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How To Review A Hospital Bill And What To Do If You Find An Error

If You Need Help Reviewing A Hospital Bill: Professional Claims Assistance

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If you are not able to decipher your hospital bill

  • A registered nurse or other healthcare professional can help make sense of the medical codes and jargon. 
  • Your local disease specific non-profit organization should also be able to help or at least point you in the right direction.

If you want help auditing your hospital bill

  • If you have insurance, speak with the insurer before engaging a professional. Many insurers have professionals who can conduct the audit at no cost to you.
  • If you are not insured, or if the insurance company audit is not satisfactory, consider hiring a professional claims assistance professional (also known as medical billing advocates). Many of these professionals work for a percentage of the recovered charges so it basically doesn't cost you to use them.

Because the profession is new, there is no standard certification in place or state licensing. Anyone can say he or she is a professional. Look for a professional with experience in the particular area in which you need assistance. For example, if you think you are being overcharged, look for an advocate who has worked previously in a hospital or medical provider's billing office.

Check the amount of the person's fees. Also check their ability by speaking with at least two people the professional helped before engaging a professional claims person. (If the professional won't give you the names of two satisfied customers, look elsewhere). Fees are usually on an hourly basis or a percentage of whatever costs they save. The initial consultation should be free.

A good place to start the search is from staff at your doctor's office, family and friends, and other members of support or self-help group. 

Following is a list of sources we know about, but have no practical experience with. If you use one, please share your experience.

  • The Alliance of Claims Assistance Professionals is a not for profit corporation that specializes in hospital bill audits. They can be reached toll free at 877.275.8765 or offsite link.
  • Medical Billing Advocates of America at 540.387.5870 or offsite link (lists advocates by state and specialty)
  • offsite link is a for-profit company that is a "claims adjuster." They will review doctor and hospital bills for a fee. They claim to know the lowest fee charged for a procedure by a hospital or clinic.
  • offsite link charges a fee of $149 for a written report.

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