If you had a health condition that required a trip to the emergency room, the last thing you should be thinking about are the medical expenses you will incur.
However, even if you have health insurance, you will likely end up with several substantial bills depending on the type of care you received. Emergency room receipts often contain charges that are either incorrect or excessive. If this is the case, it is important to dispute the bill or negotiate a reduction.
Know What’s In Your Medical Records
If you were a patient in the emergency room, you can only be charged for the treatment you actually received. While this may seem obvious, it often happens that patients are billed for treatment that was not rendered. The first step to take to dispute emergency room bills is to find out what is documented in your medical records.
Receiving different bills from various providers can make it even more confusing to figure out what you are being billed for. Most people think the doctor and hospital bills they receive are the same thing, but they’re not. The treating doctors in emergency rooms are usually subcontractors and will bill separately. The charges on these bills should be carefully compared with what is in your medical records – if you incur a charge for something that isn’t in your records you should dispute it immediately.
Although a hospital bill will be broken down by category, ie. blood work, drugs, supplies, etc., it will not delineate the services that added up to the total amount. In this case, it is necessary to request a detailed itemized bill that will show each and every line item expense. Compare this itemized bill with what is in your records so that you can determine if the bill is accurate.
Be Aware of Out-of-Network Charges
Even if the hospital you visit is in your insurance network, this doesn’t mean all the providers who treat you are. Treatment rendered by out-of-network doctors and specialists can result in unexpected costs for you.
In a medical emergency, you may have no choice other than to be treated at an emergency room where you might receive care from doctors who are out-of-network. However, if your condition is not a true medical emergency, you may consider visiting an urgent care facility first – this will cost you hundreds not thousands of dollars and can demonstrate to the insurance company that you attempted the least costly option and help with negotiating reductions if you end up in an emergency room.
Identify Mistakes in Your Emergency Room Receipt
Emergency room receipts can contain mistakes that result in additional costs to you. For example, the hospital may order tests and cancel them before they are performed. If the ordering physician forgets to take these tests out of your record, they can show up on a bill.
Mistakes in coding levels also commonly appear on emergency room bills. Emergency room bills are coded by levels 1-5, and each level has a different contracted fee. If the level of care you received doesn’t correspond with the code, the bill should be disputed.
Make Sure Your EOBs Correspond With Your Bills
After thoroughly reviewing your bills for accuracy, it is vital to compare them with the Explanation of Benefits (EOB) you receive from your insurance company. When comparing them, take a close look at:
(1) What you were charged
(2) What amount the insurance company allowed
(3) What the insurance company paid or didn’t pay for
Understanding an EOB is not easy. It is necessary to review every line carefully to make sure each amount and service matches that which appear on your bills. If there is a discrepancy, contact the hospital or insurance company for clarification. Additionally, although charges may sometimes get bundled together, it is important to make sure that an in-network provider isn’t “balance billing” you — this occurs when a provider bills for the difference between what they would normally charge and what is allowed by the insurance company.
If you are self-pay, always ask for a reduction. Some hospitals will reduce your bill by as much as 70%. You may also ask whether you qualify for financial assistance.
Contact an Experienced Medical Bill Dispute Advocate
Trying to make sense of complicated and excessive emergency room bills can be overwhelming. If you are trying to dispute emergency room bills, an experienced medical bill dispute advocate can help.
Systemedic is a nationally recognized medical billing advocacy company with decades of experience in helping victims of fraudulent and unethical medical billing practices. If you are experiencing an emergency room bill dispute, contact Systemedic today at (845) 639-0007.