Medical Billing Errors Cost You Money
Undetected medical billing errors and inaccuracies can cost you and your health plan a lot of money. When medical billing errors and inaccuracies go undetected, your health care provider receives payments that it has not earned. In addition:
- You and your health plan unnecessarily pay money to your health care provider
- Your cost for coverage under the health plan may increase
- Your co-pay, deductibles and other cost shares may increase
- Your health plan benefits may be reduced
If a health care provider asks you to pay charges declined for payment under your health plan, you should consider investigating whether your health care provider inappropriately included these charges on your bill due to medical billing errors and inaccuracies before paying the charges.
Always Review Each Medical Bill to Identify Potential Overcharges
If you find questionable charges on the bill, you should:
- Write to your health care provider and request that the charges be removed from your medical bill
- Send a copy of your bill to your health plan administrator
By not paying inappropriately billed medical charges, you and your health plan administrator can work together to make your health care dollars go further.
Moody Review, Inc. Medical Bill Verification Tools help your health plan administrator evaluate your medical bills for errors and inaccuracies [1]
To help you and the health plan avoid paying for medical charges that were erroneously or inappropriately billed, your health plan administrator has contracted with MRI to conduct Medical Bill Verification.
MRI Medical Bill Verification Tools use procedures and processes that rely upon nationally recognized and defensible resources to help your health plan administrator evaluate the medical bill for potential billing errors or inaccuracies.
The MRI Medical Bill Verification Tools do not audit for medical necessity or medical appropriateness or involve a review of the medical record itself.
MRI identifies charges that may have been inappropriately included on your bill due to medical billing errors and inaccuracies.
Some examples of the type of billing errors that the MRI Medical Bill Verification Tools are designed to help uncover include:
- Billing for the same thing twice
- Improperly billed medications
- Operating room charges on your medical bill when you were admitted for the flu
- Unexplained or undocumented charges
- Charges on your medical bill after you were discharged from the hospital
- Labor and delivery charges for a male patient
- Excessive charges such as slippers charged at $500 per pair or an aspirin charged at $50 per tablet
What happens to my medical bill when it is sent to Moody Review, Inc.?
When you receive medical treatment your health plan administrator may send your medical bill to MRI for Medical Bill Verification. MRI nurses and other bill review experts apply the MRI Medical Bill Verification Tools to evaluate the medical bill for possible overcharges that may appear in the bill due to errors or inaccuracies on your medical bill.
Upon completion of the MRI Medical Bill Verification on your medical bill, MRI sends a verification report to your health plan administrator. The report identifies potential billing errors or inaccuracies.
Your health plan administrator reviews the MRI verification report in light of the terms of your health plan and other information and facts that the health plan administrator determines relevant to decide the amount of the charges on the medical bill that are appropriately payable to the provider.
Your health plan administrator sends you a statement, or "Explanation of Benefits," (EOB) that shows the charges that the health plan paid to the provider, the charges that the health plan did not pay and the reason that the health plan denied payment of those charges. You should review the information contained in the EOB carefully when it arrives.
If you receive a letter from MRI stating that the charges on your medical bill have been verified by the MRI Medical Bill Verification Tools or your EOB shows that your medical bill has been verified by MRI and you have any questions, please do not hesitate to call our toll free number 1.800.293.1397, extension 119.
Consumer TIPS: Who to call when
If the hospital won't correct the mistake no matter how much you complain, YOU can file a complaint to your state consumer protection agency or to the health-care fraud division or to your state attorney general's office. Contact the National Association of Attorneys General for information on your local agency at 202-326-6000 or www.naag.org.
Many hospitals turn over delinquent accounts to collection in less than 90 days. If you do not resolve the problem, an unpaid bill notation can be sent to a credit-reporting agency. To see if charges have been added to your report, contact the three major reporting agencies: Equifax (www.equifax.com, 800-685-1111); Experian (www.experian, 888-397-3742); and Trans-Union (www.transunion.com, 800-888-4213).
"My husband and I have saved at least $10,000 since 1992 by catching medical errors," Ms. Martin said. "It's everything from being double-billed or billed for services my health insurance has already paid or even for services I never received." [2]
Ms. Martin is among a growing number of people finding errors in their medical bills. Some people seek help through organizations such as the People Organization, a Detroit-based, nonprofit volunteer group that helps resolve patients' billing disputes, and Medical Billing Advocates of America (540-387-5870 or www.billadvocates.com), a group founded by Pat Palmer, one of the authors of "The Medical Bill Survival Guide: What You Need to Know Before You Pay a Dime," (Warner Books, $6.99).
[1] MRI does not provide services directly to patients.
[2] Sheryl Kennedy and Tara Ransom, Detroit Free Press, July 9, 2001
