Receiving a high medical bill can be stressful, especially if you believe it's inaccurate or excessive. In Wisconsin, you have rights as a consumer to dispute medical bills and work with insurance companies to resolve issues.

Understanding Your Rights

• Patient Protection and Affordable Care Act (ACA): This federal law requires insurance companies to provide clear explanations of benefits and coverage.
• Wisconsin Fair Claims Settlement Practices Act: This state law outlines specific guidelines for how insurance companies must handle claims.

Steps to Dispute a Medical Bill

1. Review the Bill Carefully:

   • Check for errors, such as incorrect procedures, services, or dates.
   • Verify that the charges align with your insurance plan's coverage.

2. Contact the Healthcare Provider:

   • Reach out to the billing department and explain your concerns.
   • Provide documentation to support your claims, such as medical records or insurance explanations of benefits (EOBs).
   • Be polite and persistent.

3. File a Grievance with the Healthcare Provider:

   • If you're not satisfied with the provider's response, file a formal grievance.
   • Follow the provider's specific grievance process.

4. Contact Your Insurance Company:

   • Review your insurance policy to understand your coverage.
   • File a claim with your insurance company and provide all necessary documentation.
   • If you disagree with the insurance company's decision, appeal the denial.

5. Seek Help from a Patient Advocate:

   • A patient advocate can assist you in navigating the complex healthcare system.
   • They can help you understand your rights, negotiate with providers and insurers, and file appeals.

Additional Tips:

• Keep Detailed Records: Maintain copies of all medical bills, insurance EOBs, and correspondence with providers and insurers.
• Be Persistent: Don't give up on disputing a bill, even if it takes time and effort.
• Consider Mediation: If you're unable to resolve the issue directly with the provider or insurer, consider mediation.
• Know Your Options: If all else fails, you may need to seek legal advice or file a complaint with the appropriate regulatory agency.

By understanding your rights and taking proactive steps, you can effectively dispute medical bills and ensure you're paying only for the services you received.

Attorney Nathan DeLadurantey offers free consultations to explain your legal rights in Wisconsin. Free consultations can be scheduled online.