Medical Bills Can Be Bogus (Incorrect)

Let me share a conversation I had with ChatGPT today.

Me: "What percentage of medical bills in the United States are inaccurate?"

ChatGPT: "In the United States, studies estimate that up to 80% of medical bills contain errors. The types of errors can range from duplicate charges to coding mistakes, unlisted procedures, or services that were never provided. This high percentage can lead to inflated costs for patients and difficulties in managing medical expenses.

Many errors result from the complexity of medical billing systems, insurance coding, and the involvement of multiple stakeholders like hospitals, physicians, and insurers. Reviewing bills carefully and verifying them with healthcare providers or insurance companies is often recommended to avoid overpaying." (Emphases added)

With such a declaration, there is sure to be controversy in how this was assessed; and you could also argue that some of the alleged errors are not financially impactful (maybe).

So, I'm not declaring this to be the most accurate statistic or pretending that I did the original research to determine this.  You can & should follow this up with your own research, and you may want to start with this article from AKASA or this video on YouTube.

And now that I mentioned what I'm not doing, here's what I am doing--sharing a story.

Here's the Story:

Several months ago, one of our children was at the pediatrician for an annual visit, and the doc advised us to consult an orthopedic specialist regarding the possibility for scoliosis. We agreed and scheduled the appointment. 

At the specialist appointment, a series of diagnostic X-rays were performed; and as expected, we received a slew of medical bills for these services.

Thankfully, the outcome is that our child does not have scoliosis, which is a relief; but what was not a relief was the medical bills! Here's why.

One of the medical bills came back for ~$1,100 and was completely denied by the insurance company. So, the service price was ~$1,100, and we were being billed the full amount.

Lucky for me, I married an amazing woman that isn't afraid to dig her heels in a bit when it comes to handing over large sums of money. It also helps that she previously worked as a medical bill processing specialist and understand the system far, far better than I do!

Image generated by ChatGPT on 16 Sep 2024

She learned that the reason for insurance denying to pay was because the services were coded (incorrectly) as "routine services" rather than "diagnostic services." 

That's right, one coding error meant we were being asked to pay ~$1,100 out of pocket. 

No bueno!

The exact way she navigated the situation isn't the point of this article, but rather to share this message: you should not assume that your medical bills are 100% accurate or "set in stone." 

In fact, you should assume medical bills are wrong (inaccurate) when you first get it, and remember that they are negotiable.

After calling around to the doctor's office, the hospital, and the insurance company, she got ahold of someone who knew how to do their job. This person validated our concerns with the bill and agreed that some type of mistake was made. She agreed to call us back in a few days so they could do an internal review.

They called today and told us not to worry about that ~$1,100. It was all covered!

Happy ending? Yes!

Impressed with our medical billing system? No!