Over the last few years, I've encountered several major issues with medical billing. It's made me quickly understand how to dispute your medical bill, get errors corrected, and reduce your payment.

First, I was incorrectly billed for the wrong procedure - one that cost almost 10x more than the one I had. Second, I had a procedure done at one location, and again at a second location, with the second location charging almost double the first.

The fact is, I don't "use" a lot of medicine. If these errors happen with this frequency - looking at my bill history, I put the error rate at roughly 2% - it's likely impacting others as well.

I wanted to put this ultimate guide for disputing a medical bill together so that you know exactly what to do if you think your medical bill is outrageously prices or plain wrong. 

My Medical Billing Issues

As I mentioned before, I had both an incorrect billing issue and an "outrageous" pricing medical billing issue. I as able to resolve both successfully, and I learned a lot along the way.

Here's what happened to me:

The Broken Bone

In my first encounter with disputing a medical bill, I was charged for a surgery I never had! I had broken my ulna (wrist bone) and gone to urgent care. At urgent care, I got an x-ray, and they discovered it wasn't a bad fracture. As such, they put me in a wrist brace and sling, gave me some pain meds, and said I would be fine but let it heal for 6 weeks.

No cast, no surgery, nothing major.

But when the bill came, it was for $8,500! How could my urgent care visit and x-ray cost $8,500 was beyond me.

In the end, I discovered that the medical billing code was 1 digit off - meaning they billed me for a broken ulna surgical repair (actual surgery to repair the bone) versus a broken ulna non-surgical consultation. One error in medical billing send the price from about $800 for the urgent care visit and x-ray to $8,500.

The Expensive CT Scan

I've had two CT scans in my life - and for some reason, one was double the price of the other. The first CT scan was at one office, and it ended up costing $600. My doctor booked my second appointment at another office (due to scheduling), and the bill for this one came back at $1,200. For the same thing!

In this case, there was no billing error - just outrageous pricing. After a few phone calls and discussions, asking the right questions, and talking to the supervisor, I was able to get the bill reduced by 50% - to the same cost as the other procedure. 

General Notes Before Disputing A Medical Bill

Before we dive in on the step-by-step way to dispute a medical bill, there are some general notes I want to cover first.

When disputing a bill, it's important that you do your research and understand what happened and what's going on. That way you can help troubleshoot the problem without passing blame. Customer service reps will be much happier to work with you if you adapt this approach.

Second, realize that mistakes will happen. Even if 99.999% of medical bills are done correctly, there will still be errors. People still process these. Be sympathetic up front to this. 

Third, take diligent notes of all your conversations and encounters throughout the process. You should record conversations if possible (and allowed), and get things in writing. At a minimum, I recommend:

• Date and Time
• Who you spoke to (first and last name, ID number if possible)
• Details of the conversations
• Commitments from the company/individual with specific timelines to follow up (i.e. When can I expect this to be resolved? When should I follow up if I don't receive anything?)
• If on a cell phone, screenshot your phone at the end of the conversation to highlight the phone number you called, and the length of time you were on the call. If you can't do this, keep your phone statement with the call.

If you're mailing documents or doing any written correspondence, I recommend:

• Ensuring you keep a copy of everything you send, with date mailed
• Send all mail certified mail with return receipt - put the return receipt with your copies of what you sent so you have proof they received it

Finally, when disputing a bill, it's important that you ask about the due date of the bill. You want to ensure that collection on the bill is paused or suspended while the bill is being disputed. If they don't do that, ask that the due date be extended out a period of time. This is especially important because medical bills can end up on your credit report and hurt your credit score.

The bottom line is you don't want this company to send you to collections while you're disputing their bill.

Step 1. Review Your Bill & Explanation Of Benefits

The first thing you get (typically before your medical bill even arrives) is your explanation of benefits from your insurance company. I would venture that 95% of people throw these away and don't even know what they are for.

Next, your actual bill will come in the mail.

It's so important that you review BOTH your medical bill AND explanation of benefits. This could be the first sign of something wrong.

First things first:

What Is An Explanation Of Benefits?

The Explanation of Benefits is a document provided by your insurance company the explains your insurance benefits as it pertains to a bill.

While every company lays out their Explanation of Benefits differently, you will usually see something like the following:

• Amount Billed By Provider (this is how much the doctor or hospital charges)
• Plan Discounts (this is a discount negotiated by your insurance company)
• Amount paid by insurance company
• Amount you will owe the provider

Most explanation of benefits forms will also include information about your deductible, co-pay, co-insurance, and more.

If a procedure is not covered, the explanation of benefits will also typically have a code or error, with a short explanation as to why it's not covered. To get more information, you typically have to call.

Here's an example: