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How Do You Know If You Are Due a Refund on Your Medical Bill?

Updated: Aug 18, 2023

If you are one of the thousands of American patients owing huge sums of money to a hospital or your doctor, add another kind of problem to the list: reports from communities around the country show that it can often be extremely difficult to get your money back if you are due a refund on your medical bill from your doctor's office or other healthcare provider.

Did I say "overpay"? How does this happen? Medical bill overpayment, like many other kinds of clerical errors, can often be attributed to the unnecessary complex 'triangular' billing arrangement between a provider, a patient, and that patient's health care insurer. Over the years, most American consumers have become convinced that getting insured is the right way to go to avoid high health care costs and risks of medical bankruptcy. Paying out of pocket for medical care has become impossible for the vast majority of Americans, and so, many of us, by various means, have lined up to sign onto a policy from a health care insurer in our state of residence.

With consumer directed health care plans and high deductibles, though, that is no longer the case.

In many cases, consumers overpay on medical debt because they get an obsolete bill from their provider. The bill that they got from the provider does not show submission to the insurance company, which may have happened in the interim. Nor does it show any payment. However, in many cases, the provider billed late, or the insurer paid late, or both. Patients who don't understand the complicated dance of health care finance often open their wallets before questioning a bill, only to find that money tied up in red tape when they iron the issue out.

Another example is when your provider does not verify your insurance benefits prior to your visit. You arrive to your appointment and may be expected to pay your deductible and or co-pay, at the time of service. The medical office's staff may ask you if you have a co-pay. You don't know exactly and hand over your card. There may be an amount listed on your card but it may not apply for the physician type you are visiting. The staff person may then take that amount and tell you if it is less, you will receive a refund. The foolproof way is to actually verify the benefits with your insurance carrier. While forward thinking practices are doing this, many are not.

Making Overpayments Right It can be great news to get an updated letter from your health care provider stating that, in fact, your insurance has paid your bill for you. The trick can be getting back that money that you already paid to your doctor's office.

One big problem is the use of inferior billing services. Providers may sign up for automated accounts receivable and accounts payable finance without asking the tough questions about how they are represented by this specialized office. In some cases, the finance company doesn't treat accounts payable with the same care that they do the other side of the operation. Companies can be aggressive in collecting money from patients but very slow to dole it back out if there has been a mistake. Stories of patients waiting months to get medical refunds often show up in the news when these discouraged 'creditors' turn to their local media for help. When the news reporters have to show up to get a check in the mail, there's something wrong.

What can you do to protect yourself? Consumer advocates suggest always checking the explanation of benefits form or EOB from your insurer and make sure that it matches the bills that you got from a provider. And, know what your co-pay, deductible and coverage is before you show up at your doctor's office.

MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

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