Issue:
A billing discrepancy was identified by the customer, prompting an inquiry regarding the resolution process.
Cause:
- Insurance claims still pending or recently processed
- Duplicate or overlapping charges
- Services billed before coverage or adjustments were applied
- Coding or posting errors
Resolution:
When a patient reports a billing discrepancy, follow these steps:
- Verify patient and bill details
Confirm the patient’s identity and collect the bill number, date of service, and disputed charge. Review billing and insurance records
Compare the billing statement with services rendered and insurance processing (EOB, adjustments, or pending claims).Confirm or Identify the cause
Common reasons include duplicate charges, insurance not yet applied, or pending adjustments.Correct or explain
If an error is found, submit a correction or apply a credit. If charges are valid, explain the reason clearly to the patient.Document and confirm
Record all actions taken and confirm next steps with the patient, including when an updated statement will be issued.
Escalation / Next Steps
Escalate to the billing or insurance resolution team if:
- The discrepancy cannot be resolved during the interaction
- The balance is significant
- Financial hardship or care impact is identified
Offer payment plan or financial assistance options when appropriate.