Basic steps you can take to determine if your medical bills contain over-charges; how to detect errors and what to do about them.

1. How To Be Your Own
Healthcare Consumer
Advocate
Courtesy of:
Montana Medical Bill Review

2. Overview: Medical Billing
Process
Consumer (patient) goes to doctor, hospital,
or other provider for prevention or treatment
Data collection
Services rendered and documented
Billing document generated using collected
data and codes from patient’s medical
record
Electronic claim form submitted by provider
to insurance company (If no insurance,
payment collected from patient.)
Provider receives payment from insurer in 30
days

3. Anatomy of a Medical Bill
Doctor’s Office Visit
Hospital
Physician Service – Inpatient

11. Top 10 Things You Can Do to Help
Find Billing Errors
 Check Name
 Check DOB
 Check Account Number
 Check SSN
 Check New Patient vs. Established Patient
 Request a detail bill
 Check type and number of procedures (X-rays, lab tests,
EKG,etc.)
 Hospital bill – check inpatient vs. outpatient
status/number of days
 Check room rate – Private vs. SemiPrivate/ICU, etc.
 Check type and amount of medications

12. Working with Provider or Insurance Company to Correct Errors
 Collect all your information (bills, account statements, EOB, cancelled
checks, credit card statement, insurance policy number,etc.) and have it
available to refer to, before you contact provider or insurance company
customer service
 Remain calm
 Smile when you talk on the phone 
 Provide necessary information to verify your identity and account number
 Briefly state your issue/concern/questions
 Ask for clarification of any charges or insurance payment denials
 Specifically identify billing errors
 Request a corrected bill
 If necessary, use the appeals process outlined in your insurance policy to
appeal a claim denial you believe is in error
 Follow up: review account statement from provider to confirm corrections;
review subsequent EOB from insurance company to confirm claim
status/payment