Your Coverage & Care
Your Coverage & Care
 
Appealing Denied Claims

Common Medical Billing Errors

Medical billing and coding errors are unfortunately common. That can cause your claim to be denied or increase what you have to pay out of pocket. After you receive care, you’ll get an explanation of benefits from your insurer. If you didn’t get an itemized bill or statement from the health care provider, make sure to request one. That way, you can compare the EOB with the bill and verify:

  • what service or product the provider billed for
  • what your insurer has paid
  • what you are being charged for  

If a service or product that you received wasn’t covered and you disagree, here are a few errors that may cause the claim denial.

Missing or Incorrect Patient Information

A mistake is made with the spelling of your name or the digits in your policy number or group plan number.

Incorrect code

The billing specialist may entering too many or too few digits for the code that describes a symptom, diagnosis or treatment.  Also, codes get updated and sometimes a code may be changed or deleted from the system.

Wrong or switched number

A typo (e.g. an extra zero) or switching the place of two numbers can cause you to be charged for more products than you actually received. 

Duplicate charge

The same test, procedure or product is charged twice.

Service not received

A test or procedure was not performed during your doctor visit,  but was incorrectly added to the bill.

Unbundled charges

A group of certain procedures that occur together should be charged under a single code.  Sometimes providers “unbundle” or separate services into individual charges.  That’s not allowed but you may need a claims assistance professional to help you uncover this.

Upcoding

Sometimes a provider may use the wrong code that causes you and your health plan to be charged for a more expensive procedure or product than the one you received. Sometimes it’s a mistake by the provider. When  it’s done intentionally (upcoding), that is illegal. With coding errors, you may need a claims assistance professional to help you uncover it.

Incorrect balance billing

After your insurer pays the amount owed for a procedure or product based on your health plan, you might have a balance. If you disagree with this charge, double check with the insurer.  The balance on the bill might be a mistake by the provider.

Mismatched diagnosis/treatment codes

If the diagnosis and treatment codes don’t match, your insurer will reject the claim.  You can’t be diagnosed for stomach flu and be treated for a respiratory infection.

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