Dispute and negotiate charges

If you've examined your explanation of benefits (EOB) or your Medicare summary notice, and compared them to your hospital and physician bills, you're probably feeling confused and overwhelmed. But don't give up, don't give in, and don't wait. If the charges are incorrect you need to dispute them as soon as possible. And if they're higher than expected, there's often room for negotiation.

• Call your insurer's customer service line, tell them you suspect a hospital or physician billing error, and ask them how to proceed.
• Call the hospital and physicians' billing offices to discuss discrepancies and how to resolve them.
• Know your rights under state and federal laws to ask your insurance plan for an internal review. Find out about your state's regulations and learn how to handle the review process.
• Keep a record of what you discussed, with whom you spoke, and when the conversation took place.
• Create a spreadsheet to track the process of disputing/negotiating each of your bills. Note the initial charge, the amount insurance paid, the amount you owe in deductibles and co-payments, and the amount you're disputing or negotiating.
• Be aware of deadlines for disputing your bills, typically up to six months.

Common errors include: bills from out-of-network providers you thought were in-network, fees that far exceed the cost you estimated for a procedure, and even charges for services you never received. If this sounds familiar, speak with your insurer, your provider, and the hospital's billing department to resolve your bill. "It's the art of negotiation," says David Wilcox, MD, an emergency medicine specialist and consultant to several health care insurers in Connecticut. "If everyone feels a bit put out, it probably means that everyone lost and everyone won a little bit," he says.

If you receive an out-of-network bill from a provider who you thought was in network, ask the provider's billing office if they'll accept your plan's in-network rate, or if they'll negotiate a lower rate.

When you receive a bill that's been denied by your insurer, first contact the insurer for an explanation. Then, if necessary, speak with a patient care advocate at the hospital or billing company and inquire about the accuracy of the code, says Dennis Beck, MD, a nationally recognized expert in emergency medicine reimbursement. Sometimes an incorrect billing code can make all the difference.

If in the end you have to write a large check, or arrange to pay off your bills in installments, you may be able to deduct your medical expenses on your federal tax return. The IRS allows deductions for medical expenses that exceed 7.5 percent of your adjusted gross income.