The Wrong Number
Tom says he checked the total. TSL notices a different patient’s name on the bill.
Explore the real law behind this episodeTranscript
TSLTom calculated her offer using someone else's bill.
Tom BriggsThe medical total is right here. We checked it.
TSLYou checked the number. Try the name.
TSLCheck the patient name, treatment dates, and charges on the records used to evaluate your claim. Flag mismatches and request corrected documents before relying on the total.
The Wrong Number: Checking the Records Behind an Offer
Tom calculates an offer from another patient's bill. Checking the arithmetic is not enough when the underlying document belongs to the wrong person. Start with identity and treatment details before relying on the total.
Check the document, then the calculation
Compare the patient name, provider, service date, account or invoice reference, and services listed with your own records. Identify the specific mismatch and ask which documents were used in the evaluation. Request a corrected calculation and an explanation of the change. A wrong document may increase or decrease a total; finding it does not automatically establish the proper settlement amount.
Use the right correction process
A mistake in an insurer's claim summary should be raised with the claims representative. A mistake in your medical or billing record may also require contacting the provider or health plan that maintains it. HHS explains that HIPAA-covered providers and plans have processes for requesting amendments. A request may be denied, and a statement of disagreement may then be available; disagreement alone does not require rewriting a record.
Keep a careful record of the correction
Save your request, the response, and replacement documents, identifying which earlier document was superseded. Recheck the corrected total for duplicates or missing dates. If the packet contains another person's private information, notify the sender and request secure handling instructions instead of forwarding it widely. Provide your own identifying details through an appropriate secure channel, using only what is needed to locate the error.
Questions this episode raises
- Can the claims adjuster amend my doctor's medical record?
- A claim-file correction and a provider-record amendment are separate processes. Contact the organization maintaining the medical record for its amendment procedure.
- Does fixing a wrong bill prove the rest of the offer is correct?
- No. Review the replacement documents and calculations, and separately evaluate the evidence, losses, coverage, and settlement terms.
Sources and further reading
Episode explanation by Impact Legal. Updated .