What to Do If You Get a Surprise Medical Bill

 

Susan scheduled what she thought would be a routine outpatient procedure, an endoscopy recommended by her doctor. She confirmed the hospital was in-network, verified coverage with her health insurer, and even paid the expected copay in advance.

But a month later, she received a bill for over $1,400 from an out-of-network anesthesiologist she had never met. Confused and frustrated, Susan asked herself what many Americans do each year: “How is this even possible?”

Why Surprise Medical Bills Happen

Despite growing protections for consumers, surprise medical bills such as unexpected charges from out-of-network providers, can still occur, especially when patients are treated by a doctor or specialist not directly chosen by them. In hospitals and surgical centers, it’s common for radiologists, pathologists, or anesthesiologists to bill separately even if the facility is in-network.

Medical billing is complex, and errors are shockingly common. A 2021 study by the Medical Billing Advocates of America found that as many as 80% of medical bills contain errors, ranging from simple data entry mistakes to miscoded procedures and duplicate charges.

Steps to Take If You Receive a Surprise Bill

1. Don’t panic and don’t pay right away. Start by reviewing the bill against your Explanation of Benefits (EOB). Look for inconsistencies in provider names, billing codes, and amounts covered.
2. Call your insurance company to confirm what should have been covered and whether the provider was incorrectly listed as out-of-network.
3. Contact the provider’s billing department. Sometimes a bill is sent automatically without insurance being properly applied. They may be able to resubmit the claim or correct errors.
4. Dispute the bill in writing. If the bill is incorrect or appears to violate state or federal protections (like the federal No Surprises Act for certain services), file a formal dispute with both the provider and your insurer.
5. Request an itemized bill. Vague charges like "lab fees" or "supplies" should be broken down in detail to verify accuracy.

What Happens If You Ignore It?

If the bill is legitimate and you fail to address it, it can be sent to collections, damage your credit, and accrue interest. If you're struggling to pay, ask about payment plans or financial assistance, as many hospitals have options.

Final Word

No one should face financial ruin because of confusing or erroneous medical bills. If you receive a surprise bill, take action early, document everything, and advocate for yourself. And if you’re unsure how your insurance applies, contact our office. We’re here to help you understand your coverage and protect your financial well-being.