How to dispute insurance errors:
- Keep detailed written records of every contact you have with the provider or insurance company – dates, times, who you spoke with, what they said, next steps, etc. If you fax something, keep a copy. If you email something, keep a copy. If you mail something, you guessed it, keep a copy.
- If the customer service person makes you a promise, get it in writing. So if the hospital says they will adjust or write-off a charge, ask for written confirmation, preferably by email. If the claims adjuster says that they will investigate your issue, ask for them to write you a note indicating this, along with a projected timeframe for their response.
- If your account has wrongly been sent to collections, demand that the provider immediately correct this and provide you with a written explanation that you can send to the credit reporting agencies.
- Request detailed bills from your provider, and review them carefully. If you don't understand a charge, ask for an explanation. If the explanation doesn't make sense to you, ask to speak to a supervisor. If you believe that a charge is inappropriate (either an error or outright fraud) don't hesitate to challenge it, preferably in writing. If you believe fraud is involved, report it to your state's insurance department and/or federal agencies (in the case of Medicare, for example).
- If something doesn't make sense to you on a bill or explanation of benefits, question it right away. There are usually grievance or appeal procedures, but these must be done within the timeframes stated in your policy documents.
- If you are told not to pay a bill while it is being researched or revised, get it in writing! If you agree to a payment plan or a partial payment as "payment in full", get it in writing!
- If you don't have the time to handle your medical bills and related insurance yourself, there are professionals available to assist you. Medical billing advocates are there to take care of these issues for you. You can choose to have a medical billing advocate review all of your medical bills, or only engage one to assist with sorting out a difficult issue.
Sheri Samotin is President of LifeBridge Solutions, specializing in helping elders and their families with family transition coaching and medical billing advocacy. Read her full biography