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How to Contact Your Medical Provider to Resolve a Medical Bill Before it Goes to Collections

+ Checklist & Step-by-Step Call Scripts

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What you've heard is true.

Resolving an Unexpected Medical Bill is Awful!

When you first receive that unexpected medical bill, whether it is a small balance or huuuuge figure will likely get you reeling. Then, you’d think, there must be a mistake somewhere! It’s either there’s an error in the bill or an issue with your insurance company. You might be right.


However, you would likely spend hours listening to hold music, responding to phone voice prompts or suddenly be disconnected. All in an attempt to resolve what you believe must be a mistake. And, the back and forth? It may take hours, months or even years to get a resolution.


We understand the frustration and want to help you avoid it. That’s why we’ve created this guide to enable you to advocate on your own behalf to verify you actually owe your unexpected balance! In this practical guide, you will learn the exact things to say and do when contacting your medical provider or insurance company to resolve your surprise medical bill quickly.

Table of Contents

Checklist for Contacting Your Medical Provider to Resolve a Medical Billing Issue

Contacting Your Medical Provider to Resolve Your Medical Bills 

Scripts of What to Say When You Contact Your Medical Provider

What to Do When You Can’t Resolve Your Billing Issue with Your Provider

The Easiest & Fastest Solution for Resolving Your Medical Billing Issue

The Easiest & Fastest Solution for Resolving Your Medical Billing Issue

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First, the Checklist

Knowing what to do when contacting your medical provider about a surprise bill will enable you to resolve the issue faster. Use this checklist to ensure you do everything required to resolve your medical billing issue.

Checklist for Contacting Your Medical Provider to Resolve a Medical Billing Issue

Before Contacting Your Medical Provider
  • Breath in and out. Calm down. Focus. 

  • Review all the documents for the medical procedure. 

  • Scrutinize every section of the bill.

  • Compare the bill with your insurance’s explanation of benefits (aka EOB). 

  • Have all relevant documents in front of you when you call.

  • Review your insurer’s EOB for their specific appeal process in the event an appeal submission makes sense.

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When Contacting Your Medical Provider
  • Get a dose of patience. Be polite…yet firm. An aggressive or defensive posture will only work against you.  

  • Focus on the facts. 

  • Ask questions. Clarify anything you do not understand.   

  • Take down the names and phone numbers of everyone you speak to. 

  • Note every vital piece of information and commitment made on the call.

  • Request for information and commitments made to be sent to you in writing. 

  • Record phone conversation, if and when permitted by law. 

  • Screenshot phone call detail to show the number called, date and time.

  • Start a communication tracking log.

After Contacting Your Medical Provider
  • Send a written dispute request and summary of your side of the conversation. Focus on the facts. 

  • Organize and file every piece of written correspondence you send and receive as it relates to your case. 

  • Reach out to your insurer to help with the dispute or to keep them updated.

  • Get your medical provider and insurance company to communicate with each other. 

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What NOT To Do
  • Toss mail from your medical provider or insurer; bury your head in the sand.  

  • Assume your insurer will eventually pay the bill; they just need more time.  

  • Drop the ball or fail to follow up. The billing problem is not their first priority.   

  • Hope it will just go away. These matters never go away.

What To Do
  • Open and read mail from your medical provider or insurer. 

  • Contact the relevant parties for charges you do not understand. 

  • Follow up. Follow up. Follow through. Continuously. Until resolved.  

  • Hire a third party resource if your efforts prove fruitless.

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Contacting Your Medical Provider to Resolve Your Medical Bills

Your first instinct when you get an unexpected medical bill will be to contact your medical provider. That’s a good move! However, you should first review the bill to figure out the problem – not just take a look at the balance. It may be an error. As many as 80% of medical bills (majority hospital related) have errors in them. It may also be an insurance claim denial that left you stuck with the balance.

Medical billing issues can occur as a result of several situations. Sometimes a seemingly simple scenario is more than what meets the eye. Whatever the case, the scripts below will give you a starting point to advocate for yourself and dig deeper. Yes, it can be intimidating and yes, the individual on the other end may be apathetic. But, carry on and keep your focus!

Scenario 1

You get a surprise medical bill from your provider, and it isn’t apparent why you could have gotten the bill.

You: Hello. I got a medical bill I don’t understand (or, I got a medical bill I didn’t expect to have to pay or be so high). Can you explain the charges? Why am I being charged for XYZ?


Them: Let me check that for you. {goes on to explain and you discuss the bill}


You: Okay. I hear what you’re saying. But, I want a detailed line-item bill. Can you send it to me please?


Them: Yes. We can send a detailed line-item bill. How do you want to receive it?

 
You: Thank you. Also, please confirm you have our discussion noted in my account history to avoid having to repeat myself when I call again. When can I expect the promised XYZ? 

Why? With the line-item bill, you can confirm you got charged for only the services you received, as well as compare it with the insurer’s explanation of benefits (aka EOB). This will help you spot any errors in the billing such as demographic information and coding errors.


What to Do? Go through the itemized bill with a fine comb. Check what was diagnosed, prescribed and actually done by your medical provider. Then, compare the bill with your insurer’s EOB to ensure they match. Search the codes online to know what they mean, and ensure that that was the actual procedure you had. Also check if the diagnosis code aligns with the procedural service code.


What else? A line-item bill contains all the minute details of the medical procedure, including information like medical billing CPT code, description and total price, insurance adjustment, and patient amount due. An EOB is the document you’ll get from your insurance company with their claim decision following your medical provider’s claim submission. It contains the charges, the percentage of the charge they will cover or allow, adjustments and payment decision. It will also provide denial information and amounts due by the patient.

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What to Do When You Can't Resolve Your Billing Issue with Your Provider

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Sometimes, you will be unable to resolve your medical billing issue with your medical provider, despite your best efforts. Here are the things you should do next when there’s no headway with your medical provider.

1. Contact Your Insurance Provider

First of all, contacting your insurance company isn’t just for when you can’t find a solution with your medical provider. When you get an unexpected bill, you should reach out to your insurer to find out if the problem is from your plan’s limitations. You would get information about whether your procedure isn’t covered under your plan resulting in a claim denial. Or, perhaps they didn’t receive the claim from your provider at all. They can also help you interpret your explanation of benefits (aka EOB) in relation to the surprise medical bill.


Now, if the problem is from your medical provider, such as a coding error, contacting your insurer can help. This especially works if the error results in your insurer paying more money. For instance, say you mistakenly get billed for an elbow surgery instead of a wrist surgery, and you got an unexpected amount after your insurance paid their percentage. If you contact your insurance company about it, they will take it up with your provider. This is because your insurer is getting a higher bill than they have to pay, and resolving the issue will benefit them too.


Note, however, your medical provider’s medical record of your service or treatment has to substantiate the CPT codes assigned and level of service provided. A medical provider will not arbitrarily change the coding because the insurance company (or you) asks them to.

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What else?

 

Just like with contacting your medical provider, ensure you keep a communication log and ask for a reference number. Then, when you call back, you can state you are following up on “reference number XYZ” which will have the details of the call. Be aware, though, the agent on the follow up call may let you know the reference number doesn’t exist or when it does, there are no detailed notes, just a call transfer took place. Keep your cool and carry on!

2. File an Appeal

If the medical bill issue is a claim denial and you can’t seem to resolve the issue when you contacted your insurer, then you should file an official appeal. An official appeal will enable you to get a full and fair review of your medical bill dispute. When you submit the appeal request, your insurer may contact the provider directly to examine the complexities of your case, such as service delivered, diagnosis, medical records, etc. Your medical provider can also help expedite the process by writing you a letter to support your case. You may find the appeal process on your EOB or contact your insurer to ask for it. Major insurers have patient portals that may also include an electronic method to submit your appeal. Note, your insurer may have a deadline in which to submit an appeal and different levels of the appeal process.

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3. Contact Your State's Insurance Comission

Most people aren’t aware that a state insurance commission can help them resolve medical billing problems. This is a government agency that ensures insurance companies comply with the law. You can contact them when all else fails, especially if it’s an insurance coverage issue. They will contact both your medical provider and the insurance company to help resolve the problem. Ensure that you submit all paperwork and documentation in the correct order to expedite the resolution process. 

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The Easiest & Fastest Solution for Resolving Your Medical Bill Issue

No doubt, the scripts for contacting your medical provider (or insurance company) do work. We’ve used them to help our clients resolve their medical bill issues before it goes to collection. The things to do if you can’t get a resolution with your medical provider also helps. If, however, you do not have the time to stay on top of a medical billing issue, there is an alternate option: hire a medical billing advocate!

Medical Billing Advocate to the Rescue

You can avoid being placed on hold for hours when trying to contact your medical provider or insurer (or more commonly, experience a hang up from the other end after being on hold for much longer than you think you should be). And, you definitely don’t have to continue to put up with the back and forth between your medical provider and insurer. With a medical billing advocate, resolving your medical bill issues won’t be a nightmare. 


Medical billing advocates are experts who assist in resolving your medical billing issues. They can analyze your medical bills and figure out the issue faster than you ever could. Depending on the billing problem, an advocate can help you correct errors, dispute unreasonable charges, file insurance appeals, and even negotiate a lower bill.

How to Know When to Hire a Medical Billing Advocate

Not all medical billing issues require the assistance of a medical billing advocate. Minor problems such as your medical provider having incorrect insurance details can be resolved quickly. However, you need a medical billing advocate if you check any of the boxes below.

You’re tired of the stress and anxiety of resolving the medical billing issue yourself or don’t have the time.

You can’t make sense of the explanation your provider and insurer gave for the unexpectedly huge bill.

Your insurer is denying your claim for unclear reasons, and you haven’t been able to resolve the issue despite contacting them several times.

Your medical provider is blaming your insurance company and vice versa, and you’re stuck in the middle.

You don’t understand the numerous codes and numbers on your bill and don’t have the time to look them up online.

You have a large bill from several providers and can’t figure out where the billing issue originates.

You are considering declaring bankruptcy because your medical bills are too much and overwhelming.

You’re in charge of managing another’s medical bills and you can’t seem to keep track.

You want to negotiate for a lower bill or settlement for a massive bill after a prolonged stay in the hospital.

What Else?

Just like with contacting your medical provider, ensure you keep a communication log and ask for a reference number. Then, when you call back, you can state you are following up on “reference number XYZ” which will have the details of the call. Be aware, though, the agent on the follow up call may let you know the reference number doesn’t exist or when it does, there are no detailed notes, just a call transfer took place. Keep your cool and carry on!

About the Author
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Medical Bill & Claim Resolution (MBCR) is a patient medical billing advocate with knowledge and experience working the complicated medical billing and insurance system. MBCR understands the errors that occur during billings gained from extensive experience in billing and collection matters. MBCR translates medical speak jargon into plain language that can easily be understood as well as guide patients through the process when a resolution seems unreachable.

MBCR would love to hear about your medical billing success stories or if you haven’t quite crossed the finish line, please reach out to us by visiting www.medicalbillandclaimresolution.com. We’ve love to hear from you!

DISCLOSURE: MBCR provides the information contained herein as an educational tool resource. MBCR makes no representations or guarantees that all medical bill issues will be resolved. MBCR pledges to do the absolute best to advocate on your behalf with your help. 

© 2021 Medical Bill & Claim Resolution (MBCR)