When you needed medical care due to an illness or injury, you visited the doctor, received the necessary treatment, paid the fee at that time, and didn't think about it again until you received your medical bill. Reading a medical bill, with its numerous codes and detailed information that may or may not be accurate, is no easy task. However, it is crucial to understand and interpret any medical bill you receive because errors frequently occur. Medical bills serve as a means for companies to organize charges, but mistakes can happen. Therefore, knowing how to read and comprehend your medical bill is paramount.

Types of Medical Bills

The first step is understanding the purpose of the bill. There are several types of medical bills you may encounter:

• Inpatient medical bills: These bills encompass the charges for your hospital admission. Typically, inpatient medical care includes charges from the hospital and the specialists who provide care.
• Surgery bills: Whether you undergo inpatient or outpatient surgery, you will receive a separate bill for the surgical procedure. Your surgeon and any specialists involved may also send you individual bills.
• Doctor's bill: Visiting your doctor's office for care usually results in a bill for the services provided.
• Emergency department bills: A visit to the emergency room often leads to a specialized bill, which often carries a higher fee.
• Imaging bills: If you receive diagnostic tests or lab work outside of a hospital setting, you may receive a separate bill for those services. Imaging procedures like CT scans, x-rays, and MRIs may involve additional fees.

These examples represent only a fraction of the medical bills you may receive for your treatment. Remember to ask your healthcare provider, at the time of receiving care, who you can expect to bill you.

Elements of a Medical Bill

Examine the following components typically found in a medical bill:

• Statement date: This is the date when the bill was issued.
• Member information: Your full name and health insurance ID number.
• Patient account number: This identification helps the medical provider identify you as their patient.
• Provider information: This section should contain the provider's name, address, contact information, and any affiliations with hospitals or other providers.
• Date of service: The date you received the care is indicated.
• Claim number: This number identifies the actual claim filed for the cost.
• Service code: Each service provided is represented by a code, indicating the type of care, procedure, services, or supplies involved.
• Total amount of care: This is the cost of the care you received.
• Covered by plan: The total amount covered by your insurance company is specified.
• Not covered: Any charges that your health insurance plan does not cover will be listed here.
• Reason code description: This code corresponds to the explanation of why the insurance company is not paying for those costs.
• Deductibles and copayments: Any deductibles or copayments you have paid or still owe are mentioned in this section.
• Total net payment: This indicates the amount paid by the health insurance company.
• Total patient responsibility: Typically, this is the amount you owe for your medical care.

Insurance Coverage and Claims

Your health insurance policy outlines its coverage, including the allowed charge, the amount the insurance company will pay, and any deductibles, coinsurance, or other costs you are responsible for. Whenever you have questions about the debt you owe, contact your health insurance company as a starting point.

Billing Errors and Disputes

Billing errors are not uncommon. If you come across unfamiliar items, contact your insurance company first to verify the information they have. Subsequently, reach out to your medical provider to dispute the claim. They must prove you owe the debt or remove the error from your medical bill.

Please note that your health insurance company may be unable to resolve any debts you owe to healthcare providers. However, the providers should be able to verify the care you received and that you were aware of the charges for those services before receiving them.

Payment Options and Assistance

If you are uncertain about your ability to pay what you owe, contact the medical provider and express your concerns. They are likely to work with you to set up a payment plan. They may also offer assistance programs or provide insights to help you overcome financial difficulties.

Working with a Medical Billing Advocate or Financial Counselor

Always advocate for yourself. If you are facing financial hardships, seek help from a professional such as a medical billing advocate or financial counselor with experience dealing with medical debt. Request assistance to restructure and negotiate your debt, making it more affordable.