How to Get an Incorrect Medical Bill Corrected

I'm not sure if many of you have run into this situation before or not, but let me tell you this from personal experience: doctors' offices and insurance companies do not get along (nor do they communicate well) when it comes to settling medical payment issues. Here's an example we (mostly my wife) had to deal with last year:

I went in for a tetanus shot as I hadn't had one in almost nine years and I was working in the garden a lot (I read somewhere that the organic materials in some rose gardens can lead to tetanus if just the right circumstances occur, so why should I take any chances). I got the shot and was in and out in a few minutes. But when they billed the insurance company, they put it under the wrong "code." As such, the insurance company deemed it a non-essential medical trip that I needed to pay for myself.

This led to run-around that rivaled that of trying to get a driver's license in most states:

• The insurance company declined payment
• The doctor sent us the bill to pay it
• We called the doctor's office to see what was up, they told us the insurance company declined it
• We called the insurance company -- they said it was coded incorrectly (but they wouldn't tell us the right code -- of course!!!)
• We called the doctor back and they said they'd re-code it
• The doctor's office sent in the bill again WITH THE SAME CODE
• The entire process repeated TWO times
• Finally, they sent it in with the right code and the insurance company declined it for some other bogus reason I can't remember

During this whole time, we got increasingly threatening bills from the doctor's office telling us that they were going to charge us interest, turn us into a credit collection agency, etc. -- despite the fact that we were talking to them all through this process (they were automatic bills/statements). It became so frustrating and time-consuming that we eventually just gave up and paid for it (something like $30). Ugggggggh!!!!!

Anyway, this background made me read a story in the August issue of Money magazine titled "How I Did It" with the sub-text: A routine visit to the doctor led to a $1,600 bill from my health clinic. But I fought back and won." The story was about a young lady who had a similar problem to mine (except a lot more money) where her tests had been falsely coded and the insurance company wouldn't pay for them. Basically, the same thing happened to her that happened to me: the doctor's office promised to recode the tests but didn't, then did (or did they?), and it was just a complete run-around from both the doctor's office and the insurance company.

Then she hit pay-dirt and found a solution:

I realized I needed help. I found out about an insurance help line run by the office of one of my senators, and they paired me with a caseworker. That did it. Whenever I had called the clinic, I felt as if I had no voice, but my caseworker was calling from a senator's office, which got their attention. Someone finally recoded the bloodwork, and my insurer covered most of the bill.

I never knew that some senators had this service, but if you're ever in this situation, it's probably worth it to check and see how yours might help. Especially if the bill is pretty substantial. I could save you some big $$$$$$$$$.

Comments

[Katie]

I had an erroneous charge (of $1400) from the hospital after I gave birth - they knew it was a mistake, but nobody would fix it. I called numerous times, wrote numerous letters..and nothing happened. Finally, my mother (who works for a hospital) told me to write to their PR Department (each hospital has one) and explain the whole situation and that I was going to write a big letter to the L.A. Times (my local paper) if they didn't fix this problem right away. Needless to say, within a short time, it was cleared up.

[Andrew]

I've found out from my own personal credit report that I reportedly have nearly $3000 in unpaid medical bills that occurred after an accident which was not my fault. I had insurance which did not pay for my ambulance ride, and I wound up paying for it out of pocket. However, I was never informed of any other unpaid bills from mail, or phone calls, they just showed up on my credit report one day without any warning. One credit bureau has deleted the claims after I requested an investigation, but it is a HUGE PAIN to clear all of this up.

[Sally Parrott Ashbrook]

Yeah, medical stuff can be a total racket. I've fought some stuff till I was blue in the face. What insurers deem "medically unnecessary" is often absurd. I can't tell you the exact solution, but our whole system needs revamping.

[SB]

This website will let you search for the CPT codes that doctors offices and insurance companies use. This is an important resource to have at your fingertips. If you know what procedure you are going to undergo you can find the CPT code for it, then call your insurance company to find out what they consider to be the reasonable and acceptable charge for this procedure. Then go back to the doctor and make sure his charge is in the same range. You could use this as a negotiating tool as well.

The website is: https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?locality=AZ