Not long after a visit to the emergency room or any serious medical procedure, the bills start showing up in the mail. Some look like duplicates, many are hard to decipher, and some actually aren’t bills at all. Here how to decipher and identify all those confusing pieces of paper before someone comes looking for money you didn’t know you owed.
Not Every Document with Dollar Signs That Comes in the Mail Is a Bill
After a visit to the hospital or even a trip to your local physician, the paperwork you’ll get in the mail can be divided into two categories: bills and not-bills. This seems obvious, but they look alike, so it’s easy to be confused.
The not-bills (helpfully labeled “THIS IS NOT A BILL”) come from your insurance company. This document is your Explanation Of Benefits, or EOB, and it’s your record of what the insurance company actually paid for, and how much they paid. These are the ones that probably freak you out until your eyes land on “this is not a bill” somewhere on the page. Key information includes:
- Who your provider was
- A brief description of each medical service performed and the code it’s known by
- How much the provider charged
- How much the insurance company paid
- How much you’ll (eventually) owe
- How close you are to meeting your deductible, if you have one
The exact details depend on your insurance company, and you can check your insurer’s website for more information on how to understand your EOB.
If you see anything on this document that looks like an error, report it to your insurance company. Trust me, they’ll want to know about it. For example, if you were billed for more operating room time than your surgery used, or if you were billed for services that don’t sound like they matched up to what you received, the insurance company won’t want to waste their (and by proxy, your) money.
The Real Bills Come From the People Involved With Your Care
The actual bills, meanwhile, come directly from hospitals, doctors, labs, and other people and organizations that provided part of your care. You may even receive more than one bill from the same provider. For example if your care included more than one procedure in one visit, you’ll probably get multiple bills. Don’t sweat it, just gather the bills, open them, and take stock of the damage. It may not be as bad as you fear. I’ve definitely dug into piles of bills only to find that some of them are for annoyingly small amounts, like two dollars for my share of a minor procedure that went just over the amount insurance would pay.
Those bills represent what you owe after the insurance company negotiated down the price and then paid their share. Check the bills against the EOB to make sure you’re not being charged for things the insurance company already paid for—that’s double billing, and it happens more often than you’d think. Point this out to the provider, and they should take the charge off your bill. They can’t legally charge you for something that has already been paid.
Request More Information If the Bills Don’t Make Sense
Some of the bills might not give you enough information to know if they are accurate and fair. If what you got is a summary bill—just a few numbers without much useful information—call the provider (not your insurance company) and ask for an itemized bill.
If you get one and it’s still not clear, call back and ask what the individual charges mean, and don’t stop calling or asking until you get someone who can explain them to your satisfaction. It’s your money, after all, and you deserve to know where the charges are coming from.
Be aware that if you’re paying bills for someone else in your house other than a child—your spouse, for example—their provider may not be able to discuss that person’s medical care with you unless they have explicitly given permission. So when you’re the patient, make a habit of asking for and signing a release form (it may look like this one) whenever you seek treatment from a new provider. That way either you or your partner can discuss your bills.
Even with all the information the provider can give you, you may still feel like you’re in over your head. If you get the runaround, or if you’re just not sure where to start to understand a massive bill, consider bringing in a billing advocate to help you (more on that in a moment.)
Watch Out for Illegal Billing and Check for Errors
Medical bills can reach astronomical dollar amounts even when everything is on the up-and-up. What’s even worse is to be stuck paying for someone else’s error, or to be snookered by an illegal billing practice.
Some billing mistakes are hard to spot unless you’re really familiar with the billing industry. For example, upcoding occurs when you’re charged for a more serious (and expensive) procedure than what you actually received. Unbundling means that you are charged for something that includes multiple components—like a room fee, or a surgery—and then you’re also charged for some of the components separately (so you pay for the room fee buried in a bigger bill, and then get another bill for the room fee.) You can read more of these common billing errors in-depth here.
Whether those errors are intentional or just honest mistakes, it’s illegal to bill you for them. Medical charges must be both “true and accurate,” and represent a “fair and reasonable” price, according to a spokesperson from the Medical Billing Advocates of America (MBAA).
Unfortunately, there are plenty of billing issues that are unfair but still legal. For example, the infamous “surprise medical bill,” where an out-of-network provider or service was involved in what would otherwise be in-network care, and you had no idea. Depending on your insurer’s terms for out-of-network coverage, you could be on the hook for a lot of money. To avoid this, MBAA suggests checking beforehand that all the providers for your care, procedure, or hospital stay will be in-network, and getting a written statement to this effect. (That might not stop them from sending you the bill, but it gives you or a billing advocate some ammunition when disputing the charge.)
“Balance billing” is another awful, related idea. In this case, a provider who doesn’t like your insurer’s reimbursement rate will take the insurance company’s money, and then send you a bill for the rest of their desired fee, aka the “balance.” In other words, it kills a big part of the benefit of insurance, from your point of view: even when a procedure is covered, you’ll still get bills.
Balance billing is illegal in many states. You can find a complete rundown of state balance billing laws here. Some states protect people in some insurance types but not others (like HMOs and not PPOs, for example,) and some protect you when you’re seeking emergency services but not in other situations.
Negotiate—or Hire Someone to Negotiate for You
If you spot errors or unfair charges, you can call the provider or insurance company, or write a letter disputing the charges. Sticking up for yourself can take a lot of time and energy, but if you think you have a chance of saving a lot of money, it may be worth it.
Even if the charges are correct, it often pays to negotiate anyway. Don’t just take a medical bill as a flat number. Providers are used to lowering their charges in negotiations with insurance companies, so if you’re getting a bill where your insurance company wasn’t involved (perhaps it’s for something not covered under your plan) the provider may be willing to give you a discount.
Still too pricey? Many providers are willing to set up a payment plan. There are also charity programs to help with medical bills if it would truly be a hardship for you to pay them. For these, start by talking to the hospital that provided your care. Nerdwallet has a rundown of your options here. Depending on your situation, you may even qualify for government assistance.
If all this sounds daunting, there’s good news. It’s possible to hire a professional to negotiate bills, or to chase down money you’re clearly owed. Here are some organizations that can help you find an advocate to help with your bills:
Billing advocates sometimes charge a flat or hourly fee, but in other cases they’ll take their pay out of the money they save you. So if they take 25% of the money saved, you’re still way better off than if you had paid full price without them.
Whether you approach medical bills by yourself or with professional help, it’s good to be able to understand these potentially confusing pieces of paper. The numbers on them shouldn’t be mysterious and they definitely aren’t carved in stone. So pay attention, and you just might save yourself some money—and headaches.
Illustration by Jim Cooke.