Appealing an Unexpected Medical Bill

If you received a medical bill that you believe was sent to you in error or the amount is wrong, you can file an appeal with your insurance company.

START WITH THE EXPLANATION

Your insurance company should have provided an explanation of benefits that breaks out the cost of the service, how much they paid, and what’s left for you to pay. Compare the amount they paid with your insurance documents to verify they agree.

IN NETWORK

A common error is for doctors or hospitals to send incorrect billing codes to the insurance company, resulting in a denial of a claim or paying for the procedure at lower out-of-network rates. If your provider is in-network, ask them to rebill the insurance company with the correct information.

NO-CHARGE SERVICES

Under the Affordable Care Act, insurance companies must cover all costs of annual physical exams and other preventative care. But if your doctor orders additional tests, your insurer may deem them an unnecessary part of your physical exam. To avoid surprise bills, ask the providers to check with your insurance so you know what is covered.