CBS Philadelphia helps recover refund after medical billing error

CBS News

30-06-2025

How to avoid a medical bill error | In Your Corner
How to avoid a medical bill error | In Your Corner
How to avoid a medical bill error | In Your Corner
Opening up a medical bill with a bigger balance than you expected can be a stressful surprise. It could also be a mistake.
Edmund Bulmash contacted In Your Corner for help after he received a big bill for a procedure he'd thought was covered by his insurance.
The 74-year-old Camden County, New Jersey, man went in for a tooth extraction in February, a procedure his primary care dentist doesn't provide. So Bulmash said he found an in-network oral surgeon and scheduled the surgery.
But afterward, he said he was shocked to be hit with a $930 bill, significantly higher than what he expected.
"It's a lot of money," he said. "I'm a retiree on a fixed income."
Bulmash reluctantly paid it.
"It was definitely in the network; otherwise, I wouldn't have used them," he said. "So I thought it would have some portion of it compensated."
CBS News Philadelphia reached out to Bulmash's insurance provider, Horizon Blue, which agreed to look into his case.
A few weeks later, Bulmash said he received a check in the mail for a partial refund of $340, along with an explanation stating he should've only been billed $590.
Turns out, Bulmash was incorrectly charged the provider's out-of-network rate, but ultimately still owed out-of-pocket because his particular dental plan only covers primary care services.
"I'm happy," Bulmash said. "I mean, it's not $930, but I'm happy."
In an emailed statement, a spokesperson for Horizon Blue said Bulmash's case, "is a reminder that people can contact their insurance plan before getting care if they have any questions, want to discuss options, or understand ways they can lower their out-of-pocket costs."
The statement went on to read, "While we were able to get Mr. Bulmash a refund of monies he was owed by the dentist he chose for his care, we always prefer to help members understand their benefits and get the care they need at the price they expect."
Kevin Brasler, executive editor with the Delaware Valley Consumers' Checkbook, said when you get a surprise bill, don't immediately pay it.
"As a consumer advocate, this is kind of strange to say," he said. "But paying for healthcare itself is just enormously complicated."
Brasler says it's important to do your homework to determine if it might be an error, or if your insurer just didn't pay the claim yet, or if the provider billed incorrectly.
"So start by calling the provider and say, 'I got this bill can you explain it to me? Why am I responsible for this amount of money versus what I expected?" he said.
Ultimately, if you are billed correctly but still owe a large balance, Brasler said you have other options to consider:
You might qualify for a financial assistance program. Many hospitals offer assistance in various ways -- for example, price discounts, lowered or eliminated copays and deductibles.
You can request a payment plan. Providers typically allow you to pay bills over time, without interest.
You may even be able to negotiate a lower price.
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