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How To Dispute A Medical Bill

Being saddled with sickness is already very taxing. But disputing a medical bill with your health provider when your health is already down might bring you into a relapse. You don’t need this unnecessary stress while you are recuperating. But will you just let the doctor or the hospital get their way? If you know that something is amiss, you can really dispute your medical bill. And these are the steps you need to take.

Step One: Compare Your Medical Records.

The first thing you should do before disputing your medical bill is to compare it with your own personal records. Examine the total number of days the hospital charged you with, including the total hours you have undergone surgery, the specific doctors that have attended or performed your procedure and the actual procedures that were done. List those things that did not match your records.

You can only effectively dispute the medical bill if you have all the right records and the specific charges that the hospital or doctor have included in the bill. Hang onto your records of the bills from the hospital, the doctor, the laboratories and medical supplies and so forth. Oftentimes, these bills are separate from each other. In addition, you can expect other bills that the hospital or doctor may issue after a month of being hospitalized.

To make things easy, get one big folder and stack up all the bills that you have been given by the doctor, the hospital and all things related to your particular hospitalization. If there are other times that you were hospitalized, collect all the bills in a separate folder. Itemized all the bills. If the hospital did not give you an itemized billing, ask for one.

Step 2: Negotiate With The Hospital

Once you have thoroughly researched and compared your personal records with those of the hospital or the doctor, you can start your negotiations. You can successfully challenge their bills if you will show them proofs that their prices are way off line compared to the charges of other doctors and hospitals.

By performing an online search, you will be able to determine the current prices of hospitals and doctors with respect to the procedures and medical services that they have performed on you. The FAIR Health and Healthcare Blue Book websites are two online portals where you can get these prices.

Be prepared to do some honest to goodness research because some hospitals and doctors are not rational or transparent in the way they are charging their patients. You can also use the Medicaid rates as your guide for medical service fees.

Step Three: File An Appeal

Once you find any proof of incorrect medical bills or overcharging of services, you can file an appeal with your insurance company. All insurance companies have a process where their clients can file such appeals. There are times when patients were able to file two or even three appeals. You may need to call your insurance company. It will entertain your call since it has more to lose because it will be the agency that will cover or pay your medical bills. The insurance company will contact the hospital directly on your behalf.

Once you have filed this appeal, be sure to inform the doctor or the hospital that you have done so. Don’t forget to inform them. This would require them to postpone the due date of your medical bill until the time that your appeal is heard and acted on. In addition, your bill will not be endorsed to the collection department without you being informed about it.

Step Four: Write A Dispute Letter

After calling your insurance company and filing an appeal, you should write your dispute letter. Summarize everything in your research, and include the activities that you had with the insurance company and cite the reasons why you are disputing your medical bills. Include the following in your dispute letter:

  • The details of your account
  • The specific bills that you are challenging. They should be as specific as possible giving the amount charged, what you think is the correct charge and when the charge was billed.
  • Cite the specific reasons why you are disputing the charges. For example tell them that you are challenging a certain item in your medical bill because it is supposed to be part of the standard items which should be included in the room rate.
  • Attach your supporting documents. These documents could include the amounts of service fees that are charged by other hospitals. For example, tell them that the average costs of your medical procedure in other hospitals are lower. And then show them the documents which prove that this is so.

Step Five: Seek The Help Of An Advocate

Since you are issuing a challenge, your medical providers may seek legal help. Therefore, be ready to seek the help of an advocate. Your best option is to hire a patient or medical-billing advocate. This professional is usually paid by commission. In other words, their pay is dependent on the amount of money that you can save if your dispute is successful.

Typically it will be between 20 to 30 percent. In real figures, if you are able to save $20,000, the fee of the advocate will be $5,000. But some advocates are willing to be paid by the hour. You can find them in ads listing ‘health-care claims advocates,’ ‘medical-claims professionals,’ or claims-assistance professionals.’