What We Check
We scan your bill for these common billing errors. Each one can add hundreds or thousands to what you owe.
Upcoding
Charged for a more expensive procedure than what was performed
Upcoding happens when a hospital bills for a higher-level service than what was actually provided. For example, billing for a comprehensive ER visit (Level 5) when you had a straightforward visit (Level 3). This can add hundreds or thousands of dollars to your bill.
Example: You went in for a minor issue and were billed as a critical care visit.
Unbundling
Services that should be billed together were split to increase cost
Unbundling occurs when a hospital bills procedures separately that should be covered under a single billing code. Federal billing rules define which procedures must be bundled together. Splitting them inflates your bill.
Example: A blood draw and the lab test were billed as two separate charges instead of one bundled code.
Duplicate Charges
Same service billed more than once
Duplicate charges are when the same procedure code appears multiple times for the same date of service. This is one of the most common billing errors and is often a simple data entry mistake that costs patients real money.
Example: Your blood panel shows up twice on the same day for the same amount.
Pharmacy Markup
Medications charged far above market price
Hospital pharmacies often charge dramatically more than retail for the same medication. We compare every drug charge against national drug pricing databases to find excessive markups. A $5 pill should not cost $150 on your bill.
Example: Acetaminophen (Tylenol) billed at $25 per pill when it costs pennies at a pharmacy.
Balance Billing
Charged more than your insurance's allowed amount
Balance billing happens when a provider bills you for the difference between their charge and the insurance-allowed amount. In many states, this is illegal for in-network providers. We compare your patient responsibility against your EOB (Explanation of Benefits) allowable amount.
Example: Your insurance allowed $500 for a procedure, the hospital charged $800, and billed you the $300 difference on top of your copay.
Modifier Errors
Missing or incorrect billing modifiers
Billing modifiers provide additional information about procedures. Missing or incorrect modifiers can lead to incorrect billing. For example, a modifier indicating which side of the body was treated, or that a procedure was performed by a different provider.
Example: A bilateral procedure was billed twice instead of once with a bilateral modifier, doubling the charge.