How to Dispute a Surprise Medical Bill
Surprise Medical Bills: What They Are and How to Fight Them
Imagine receiving medical care you thought was covered by your insurance, only to be blindsided by a bill for hundreds—or even thousands—of dollars. This is a surprise medical bill, and it’s one of the most stressful and confusing issues families, caregivers, and patients face when navigating the healthcare system.
At Billow, we’re here to help you understand what surprise medical bills are, why they happen, and how you can protect yourself from overpaying. With the right knowledge and tools, you can take control and minimize the financial stress of unexpected charges.
What Is a Surprise Medical Bill?
A surprise medical bill occurs when you receive care from an out-of-network provider, often without your knowledge, resulting in higher costs not covered by your insurance. These bills often arise in situations where patients have little to no control over who provides their care, such as:
- Emergency Room Visits: When you’re taken to an out-of-network hospital or treated by out-of-network specialists.
- In-Network Hospitals with Out-of-Network Providers: Even if the hospital is in-network, the anesthesiologist, radiologist, or lab services may not be.
- Ambulance Services: Many ambulance services, including air ambulances, are out-of-network.
Why Do Surprise Medical Bills Happen?
Surprise bills often stem from a lack of transparency between providers, insurers, and patients. Here’s why they occur:
Out-of-Network Providers: You unknowingly receive care from a provider who isn’t contracted with your insurance.
Balance Billing: The out-of-network provider bills you for the difference between what your insurance pays and their full charges.
Insurance Denials: Your insurance denies coverage for certain services or deems them "unnecessary.
How to Spot a Surprise Medical Bill
A surprise bill often appears as a statement with charges that:
• Exceed your Explanation of Benefits (EOB) from your insurer.
• Include terms like "out-of-network provider" or "balance due."
• Come from unexpected sources, like labs or specialists you didn’t meet.
Tips to Prevent Surprise Medical Bills
While not all surprise bills can be avoided, these proactive steps can reduce your chances of receiving one:
1. Confirm Network Status Before Treatment
Always verify whether the hospital, clinic, or specialist is in-network with your insurance plan. Ask explicitly if all services (e.g., lab work, anesthesia) will also be in-network.
2. Request an Itemized Estimate
Before non-emergency procedures, ask for a detailed cost estimate, including potential out-of-network charges.
Example Question:
“Are there any out-of-network providers who may be involved in my care?”
3. Understand Your Insurance Policy
Know what’s covered and what isn’t, including deductibles, co-pays, and out-of-network limits. Familiarize yourself with your state’s protections against surprise bills.
4. Ask for In-Network Alternatives
If your provider is out-of-network, request an in-network option or ask if they can accept the in-network rate.
5. Document Everything
Keep a record of all communications with providers and your insurer, including dates, names, and key points discussed.
How to Dispute a Surprise Medical Bill
If you receive a surprise medical bill, don’t panic. Use these steps to dispute it:
1. Request an Itemized Bill
An itemized bill breaks down all charges, making it easier to identify errors or overcharges.
What to Say:
“I’d like an itemized version of this bill to review the charges in detail.”
2. Cross-Check with Your Explanation of Benefits (EOB)
Compare your itemized bill to your EOB from your insurance company to identify discrepancies.
3. Contact Your Insurance Provider
Ask your insurer to confirm what they’ve covered and why certain charges weren’t paid.
What to Say:
“Can you explain why [your specific charge] wasn’t covered and if there’s an appeal process?”
4. Negotiate with the Provider
If the bill remains high, negotiate directly with the provider. Many are willing to lower charges or offer payment plans.
What to Say:
“This charge is higher than I can afford. Can we discuss a discount or payment plan?”
5. Leverage State or Federal Protections
The No Surprises Act (effective January 2022) protects patients from many types of surprise bills, including:
• Emergency services at out-of-network facilities
• Certain out-of-network providers at in-network facilities
Three Scripts for Addressing Surprise Bills
When Calling Your Provider:
“I’ve reviewed my bill and noticed charges for out-of-network services. I wasn’t informed these providers were out-of-network. Can you explain these charges and discuss adjustments?”
When Calling Your Insurance Company:
“I received a bill for [amount] from an out-of-network provider. Given that this was an emergency, I believe this should be covered under the No Surprises Act. Can you review my claim?”
When Requesting Financial Assistance:
“I’m unable to pay the full amount of this bill. Are there any financial assistance programs or discounts available?”
How Billow Can Help:
Billow makes navigating surprise medical bills simple and stress-free:
Blip Detection: Our AI scans your bills for errors, unexpected charges, and out-of-network fees.
Personalized Guidance: Get clear recommendations on how to address and dispute surprise bills.
Dispute Tools: Access pre-filled dispute letters and expert tips to resolve billing issues quickly.
Surprise medical bills shouldn’t leave you feeling powerless. With Billow, you’ll have the tools and guidance you need to understand your charges, dispute errors, and save money.
Start Your Journey with Billow GPT Today