How to Check Your

Medical Bill for Errors

At least 50% of the medical claims DirectPath reviews for
employees contain a mistake, so chances are you have been
incorrectly charged at one point or another. To avoid paying
more than you should after receiving care, make sure to take
these steps to confirm you have been billed properly.

1
The date(s) and description of
Review Your Explanation •

service are accurate

of Benefits (EOB) • You recognize the provider name(s)
Once your insurance company • It is itemized. If the EOB is not
has processed your medical bill, itemized, contact the billing office
and request an itemized bill
you will receive an EOB. The
• You received the services listed
EOB is not the medical bill. It
• The current procedural terminology
summarizes how much of the bill (CPT) code matches your billing
the insurance company has paid statement
and the reason(s) why. Most • The “notes” section explains why
providers submit EOBs your insurance didn’t cover a charge
— you have the right to appeal the
electronically within three to four denial if you disagree
days after patients have been • It includes whether you’ve met your
serviced, though they can take deductible for the year, and if not,
up to 30 days to process. how much is remaining
• Your provider submitted the claim to
your insurance company/all the plans
through which you have coverage

WAIT UNTIL YOU RECEIVE A BILL FROM YOUR

PRO TIP:
PROVIDER BEFORE YOU PAY ANY THING.

2 Assess Your Medical Bill

Medical bills usually arrive XX days
after your EOB. When your medical
PRO TIP:
bill arrives, consider the following:

• Were you billed for the right kind of room (private, PROVIDERS MAY SEND
semi-private)?
OUT SERVICE BILLS —
• Were you billed for the correct number of days?
SOME TIMES MORE
• Were you billed only for tests you received?
THAN ONCE A MONTH
• Do charges for tests appear to be reasonable?
— AND PATIENTS
• Were medications that your doctor prescribed billed
WORRY THE Y’RE L ATE
over the entire stay, even though you only took them
once or twice? ON PAYMENTS. D O NOT
• Were you billed for consultations with specialists to PAY THE BILL BEFORE
whom you were referred but did not meet with? RE VIE WING THE EOB.

SURPRISE BILLS BAL ANCE BILLING

If you received out-of-network care without When out-of-network providers bill you for the
realizing it, call the hospital’s billing office and difference between their charge and what the
dispute the bill. You can get the bill reduced or insurance company pays them.
even waived.

CALL THE BILLING OFFICE TO ASK IF THE PROVIDER WILL

DISCOUNT FOR PROMP T PAYMENT IN FULL, OR E VEN WRITE
PRO TIP:
OFF THE BAL ANCE. IF THE PROVIDER REFUSES, ASK FOR A
PAYMENT PL AN OR FINANCIAL HARDSHIP APPLICATION.

3 File a Claim

You should file a claim if: How to file a claim:

• There is an error on your EOB or medical bill.
Ask for corrections.
• Your medical bill doesn’t indicate an expected
payment from your insurance company.
The provider may have misplaced your
information, or their bill arrived before your
insurance company processed the payment.
• You want to file a grievance if you’re
dissatisfied with the level of care you received
from a physician or facility.
• You need to negotiate a balance bill.
• Your original claim was not submitted to all
the health plans through which you have
coverage.
• Complete a claim form. Download the form
from your insurance company’s website. This
document gives your insurance company more
information about the care you received and
will help them determine if it should be
covered under your health plan.
• Call your insurance company’s billing office.
Tell them you will be sending a claim form.
Ask if there are any other documents they
need from you and how long they expect it
will take for the claim to be paid.
• Send the claim form to your insurance
company. In most cases, you will be expected
to mail in your claim, though sometimes you
can submit it by email or fax.
• Keep an eye on the calendar. Call your
insurance company if you do not receive your
claim within the timeframe they gave you.

CL AIM FORMS WILL ASK FOR THINGS LIKE:

• Your insurance policy number, group plan • Whether there is co-insurance or
number or member number dual coverage
• Who received the services (i.e., primary • What the visit was for
insured or dependent)

Fill out the appeal form(s) your

4
•

Appeal denied claims insurance company provides with

the letter rejecting your claim
You have 180 days to appeal a
• Gather other evidence/documentation
denied claim. To file an internal to help your case
appeal, you should: • Submit the appeal to your
insurance company
• You should receive a written decision
from your insurance company in
30-60 days. If the claim involves
an urgent health issue, ask the
insurance company to expedite
the process.

P OSSIBLE RE ASONS YOUR CL AIM WAS DENIED :

• You have uncovered charges (e.g., care was • The bill went to the wrong insurance company
deemed “medically unnecessary”) • Your claim contained transcription errors
• You used an out-of-network provider or typos
• A referral was required

YOUR APPE AL MUST INCLUDE: D O CUMENTATION YOU’LL NEED :

• Your name • Medical records
• Your identification number • Doctor’s notes
• The dates of service the claim is based on • Referrals
• Your provider’s claim number • Letter of medical necessity from physician
• Prescriptions
• The name and title of the insurance person
you talked to about your claim

About DirectPath
DirectPath guides employees to make better health care decisions with individualized education for selecting the right
benefit plan, expert assistance in making informed care choices and rewards for sensible financial decisions. Its customers
experience significant ROI on their benefits investments through increased employee participation, management of the
evolving regulatory environment and reduced cost through a benefits plan system of record.

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