Medical bill errors: Consumer groups say it happens more than you think

When you get the bill for your medical care, do you know exactly what you’re paying for? Consumer groups say errors on medical bills are more common than you might think, and it’s important to know what to look for.

It started as a cancer scare for Scott Sinagra.

“It jumped to the point where it’s like it’s a concern,” Sinagra said.

So Sinagra says his doctor ordered an MRI. He says the office promised to run it by insurance ahead of time to make sure it was covered. He told Action 9 investigator Jason Stoogenke that the office told him it was covered.

“About two months later, I get a bill and I’m going, ‘OK, well where did this come from?’” he said.

He says he was under the impression he shouldn’t have owed anything, or very little. Instead, his bill came to about $5,200.

“Me, as the patient was, hey, I’m just doing what I’m supposed to do. I’m just being there to try to get healthy again and identify what the heck is going wrong,” he said.

He says he asked his insurance what happened. “They didn’t have any record that my doctor’s office actually reached out to them,” he said.

So Sinagra says the insurer wouldn’t pay the claim.

He says he went back and forth for months, between his doctor’s office, the MRI provider, and insurance. He says that, finally, the MRI provider cut his bill in half, but he really feels the doctor’s office is the one that should have made things right.

Either way, he says that means he still owes about $2,500, thousands more than he says he should have.

“I just want somebody to take responsibility for their actions. Me as the patient and also customer just going, ‘Well, how am I stuck here holding the bag when I’m relying on the people to care for what I am going through to know that they’re supposed to do?’ ... So we don’t get stuck,” he said.

Stoogenke called and emailed Sinagra’s doctor’s office multiple times for more than a month, but no one responded in time for this report.

Craig Rae and Frank Trammell own separate medical equipment stores, one in Matthews, one in Salisbury. They’re constantly interacting with patients, and they say when providers make billing mistakes, they hear about it.

“I think it happens more often than most people think,” Rae said. “We see it every day and there’s a lot of anxiety and there’s a frustration from our patients.”

Kevin Brasler with the nonprofit consumer advocacy group Consumers’ Checkbook seconds that statement.

“It’s a constant problem. It happens a lot,” he said. “The physician or the hospital didn’t bill their insurance plan or didn’t bill it properly or there was a mix-up with their insurance plan.”

The Consumer Financial Protection Bureau has said flat out, “Medical billing is often riddled with errors, including inflated or duplicative charges, fees for services the patient never received, or charges already paid.”

So what can you do about medical bill errors?

Anytime you get pre-authorization for a medical procedure, try to get it in writing.
When your explanation of benefits comes, read it. Remember: it isn’t just junk mail. It may be the key to catch a mistake early.
If anything on there makes you nervous, call your insurance. Don’t wait.
If the claim involves medicine, not a procedure, and you can’t afford it: ask the drug company if it offers payment assistance or a discount. Many give coupons.
Be persistent.

(VIDEO: Therapy dog brings joy to medical center patients, staff)