How to Challenge Incorrect Medical Diagnoses and Bills

Understanding Medical Errors

1 in 20 adults experience diagnostic errors annually according to Johns Hopkins research. Common billing mistakes include: - Duplicate charges - Upcoding (billing for more expensive services) - Unbundled procedures - Phantom charges for never-received services

Step 1: Obtain Complete Records

Request these documents within 45 days under HIPAA:

1. Itemized bill with CPT codes
2. Complete medical records
3. Doctor's clinical notes
4. Lab/test results
5. Insurance Explanation of Benefits (EOB)

Step 2: Analyze for Errors

Use CMS.gov's CPT code lookup tool to verify procedure pricing.

Step 3: Formal Dispute Process

1. Contact provider billing department in writing
2. File appeal with insurance company (strict deadlines apply)
3. Submit complaint to:
   • State insurance commissioner
   • CMS (for Medicare/Medicaid)
   • Consumer Financial Protection Bureau

When to Seek Legal Help

Consider professional assistance if: - Errors exceed $1,000 - Credit score impacted - Potential malpractice involved

Prevention Strategies

• Always review EOB statements
• Ask for diagnosis coding in writing
• Use patient advocacy services
• Negotiate payment plans directly

This article provides general information, not legal advice. Consult professionals for specific situations.