Reading a medical bill and challenging errors

Medical billing is complicated enough that errors are routine.

They are rarely deliberate, and they rarely favour the patient.

Always request an itemised statement

• A total figure cannot be verified.
• Ask for every charge listed with date and quantity.
• Ask for the rate applied to each line.
• Request it in writing if refused verbally.
• You are entitled to understand what you are being charged for.

Check the basics first

• Your name spelled correctly.
• The correct patient identifier.
• The correct dates of admission and discharge.
• The correct insurer details if applicable.
• Simple mismatches cause large downstream problems.

Common errors to look for

• The same item charged twice.
• Services on dates you were not there.
• Quantities higher than plausible.
• Charges for tests that were cancelled.
• Room charges for the day of discharge.
• Items included in a package also billed separately.
• A higher rate applied than the one quoted.

Compare against the estimate

• Put the estimate and the bill side by side.
• Identify every line that was not anticipated.
• Ask for an explanation of each.
• Some will be legitimate; ask anyway.
• An unexplained difference is a question, not an accusation.

Compare against your own notes

• Your daily record of what happened is valuable here.
• Check tests listed against tests you remember.
• Check consultations listed against visits you received.
• Check medicines listed against what you were given.
• This is why keeping notes during admission matters.

Understand the codes

• Charges are usually tied to procedure codes.
• Ask what each code represents in plain language.
• A coding error can change the price substantially.
• Ask for a review if a code does not match what happened.
• Coding queries are routine for billing departments.

If you are insured

• Compare the hospital bill with the insurer's statement.
• Check what the insurer paid and what it declined.
• Check your deductible and co-insurance were applied correctly.
• Check no benefit limit was misapplied.
• Errors can occur on either side.

Raising a query

• Write rather than phone, or confirm calls in writing.
• Quote account and invoice numbers.
• Identify specific line items, not the total.
• State what you believe is wrong and why.
• Ask for a written response by a stated date.
• Keep it factual and unemotional.

Pay what is not disputed

• Withholding everything weakens your position.
• Pay the undisputed portion promptly.
• State clearly which items remain in dispute.
• Ask for confirmation that the account is not in default.
• Keep proof of every payment.

If the response is unsatisfactory

• Ask for escalation to a supervisor.
• Ask for the institution's formal complaints process.
• Ask whether an external body oversees billing disputes.
• Keep a dated log of all contacts.
• Persistence resolves most of these cases.

If the total is unaffordable

• Contact them before the due date, not after.
• Ask whether a reduction is possible.
• Ask about instalment arrangements.
• Ask whether financial assistance exists.
• Ignoring a bill converts a negotiable debt into a serious one.

Negotiating a reduction

• Ask whether a self-pay rate could be applied retrospectively.
• Ask whether prompt settlement attracts a discount.
• Offer a realistic figure rather than a token one.
• Get any agreement in writing before paying.
• Confirm the balance is cleared afterwards.

If you never received an estimate

• Ask for one retrospectively for comparison.
• Ask what the standard rate for that procedure is.
• Ask whether a self-pay rate could be applied.
• Lack of an estimate is a reasonable basis for discussion.

Check the dates against your stay

• Room charges for the discharge day are often disputable.
• Check charges dated before admission.
• Check charges dated after discharge.
• Ask for an explanation of any date outside your stay.

Bills arriving late

• Invoices can arrive months afterwards.
• Ask at discharge whether more are expected.
• Keep the file open until you are certain.
• Check late invoices against the original estimate too.
• Ask whether any time limit applies to billing you.

Ask for the medical record if a charge is unclear

• The record shows what was actually done.
• Compare it against the disputed line item.
• Request it through the normal records process.
• This resolves most genuine coding disputes.

Bills from abroad

• Check the currency and exchange rate applied.
• Check who bears transfer charges.
• Ask for a translated itemised statement if needed.
• Ask which country's law governs the account.
• Resolve disputes before leaving the country where practical.

When the insurer and hospital disagree

• Patients often end up caught between the two.
• Ask each to put their position in writing.
• Send each the other's statement.
• Ask them to communicate directly.
• Do not pay a disputed amount to end the argument.

Keep everything

• Estimate, bills, payment proofs and correspondence.
• Your own notes from the admission.
• Insurer statements.
• Retain for several years.
• Files are what resolve disputes; memory is not.

Ask whether the charge was pre-authorised

• Items outside an approval are often billed to the patient.
• Ask who decided to add them.
• Ask whether you were informed at the time.
• Ask whether retrospective approval is possible.

Before you leave the hospital

• Ask for the itemised bill if it is ready.
• Ask whether further invoices will follow.
• Ask who to contact about billing questions.
• Confirm your correct address for correspondence.
• This prevents most later confusion.

The point to remember

Three things:

1. Always request an itemised statement — a total cannot be checked.
2. Pay the undisputed portion and dispute specific lines in writing.
3. Contact them before the due date if you cannot pay.

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