Decoding the Medical Bill Mystery: How to Fight It

A man and woman with a mystery medical bill ponder how to fight it.
Getting a medical bill in the mail can be surprising. It’s important to review it in detail.

Previously, we explained how mystery bills happen and why billing mistakes occur, but what happens when you actually get this surprise mystery bill? It’s important to know how to read a medical bill but also how to fight it. Here’s how…

Review the details of medical bills

A lady at a desk with medical bills reviews her transaction register.
Reviewing medical bills in detail is the best way to advocate for yourself. It is important to understand each detail of these bills.

The first step is to determine exactly what this bill is for and why it wasn’t covered under your insurance policy. And if you’re one of the lucky ones who received this bill without it being sent to a medical collections company, you can start directly with the source. 

Chances are the bill you have in your hand is vague at best, so call the medical provider about the bill directly. Ask to speak with someone who handles billing and request an itemized bill to be sent to you that lists out all of your expenses – line by line. It is important to have this detailed view of your bill, otherwise there is no way to fight it. This is required by law and is your right as a consumer.

Once you receive this itemized bill, block out some time to thoroughly review it.

Here is a good checklist to keep in mind

  1. Double check to make sure you received all of the services listed. 
  2. Don’t know what these codes listed on your bill are? A helpful resource to use is Findacode.com to give you some idea or direction as to what you are being charged. 
  3. Make sure there aren’t any service duplicates (this can happen when anesthesiologists are involved and bill separately rather than in the procedure). 
  4. Start price checking your services – just like you would when searching for a new electronic or car. 
  5. Confirm all information submitted was correct – patient info, insurer, policy group number, ect. Any misinformation can result in a rejection. 
  6. Some other helpful resources to confirm or compare items on your bill are: Healthcarebluebook.com and Fairhealthconsumer.org.

After you have essentially written a dissertation on your bill, you’re likely left with a headache and a handful of questions for your insurance company and medical provider. 

When medical bills like this pop up, it can be harder to know how to fight it on the back end. Being prepared for an appointment in advance can really help save time and agony later.

Be diligent before you go to an appointment

Here are some Pre-Appointment Tips: 

  1. Check to confirm all medical providers are in-network. 
  2. Check to see if you need prior authorization before visit. Check with insurance company to see if the services you need are covered. Find out codes here if you can.  
  3. Check for your copayments and if you have a/met your deductible.
  4. Ask for information on how the hospital calculates its bills. 
  5. Ask for an all-inclusive estimate from the hospital or medial provider. 

When you get an error-filled mystery medical bill, it’s important to know how to fight it. Promptly review the details, check it for errors, review our checklist, and prepare for any appointments needed.

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