From surprise out-of-network charges to duplicate billing, understanding how to correct medical billing mistakes can save you thousands—and a lot of unnecessary stress. This guide will walk you through it all without the fluff.
Step 1: Identify the Problem Early
The moment your bill arrives, take a close look. Is the amount higher than expected? Are there services you didn’t receive? Did insurance deny a claim without explanation?
Start by requesting an itemized bill. This shows you every charge—line by line—and makes spotting errors much easier.
Common Medical Billing Errors Include:
- Charges for services never received
- Duplicate charges for the same procedure
- Upcoding (billing for a more expensive procedure than the one provided)
- Incorrect patient information
- Out-of-network charges when care was in-network
Stat: According to Becker’s Hospital Review, nearly 80% of medical bills contain errors.
Step 2: Compare Your Bill With Your Insurance EOB
Your insurance provider sends an Explanation of Benefits (EOB) that shows what they paid, what they didn’t, and why. Cross-reference your bill with this document.
If something doesn’t match, flag it. Your EOB is a valuable tool when disputing incorrect charges.
Stat: CNBC reports that medical billing mistakes cost Americans over $210 billion every year.
Step 3: Contact Your Provider’s Billing Department
Now that you have your notes and documentation in hand, it’s time to make the first call. Stay calm, and politely point out the discrepancies.
Ask questions like:
- “Can you explain this charge for me?”
- “Was this procedure billed with the correct code?”
- “Is this a duplicate charge?”
Take notes and write down the name of the person you spoke with and when. Request a revised bill if they confirm an error.
Step 4: Get Your Insurance Involved
If the billing office isn’t helpful or the error involves a denial or misapplied insurance benefit, call your insurance provider. They may reopen the claim or investigate further.
Be persistent. Sometimes, just having the provider and the insurer talk to each other is enough to trigger a correction.
Stat: A 2023 study from the Medical Billing Advocates of America showed that 25% of denied claims are approved upon appeal.
ABA Billing Services: A Lifesaver for Behavioral Health Providers
If you’re a parent of a child receiving ABA therapy or a behavioral health provider yourself, you already know how complicated things can get. ABA billing services exist specifically to untangle this mess. These services understand the exact CPT codes, payer rules, and modifiers needed for ABA claims.
Families rely on providers, and providers rely on ABA billing companies to manage claims accurately so therapy isn’t interrupted by billing delays. These services also help avoid denials, ensure pre-authorizations are submitted correctly, and track reimbursements.
Step 5: File a Formal Dispute
If you're getting nowhere with calls and emails, it’s time to file a formal dispute.
Steps to Do This:
- Send a written letter to the provider’s billing department outlining the issue.
- Attach your EOB, itemized bill, and notes.
- Send via certified mail and keep a copy.
You can also escalate the issue to your state’s insurance commissioner, especially if it involves denied coverage for essential care.
Step 6: Know When to Call in the Pros
Some cases are too complex or time-consuming to handle on your own. That’s where medical billing advocates come in. These professionals will take over your case, often saving clients hundreds or even thousands of dollars.
For providers, partnering with medical billing companies helps avoid these conflicts in the first place. They ensure that bills are submitted cleanly and accurately, which keeps patient satisfaction high and revenue flow steady.
Transitioning Between Sections
Each step in this process builds on the last. Once you’ve flagged an error (Step 1), you’ll need to support it with documentation (Step 2). That information then fuels your calls to providers (Step 3), which may need to involve your insurer (Step 4). If all else fails, escalation (Step 5) and professional help (Step 6) are your best bets. Smooth transitions matter—they keep you calm, focused, and effective.
FAQs
Q: Can I sue for incorrect medical billing?
A: In extreme cases—like repeated, deliberate overbilling—you may have a legal case. However, most issues are resolved through disputes or advocates.
Q: Who is responsible for billing mistakes—provider or insurer?
A: It depends. Some errors come from incorrect coding by providers, while others are from insurance denying claims due to policy issues.
Q: Are there deadlines for disputing a bill?
A: Yes. Most insurers require disputes within 90–180 days of the original claim. Always check the fine print.
Final Thoughts
Medical billing shouldn’t feel like an uphill battle—but for many, it does. By catching mistakes early, staying organized, and knowing your rights, you can resolve errors without letting them take over your life.
And if you’re on the provider side, especially in specialized fields like ABA therapy, don’t try to handle everything in-house. Let experts—like ABA billing services or full-scale medical billing companies—handle the backend so you can focus on care.
A clear bill helps build trust. And trust is the first step toward better healthcare for everyone.