Incorrect medical bills can negatively impact both personal finances and health. Reviewing explanation of benefits statements and medical bills is important to check for errors in charges, diagnoses, or procedure codes which could lead to unnecessary costs or improper treatment over time. Small errors in bills may accumulate and eventually exceed lifetime maximums for insurance coverage. Additionally, rising healthcare costs that result from erroneous billing affect insurance premiums for everyone. It is advised to carefully review all medical documentation received and seek help from insurance plans or billing experts if unable to resolve any identified errors or anomalies.

1. June 2016
Cover: Studio T Photography
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Expert Contributor
Errors In Medical Bills Can Impact
Your Health—And Your Wallet!
Why you should review that pesky Explanation of Benefits (EOB) from your health plan.
By Jessica Schmor, Allegiant Experts
Everyone has been on the receiving
end of that envelope from your
health plan that contains the explanation
of benefits (EOB) for the health services
that you received. If you even open the
envelope, you stare glassy-eyed at the
document. First, panic: $1,100! Second,
relief: “THIS IS NOT A BILL.” Third,
confusion: “OK, so why do I care?”
Finally, resignation: into the filing bin.
When the actual bill comes later, most
of us just pay it or question it based
upon the amount of the bill, not whether
or not we believe it to be correct.
Reviewing EOB’s and medical
bills can be confusing, burdensome
and frustrating, but it is critical.
These records can impact your
financial and physical health
and healthcare costs for all.
Incorrect medical bills can cost
you hundreds of dollars and, even in some cases, risk your
ability to have coverage at all because of how out-of-pocket
and lifetime maximums work. An incorrect charge of $800
might not be the end of the world, but it’s $800 that you didn’t
need to spend. Over time, adding these incorrect bills to the
correct ones could add up to your lifetime maximum, leading
to your insurance company no longer providing coverage.
Incorrect medical bills aren’t only about wrong charges, but
also incorrect diagnoses or procedure codes. Your records
are transferred to other providers who treat you. If you arrive
unconscious in an emergency room unable to share your accurate
health history, you may end up being treated for a diagnosis that
you do not have. The converse is also true: If your record is silent
on a critical diagnosis, you may not get the treatment you need.
Everyone feels the sting of rising health insurance premiums.
Rising health insurance premiums are directly related to the cost
of care, and if some of that cost is erroneous, it costs everyone
more. So when you see an incorrect charge or service on your
EOB or medical bill, even if the insurance company is paying
it in full, it is still costing you and everyone else eventually.
Tips to keep your healthcare costs down:
• Be proactive with your health record.
• Keep a list of appointments and what
was done (treatment list).
• Review your EOB’s and bills as soon as they arrive.
• Check your credit often.
• Seek expert help if you can’t solve it on your own.
There are many sources of help out there. All health
insurance plans have customer service representatives that
can help you understand your EOB. If you don’t get the
information you are looking for, try contacting the Special
Investigative Unit or Fraud Hotline. Even if it is not true fraud,
this department’s job is to deal with fraud, waste and abuse.
They often have more time to review the information and help
solve billing anomalies. If you can’t get any resolution from
your health plan, you can always reach out to an expert who
can assist with ensuring your bill is correct and resolving it.
While reviewing your medical bills can be painful upfront,
the long-term consequences of not doing so can be significantly
worse. So begin as soon as possible and make it one of your
personal habits, just as you do budgeting and financial planning.
Protect ALL of your assets and review your medical bills. ☐
About the Author
Jessica Schmor, RN, owner of Allegiant Experts, is a clinician
with more than 15 years of experience working with facilities,
health plans, providers and attorneys. Her knowledge of
how all parties function within the medical system has
given her rare insight into the healthcare industry.