Home > 2013 > Managing Debt

What to Do When Your Insurance & Hospital Do Battle

Advertiser Disclosure Comments 0 Comments

When you’re in recovery from a hospital visit — whether it’s a major surgery, a visit to the emergency room or just a routine procedure — the last thing you want to worry about is paying your medical bills. Although the doctors may have stitched you up, sometimes they don’t quite stick to procedure when it comes to filing your bills with your insurance company.

Here’s how to avoid a misfiled medical bill or one that contains errors.

Pay Attention

As with any other billing statements, be sure to read medical bills line-by-line to see what you’re paying for. Sarah O’Leary, CEO of ExHale Healthcare Advocates in Los Angeles, says that experts in the field have estimated that up to 40% of medical bills contain errors. Staying in the habit of diligently reading your bills ensures that you’ll be aware when an incorrect bill comes through.

It Doesn’t Hurt to Check

Even if you’re not sure that a charge is incorrect, it can never hurt to ask. “One of the biggest problems we have is that we trust our doctor, our hospital, and we give that trust away to our insurance companies,” says O’Leary. “We assume that they’re acting 100% in our best interests.” But that isn’t always the case. Even something as simple as an incorrect medical bill code or computer model can lead to mistakes, and just because you’ve already received treatment doesn’t mean you’re liable. “Everything can be negotiated,” she says. “Even if you’ve already received the health benefit, had tests run or an operation, and you have the bills in front of you — those bills can be negotiated down significantly.”

State Your Case

Once you’ve found that you’ve been incorrectly billed, inform both your healthcare provider and insurance company that you’re not responsible for the charge. If the hospital submitted the paperwork on time, ask that they provide proof to your insurance company. If they didn’t file it appropriately, you’re not at fault and be sure they know you’re not liable for the charges. In either case, open a dialogue with both institutions, because whichever company is in the wrong is responsible for the bill.

Keep a Paper Trail

Throughout all your contact with both the hospital and the insurance company, keep a record of everything. Whenever you talk to any representative of either company, take note of their name and position. If you’re disputing the bill through a written claim, send it by certified mail so that you have it on record. Keep track of dates, payment histories, any communication and anything else you need to have on file. Should your bill prove more difficult to resolve, all of this documentation will only make your case stronger.

Stay Rational

“If you become emotionally invested, which you are when talking about your or your family’s health care, you lose your objectivity,” says O’Leary. Don’t panic, and don’t lose your leverage in negotiations. “It’s unemotional on their end, but it’s emotional for us because it’s about us,” she adds.

Know the Next Step

“If you’ve done your due diligence, but they’re still saying you owe it and they’re stonewalling you, put in writing that you’re going to contact the state insurance board, and you’re going to take significant action if you hear from them again,” recommends O’Leary. Significant action may also mean hiring a lawyer and bringing the case into a courtroom. Whatever the case, if you’re not getting anywhere, know that you have leverage and can bring your claim to a higher level.

Persistence is Key

In medical billing, perseverance pays off. “The worst thing that can happen is you ignore them,” says O’Leary. “Don’t ignore it. Tackle it head on. Start a paper trail in the insurance company and the health care provider and they’ll be less likely to pass it on to a bill collector because it’s an open case.” As with any disputes, being vigilant and diligent in your communications is the key to winning your case.

Image: Comstock

Comments on articles and responses to those comments are not provided or commissioned by a bank advertiser. Responses have not been reviewed, approved or otherwise endorsed by a bank advertiser. It is not a bank advertiser's responsibility to ensure all posts and/or questions are answered.

Please note that our comments are moderated, so it may take a little time before you see them on the page. Thanks for your patience.

Certain credit cards and other financial products mentioned in this and other articles on Credit.com News & Advice may also be offered through Credit.com product pages, and Credit.com will be compensated if our users apply for and ultimately sign up for any of these cards or products. However, this relationship does not result in any preferential editorial treatment.

Hello, Reader!

Thanks for checking out Credit.com. We hope you find the site and the journalism we produce useful. We wanted to take some time to tell you a bit about ourselves.

Our People

The Credit.com editorial team is staffed by a team of editors and reporters, each with many years of financial reporting experience. We’ve worked for places like the New York Times, American Banker, Frontline, TheStreet.com, Business Insider, ABC News, NBC News, CNBC and many others. We also employ a few freelancers and more than 50 contributors (these are typically subject matter experts from the worlds of finance, academia, politics, business and elsewhere).

Our Reporting

We take great pains to ensure that the articles, video and graphics you see on Credit.com are thoroughly reported and fact-checked. Each story is read by two separate editors, and we adhere to the highest editorial standards. We’re not perfect, however, and if you see something that you think is wrong, please email us at editorial team [at] credit [dot] com,

The Credit.com editorial team is committed to providing our readers and viewers with sound, well-reported and understandable information designed to inform and empower. We won’t tell you what to do. We will, however, do our best to explain the consequences of various actions, thereby arming you with the information you need to make decisions that are in your best interests. We also write about things relating to money and finance we think are interesting and want to share.

In addition to appearing on Credit.com, our articles are syndicated to dozens of other news sites. We have more than 100 partners, including MSN, ABC News, CBS News, Yahoo, Marketwatch, Scripps, Money Magazine and many others. This network operates similarly to the Associated Press or Reuters, except we focus almost exclusively on issues relating to personal finance. These are not advertorial or paid placements, rather we provide these articles to our partners in most cases for free. These relationships create more awareness of Credit.com in general and they result in more traffic to us as well.

Our Business Model

Credit.com’s journalism is largely supported by an e-commerce business model. Rather than rely on revenue from display ad impressions, Credit.com maintains a financial marketplace separate from its editorial pages. When someone navigates to those pages, and applies for a credit card, for example, Credit.com will get paid what is essentially a finder’s fee if that person ends up getting the card. That doesn’t mean, however, that our editorial decisions are informed by the products available in our marketplace. The editorial team chooses what to write about and how to write about it independently of the decisions and priorities of the business side of the company. In fact, we maintain a strict and important firewall between the editorial and business departments. Our mission as journalists is to serve the reader, not the advertiser. In that sense, we are no different from any other news organization that is supported by ad revenue.

Visitors to Credit.com are also able to register for a free Credit.com account, which gives them access to a tool called The Credit Report Card. This tool provides users with two free credit scores and a breakdown of the information in their Experian credit report, updated twice monthly. Again, this tool is entirely free, and we mention that frequently in our articles, because we think that it’s a good thing for users to have access to data like this. Separate from its educational value, there is also a business angle to the Credit Report Card. Registered users can be matched with products and services for which they are most likely to qualify. In other words, if you register and you find that your credit is less than stellar, Credit.com won’t recommend a high-end platinum credit card that requires an excellent credit score You’d likely get rejected, and that’s no good for you or Credit.com. You’d be no closer to getting a product you need, there’d be a wasted inquiry on your credit report, and Credit.com wouldn’t get paid. These are essentially what are commonly referred to as "targeted ads" in the world of the Internet. Despite all of this, however, even if you never apply for any product, the Credit Report Card will remain free, and none of this will impact how the editorial team reports on credit and credit scores.

Our Owners

Credit.com is owned by Progrexion Holdings Inc. which is the owner and administrator of a number of business related to credit and credit repair, including CreditRepair.com, and eFolks. In addition, Progrexion also provides services to Lexington Law Firm as a third party provider. Despite being owned by Progrexion, it is not the role of the Credit.com editorial team to advocate the use of the company’s other services. In articles, reporters may mention credit repair as an option, for example, but we’ll also be sure to note the various alternatives to that service. Furthermore, you may see ads for credit repair services on Credit.com, but the editorial team isn’t responsible for the creation or implementation of those ads, anymore than reporters for the New York Times or Washington Post are responsible for the ads on their sites.

Your Stories

Lastly, much of what we do is informed by our own experiences as well as the experiences of our readers. We want to tell your stories if you’re interested in sharing them. Please email us at story ideas [at] credit [dot] com with ideas or visit us on Facebook or Twitter.

Thanks for stopping by.

- The Credit.com Editorial Team