Medical bills can be confusing. Although itemized, they contain codes that you may not be familiar with. Usually these codes are followed by a description, but sometimes even the description can be vague. Knowing understand what is being billed can help you determine if you are financially responsible or if the bill should be sent to your insurance company or a third party for payment.
Instructions
1. Look for the diagnosis code listed next to the name of the diagnosis for which you were treated. Diagnosis codes are 3-digit numbers and may be followed by a decimal point with up to 2 more numbers after the decimal point. These are standard codes used by all medical billers when completing a claim form. They are referred to as International Classification of Diseases (ICD-9) codes.
2. Locate the description of the service(s) for which payment is being sought, such as an office visit, colonoscopy or lab work. Each service or procedure is assigned a 5-digit number. These are called Current Procedural Terminology (CPT) codes and, like ICD-9 codes, they are standard. Unlike diagnosis codes, procedure codes do not contain decimal points.
3. Notice the corresponding diagnosis for each procedure billed. There can be more than one diagnosis assigned to the same procedure and vice versa. However, all procedures must be associated with at least one diagnosis.
4. Make sure that the services being billed were actually performed. An insurance company has the right to request medical records to substantiate the billed procedures. Even if all the procedures that are being billed were performed, some codes may not be separately payable. For example, during a doctor's visit, your doctor may take your temperature and check your lungs; these services are considered to be a part of your office visit and should not be billed as separate charges.
5. Identify the billed amount for each procedure and the total. If you paid your co-payment at the time of the visit, the bill should reflect this. Please note that billed charges for the same procedure vary from doctor to doctor. Generally, doctors bill their standard rate even if they have a contract with an insurance company to accept a certain rate as payment in full. Doctors that are contracted with insurance companies are generally prohibited from billing patients for the difference between the billed amount and the amount paid by the insurance company.
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