Getting a medical bill in the mail can be both confusing and overwhelming. The pages contain strange codes and terms that make it hard to understand what you are being charged for.
What’s on Your Medical Bill
The first thing you will likely notice on your medical bill are dates of service. This shows when you had appointments, procedures, or other care. Under this will be a list of medical billing codes and charges for each date.
Medical billing codes are a series of letters, numbers, or both that describe services in detail. According to the experts at Find-A-Code.com, each code represents a specific test, treatment, or service. Thousands of codes exist for all types of care, from an office visit to a complex surgery. The more complex or lengthy the care, the more codes will be listed.
Next to each code will be a charge amount. This is what your insurance company is billed. If you have insurance, the amounts listed may reflect negotiated rates between your provider and insurance company. The final charge you actually owe will depend on what your plan covers.
At the end is the total amount billed to insurance and your responsibility. This will reflect copays, deductibles, coinsurance, and any non-covered services.
Common Billing Codes and Terminology
The codes on your bill use medical terminology and abbreviations for tests, treatments, and services. Here are some examples of what commonly used codes represent:
- E/M Codes: Evaluation and management codes for outpatient office visits. Based on the complexity of visit.
- CPT Codes: Current Procedural Terminology codes that describe medical procedures and services.
- HCPCS Codes: Healthcare Common Procedure Coding System codes used for supplies, equipment, and drugs.
- ICD-10 Codes: International Classification of Diseases codes that describe diagnosed conditions.
- Modifiers: Two-digit codes added to CPT codes to show circumstances requiring more resources.
Knowing what these codes signify can give you insight into what care you received and why you were charged for it.
Interpreting Itemized Charges
Once you understand the different types of medical billing codes, you can use an itemized bill to get more detail on what specific services you were charged for. Itemized bills provide greater transparency by linking individual codes to precise services and costs.
For example, you may see a CPT code such as 36415 listed for $100 beside a date of service. Looking up code 36415 reveals it is for routine venipuncture, meaning a basic blood draw. Having this itemization makes it clearer what you were charged for compared to just seeing a total lab charge.
Requesting an itemized bill from your healthcare provider ensures you have deeper accounting of provided services. You can use the increased visibility to validate accuracy, check for errors, and understand costs related to your care. Comprehending itemized charges takes some work but is invaluable for fully decoding your medical bill.
Getting Support for Understanding Your Bill
Trying to analyze pages of unfamiliar codes can quickly get overwhelming. If you need help to make sense of your medical bills, several resources are available:
- Call your healthcare provider’s billing office – Ask questions about any codes or charges you are unsure of.
- Talk to your insurance company – They can explain covered vs non-covered services, negotiate disputed charges, and more.
- Consult online code directories – Lookup tools like the CMS HCPCS or ICD-10-CM codes can define billing codes.
Conclusion
Being an informed and proactive patient when it comes to your medical bills is important. Identifying errors early and understanding charges related to your care allows you to better manage healthcare expenses. While codes may seem confusing at first glance, resources exist to provide clarity around your bill.
