May 29, 2024

What Can Medical Overbilling Cost You?

Taylor Byas
Taylor Byas
AF Customer Engagement & Content Writer

If you’re spending a lot on medical bills, you’re not alone. Healthcare costs are projected to rise about 4.5% each year, and while some employers foot the bill for health insurance, those steady increases will likely result in higher premiums, copays, and out-of-pocket costs.

You chose your FSA or HSA because you saw value in maintaining a separate, dedicated account for your qualifying medical expenses. And if your contributions aren’t quite keeping pace with your medical spending, you might be inclined to chalk it up to the rising prices we just talked about.

You may instead be encountering signs of medical overbilling. This is not an uncommon problem, as over half of medical bills contain some kind of error. You may be unable to prevent these errors, which may be genuine mistakes or malicious behavior from a healthcare provider. Below, we’ll talk more about what overbilling is and what causes it, as well as how you can protect yourself.

Above all, we encourage you to take a closer look at your rising bills instead of just writing them off as a sign of the times.

What is Medical Overbilling?

In short, medical overbilling is when you (and/or your insurance company) are billed for more than you should be for healthcare-related visits and treatments.

Every treatment, visit, or procedure out there has a designated code. There are thousands upon thousands in existence, acting as a medical shorthand that allows a patient’s records to move from place to place and doctor to doctor with them, if necessary. If you look at a recent bill or Explanation of Benefits, you’ll see the codes for your visits, treatments, and procedures.

The codes themselves are updated frequently; as a result, medical billing is its own field, requiring continuing, specialized education.

A single error in a code can change everything about a bill.

What Kind of Billing Mistakes Are Out There? 

The three most common types of overbilling are upcoding, unbundling, and misrepresentation:

  • In upcoding, you are billed for a more expensive visit or treatment than you received.
  • In unbundling, a healthcare professional bills out services separately instead of as a less expensive bundle.
  • In misrepresentation, you may be billed for a service you didn’t receive or billed for a doctor’s time when you saw a nurse practitioner.

That’s not all that can go wrong, though. Other issues that lead to overbilling and the mistakes in 80% of all medical bills include:

  • Network confusion. Your doctor may be in-network, but the hospital they practice out of isn’t. Or your facility might be in-network, but the attending physician you see isn’t.
  • Physician mistakes. The wrong dosage of a drug may be administered, for example, or a doctor may check your left hand instead of your right. This seems far-fetched—a doctor checking the wrong limb?—but in today’s fast-paced medical world, it can happen more frequently.
  • Genuine errors. Charts can be misread or numbers transposed. Mistakes do happen, but they can impact an entire bill.

How Can I Tell If I’m Being Overbilled?

The complexity of medical coding makes it difficult to immediately see whether your bills are incorrect. Your first warning is, unfortunately, often a more expensive bill than you expected.

If you know you’ll be booking multiple appointments, possibly with specialists (say, this year you need to see the dermatologist, get new glasses, and hopefully fix your carpal tunnel), a good rule of thumb is to provide as much information up front as you can to your insurance company so they can provide you with quotes. These often won’t be exact, but they’ll be ballpark figures and something you can measure your subsequent bills against. If a bill is wildly over what your insurance quoted, it’s a sign that something isn’t quite right and you would do well to investigate.

How Can I Protect Myself from Overbilling?

Unfortunately, there’s not a lot you can do on your own to prevent overbilling and other bill-related errors. The best way to keep up with your medical bills is to request an itemized version upon every visit. The itemized invoice lets you see every single service that was performed and charged.

But as mentioned above, reading medical bills isn’t a skill you can pick up over coffee. You can generally look up your codes and make sure you were being billed for the correct services, though this takes some trial and error.

Or you can save hundreds of hours and headache by signing up for HealthLock for Mastercard®. They’ll flag items that contain potential errors, overbilling and wrongful denials to help you save.

Mastercard® FSA and HSA cardholders get HealthLock Medical Claim Monitor for Mastercard® at no monthly cost, plus a premium upgrade for the first 90 days and no auto-billing.

You already know medical care can be expensive. By guarding yourself against overbilling, you can help protect your savings accounts and your finances going forward.


Terms & Conditions

HealthLock is an end-to-end analytics-driven platform that helps protect cardholders’ medical identities and data and monitors their medical claims for errors, fraud and overbilling. HealthLock provides three plan levels:

  • Medical Claim Monitor: Helps guard against medical fraud and privacy intrusions by monitoring medical data breaches, providing alerts and helping remediate medical fraud issues.
  • Medical Claim Auditor: Organizes, tracks and audits all healthcare claims (24-month retroactive audit and ongoing auditing) in one place, verifying that all claims are accurate and identifying potential overcharges and insurance errors. This level includes everything from the previous plan.
  • Medical Claim Saver: Provides access to medical bill negotiation with providers and insurance companies to potentially help reduce bills and reverse claim rejections. This level includes everything from the previous plan.

Enrolled users receive, at no cost, Medical Claim Monitor, plus a premium upgrade to Medical Claim Saver for the first 90 days. After 90 days, users will continue to receive Medical Claim Monitor at no monthly cost and have the option to continue with Medical Claim Auditor for $4.99 per month or Medical Claim Saver for $19.99 per month. See full terms here. All third-party trademarks are the property of their respective owners.

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