that you have it on record. Keep track of dates, payment histories, any communication and anything else you need to have on file. Should your bill prove more difficult to resolve, all of this documentation will only make your case stronger.

Stay Rational

“If you become emotionally invested, which you are when talking about your or your family’s health care, you lose your objectivity,” says O’Leary. Don’t panic, and don’t lose your leverage in negotiations. “It’s unemotional on their end, but it’s emotional for us because it’s about us,” she adds.

Know the Next Step

“If you’ve done your due diligence, but they’re still saying you owe it and they’re stonewalling you, put in writing that you’re going to contact the state insurance board, and you’re going to take significant action if you hear from them again,” recommends O’Leary. Significant action may also mean hiring a lawyer and bringing the case into a courtroom. Whatever the case, if you’re not getting anywhere, know that you have leverage and can bring your claim to a higher level.

Persistence is Key

In medical billing, perseverance pays off. “The worst thing that can happen is you ignore them,” says O’Leary. “Don’t ignore it. Tackle it head on. Start a paper trail in the insurance company and the health care provider and they’ll be less likely to pass it on to a bill collector because it’s an open case.” As with any disputes, being vigilant and diligent in your communications is the key to winning your case.

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