3 Tips to Spot Medical Bill Errors for People on Medicare

How closely do you usually examine your bills? When it comes to healthcare, it might be worth your while to take a little extra time looking before you pay. 

If you’re enrolled in Original Medicare or a Medicare Advantage plan, insurance should cover a large portion of your expenses from doctor’s office visits, hospital stays, and medically necessary procedures. However, you’re still responsible for certain costs that go beyond your monthly premiums, including coinsurance, copays, and any charges for services that your plan doesn’t cover. 

By double checking that you’ve been billed accurately, you may save money, protect yourself from fraud, and gain a better understanding of how well your current health coverage meets your needs. Follow these steps to catch problems in your bills before they cost you:  

1. Keep Track of Your Appointments and Services 

Get into the habit of keeping organized records of your healthcare services. Maintain an up-to-date calendar of your appointments and save receipts or statements from your providers so you can clearly see how much you’ve spent on care.

With that information in hand, you’re better prepared to ask your healthcare providers important questions and to notice any problems in your bills. You’ll also get a clear perspective on all the care you’ve received throughout the year, which might help you make decisions about whether to update your coverage. 

2. Review Your Medicare Summary Notice or Explanation of Benefits 

If you’re enrolled in Original Medicare, you should receive a Medicare Summary Notice every three months, which outlines your claims, meaning all the services that you’ve requested to have covered through your insurance.  

If you’re on a Medicare Part D prescription drug plan or a Medicare Advantage plan, you receive an Explanation of Benefits from your private insurance carrier the month after you file a claim. This document provides similar details to the Summary Notice. 

Take a careful look at these documents to make certain they match with the actual care and prescriptions you received, especially if you receive a bill that you think contains questionable charges. Comparing the claims information in these plan notices against the receipts or statements from your provider might reveal inconsistencies that need to be addressed. 

3. Check for the Most Common Mistakes 

Medical billing involves your healthcare provider using a complicated system of codes to communicate with your insurance carrier about symptoms, diagnoses, and treatments. If there are any errors, they might result in a claim denial from Medicare or put you on the hook for unnecessary charges.  

Look out for these common issues:  

• Incorrect patient details, such as a misspelling in your name or a wrong digit in your policy number. 
• A diagnosis, test, treatment, or other service you didn’t actually receive. 
• Duplicate charges. 
• A balance due that seems too high based on the amount paid by your insurance according to your Medicare Summary Notice or Explanation of Benefits. 

If you think you found a problem, the first step is to reach out to your provider’s billing department for clarification. They may be able to provide you with a detailed bill or a copy of your medical records and correct any mistakes. If you still believe there’s a problem with your bill, contact Medicare or your insurance carrier for help.  

The best way to protect yourself against billing errors and the potential for fraud is to be well-informed about your own care, stay organized, and ask questions if something looks wrong. If your costs are becoming difficult to manage, consider exploring what other healthcare coverage options are available to you.

About GoHealth

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.