How to Read Your Medical Bill and Spot Errors

Common Billing Errors:

• Balance Billing: Charged the difference between provider's charge and insurance payment. Often illegal under the No Surprises Act.
• Duplicate Charges: Same service billed twice (common with lab work)
• Upcoding: Billed for a more expensive procedure than performed
• Unbundling: One procedure split into multiple separate charges
• Incorrect Codes: Wrong CPT or ICD codes
• Charges for Services Not Received: Medications or supplies you never got

Header Information:

• Patient name and date of birth
• Provider name and address
• Date(s) of service
• Insurance information

Service Details:

Each line item should include:

• Date of Service: When the service was provided
• CPT Code: Standardized procedure code
• Description: What service was performed
• Charge Amount: Provider's full price
• Insurance Payment: What your insurer paid
• Patient Responsibility: What you owe

Understanding CPT Codes:

- 99213: Office visit, established patient

- 93000: Electrocardiogram

- 36415: Blood draw

- 80053: Comprehensive metabolic panel

• 5-digit codes that describe medical procedures
• You can look up CPT codes online to verify accuracy
• Common codes:

Step 1: Compare to Your EOB

• Get your Explanation of Benefits from insurance
• Line up each service on the bill with the EOB
• Amounts should match exactly
• If something is on the bill but not the EOB, question it

Step 2: Verify Services Received

- Services on dates you weren't there

- Duplicate entries for the same service

- Services you know you didn't receive

• Check that every service listed is something you actually received
• Look for:

Step 3: Check for Proper Coding

• Google unfamiliar CPT codes to see what they represent
• Make sure the codes match the services you received
• Watch for "upcoding" — being charged for a more expensive version of what you received

Step 4: Look for Bundling Issues

• Some procedures should be "bundled" together under one code
• Watch for separate charges for things that should be included
• Example: If you had surgery, some pre-and post-op care should be included

Step 5: Verify Insurance Processing

• Check that your insurance information is correct
• Verify in-network vs. out-of-network status
• Make sure all applicable discounts were applied

Suspicious Charges:

• Round numbers (like exactly $500) for complex procedures
• Charges that seem disproportionately high
• Multiple charges for similar services on the same day

Coding Issues:

• Services that don't match what you remember receiving
• Very high-level codes for routine visits
• Separate charges for things typically included in other services

Insurance Problems:

• No insurance payment showing when you have coverage
• Wrong deductible or coinsurance amounts
• Missing negotiated discounts for in-network care

Step 1: Contact the Billing Department

Call the number on your bill and explain the specific error:

• Reference line item numbers
• Explain why you believe it's incorrect
• Ask for a corrected bill

Step 2: Get Everything in Writing

• Document who you spoke with and when
• Get reference numbers for your calls
• Follow up in writing if the error isn't resolved

Step 3: Contact Your Insurance

If the error affects insurance processing:

• Call your insurer's customer service
• Ask them to reprocess the claim correctly
• Get a reference number

Step 4: Escalate If Necessary

If providers won't correct clear errors:

• File complaints with your state insurance commissioner
• Contact your state's attorney general
• Consider disputing charges with your credit card company

If You Can't Pay the Full Amount:

• Ask about financial assistance/charity care programs
• Request payment plans (get terms in writing)
• Negotiate for a lower total amount

Self-Pay Discounts:

• Ask for "self-pay" or "cash" rates
• These are often 40-60% less than standard charges
• Must be requested before payment

If You Can't Pay:

• Ask about financial assistance/charity care (non-profit hospitals must have these)
• Negotiate — offer lump sum for 40-60% of total
• Request interest-free payment plan
• Ask for "self-pay" or "cash rate" — often 50-70% less