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A Guide to Reading and Understanding Health Insurance Bills

Woman looks at device with frustration.

Health insurance bills can often resemble a complex puzzle, filled with medical jargon, codes, and numbers that may seem confusing at first glance. However, deciphering these bills is crucial for ensuring that you understand your healthcare expenses and are not overcharged. Mistakes happen on claims, and it's important that we review our claims to catch those mistakes and keep from being overcharged. They may be as big as when I had a baby and was billed for a c-section when I didn't have one. Or as small as the time I was accidentally charged $25 for an aspirin when I had not received one during my appointment. 

In this guide, we will walk you through the key components of a health insurance bill and provide tips on how to read and understand them. And how to get them fixed if you do find any errors. 

  1. Reviewing the Basics:

    • Patient Information: Start by checking the basic information at the top of the bill. Ensure that your name, date of birth, and insurance policy details are accurate. Any discrepancies could lead to billing errors.

    • Provider Details: Identify the healthcare provider's name, address, and contact information. This is crucial for verifying that the services listed on the bill were indeed provided by the facility you visited. Sometimes you will get a bill from your provider, as well as from the facility where you had your proceedure done. Make sure those are both correct. 

    • Service Date: Note the date of service for each item on the bill. This will help you track and verify the services against your own records.

  2. Understanding Service Codes:

    • CPT Codes: Common Procedural Terminology (CPT) codes are numerical representations of medical procedures and services. They help standardize billing across the healthcare industry. Familiarize yourself with the CPT codes related to the services you received. You can just type "CPT" and then the code into Google and it will pull up the diagnosis or proceedure the code relates to. This is how I found out I'd been billed for a c-section I'd never had. 

    • ICD-10 Codes: International Classification of Diseases, 10th Edition (ICD-10) codes are used to describe diagnoses. These codes provide information about the reason for the medical service. Cross-reference them with your medical records to ensure accuracy. You can also google these codes. 

  3. Breaking Down Charges:

    • Service Descriptions: Each service on the bill should be accompanied by a description. Make sure these descriptions align with the services you remember receiving.

    • Charges: Look for the cost associated with each service. This will be the amount the healthcare provider bills your insurance company. Take note of any discrepancies between the billed amount and what you expected.

  4. Insurance Coverage:

    • Coverage Details: Check your insurance coverage for each service. Insurance companies often have negotiated rates with healthcare providers, leading to lower costs for covered services. Ensure that your insurance has been applied correctly.

    • Co-Payments and Deductibles: Identify any co-payments or deductibles you are responsible for. These are out-of-pocket expenses that may vary depending on your insurance plan. Especially since we just started a new year, most people have new deductibles that need to be met before insurance kicks in fully.

  5. Spotting Errors:

    • Billing Errors: Mistakes can happen. Check for duplicate charges, incorrect codes, or services you did not receive. If you find errors, contact your healthcare provider and insurance company to rectify them promptly. And remember to be polite. Billers often work with hundreds of claims a day. Mistakes are not on purpose and can usually be rectified within a few days or weeks. 

    • Out-of-Network Charges: Be aware of any out-of-network charges, as they may not be fully covered by your insurance. If you were unaware of a service being out-of-network, discuss this with your provider.

  6. Contacting Your Insurance Company:

    • Customer Service: If you have questions or concerns about your health insurance bill, don't hesitate to contact your insurance company's customer service. They can provide explanations, clarify coverage, and help resolve any issues.

    • Appeals Process: Familiarize yourself with the appeals process in case you need to dispute a claim. Insurance companies may reconsider certain claims if there is a valid reason for dispute.

Understanding your health insurance bill is an essential step in managing your healthcare expenses. By familiarizing yourself with the key components, double-checking details, and addressing any discrepancies promptly, you can navigate the complexities of health insurance bills with confidence. Remember, proactive communication with both your healthcare provider and insurance company is key to resolving any issues that may arise.

Our last tip is that if you do notice a discrepency and contact your provider, ask them to leave a note that the claim is being reprocessed so you don't incure any incorrect late fees. The billers at Live Well Psychiatry are excellent. They are pros at working with insurances. However if you ever notice a discrepency on one of your claims for our services, don't hestiate to reach out! 

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