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How do you know if the medical bill you're receiving is accurate?


A woman gets her blood pressure checked at the doctor's office. (WJAR file image)
A woman gets her blood pressure checked at the doctor's office. (WJAR file image)
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Experts say, thanks to a loophole in the Affordable Care Act, coding errors have become more common over the last 13 years – especially when it comes to routine, preventative care.

“You think about an annual exam, you get all your tests and everything, those aren't supposed to be patient sharing, those are supposed to be covered by the insurance company,” explained Mark Scribner, managing director at Boston-based Carson Wealth. “Unfortunately, whether it be by mistake or on purpose, doctors’ offices sometimes will miscode an annual exam with a wellness visit.”

He continued, “Like, if you had a cold, they might put a different code in and say that you're there for diabetes, or something outside of a regular, normal exam, and then folks end up getting billed for that and they end up spending millions and millions of dollars across the country.”

The total cost of these coding errors?

Scribner says $73 million annually is a low estimate.

While you can sometimes get the error fixed by calling your insurance company, it's a huge task and it's not guaranteed to work.

So, how do you prevent this from happening?

Scribner says you've got to be proactive during your appointment.

“Unfortunately, it's one of those things like before you exit the doctor’s office, or even while you're meeting with the doctor, just to reaffirm that the categories that they're coding are preventative types of things,” Scribner said. “If you actually don't do that by the time you've left the office, you're dealing with the billing department and sometimes, there's been a lot of folks that have been referred to collection agencies - they can't get off that treadmill, if you will, because once it's in the system it's already submitted to the insurance company and its really difficult to reverse.”

Scribner said there are have been attempts to fix this loophole in the ACA, but Americans are still waiting on a permanent solution.

In the meantime, he says to study what's covered by your insurance company before you go to the doctor, and again, if you have questions about coding, ask the office before you leave.

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