ARE YOU SURE YOU OWE THAT MEDICAL BILL?

Medical billing mistakes happen more often than people think. We're here to help you check whether the bill is correct, understand what your insurance should cover, and decide what to do next if you still owe medical debt.

QUESTIONS TO ASK

FIND YOUR COVERAGE TYPE

UNDERSTAND YOUR BILL TO SPOT MISTAKES

MEDICAL CODING

Medical coding takes a doctor’s diagnosis, injury, treatment, or medical procedure and links it to the appropriate code.

MEDICAL BILLING

Medical billing takes information from the medical code and uses it to create a bill.

INSURANCE CLAIM

If the bill is sent to an insurance company, it is called a claim.

IF YOU DO NOT UNDERSTAND YOUR MEDICAL BILL, CALL YOUR HEALTHCARE PROVIDER OR INSURANCE COMPANY AND ASK THESE QUESTIONS

Can you explain these charges to me and confirm they match the care or treatment I received?

Should this service have been coded or billed differently?

If it were coded differently, would insurance cover more of the bill?

After insurance pays, what balance would I actually owe?

CHOOSE YOUR COVERAGE TYPE AND LEARN MORE

If you have private insurance, compare the bill with the Explanation of Benefits, or EOB, from your insurance company. The EOB is not a bill.

The EOB should explain:

How much the insurance company paid the healthcare provider

How much, if any, you owe the healthcare provider

Any deductible, copay, or other amount not covered by insurance

What to do next

Call your insurance company if you do not understand why you owe money

Ask for help reading the EOB if it is confusing

Pay the provider directly, not the insurance company, if a balance is owed

TennCare should cover medically necessary treatment or medication prescribed by your doctor. What counts as medically necessary can be complicated.

Important to know

TennCare payment to a provider is usually considered payment in full

A provider generally cannot bill you for the portion TennCare did not pay

This is called balance billing

TJC may be able to help if:

TennCare will not pay for treatment or medicine prescribed by your doctor

A provider billed you for a balance TennCare did not pay

You need help understanding your rights

If your healthcare provider incorrectly billed you for the balance of the bill that TennCare didn’t pay, we may be able to help. Fill out our intake form here.

CoverKids is available to pregnant women and children under age 19.

Cover Kids typically pays for:

Free preventive healthcare

Hospital stays, sick visits, and medication with very low copays

Dental and vision benefits for children under 19

Prenatal, delivery, and 60 days postpartum care for pregnant women

TJC may be able to help if:

CoverKids will not pay for treatment prescribed by your doctor

CoverKids will not pay for medicine prescribed by your doctor

You need help understanding a denial or bill

If CoverKids won’t pay for a treatment or medicine prescribed by your doctor, we may be able to help. Fill out our intake form here.

Medicare does not pay for everything. Coverage for tests, items, and services may depend on whether you have Original Medicare, a Medicare Advantage plan, or a PPO.

Where to start:

Check whether your test, item, or service is covered

Contact SHIP for free Medicare counseling

Call SHIP at 1-877-801-0044

TJC may be able to help if:

You need help paying out-of-pocket Medicare costs

You may qualify for a Medicare Savings Program

You need help understanding your options

If you are in the Qualified Medicare Beneficiary, or QMB, Program, doctors, suppliers, and other providers should not bill you for Medicare-covered services and items.

Providers should not bill you for:

Deductibles

Coinsurance

Copayments

Other covered Medicare service costs

What to do

Do not assume the bill is correct

Ask whether the bill is for a Medicare-covered service

Get help if you are being billed incorrectly

If you are having issues with a provider who continually attempts to bill you, or if you have unpaid cost-sharing bills that have been sent to collection agencies, call 1-800-MEDICARE

MEDICAL DEBT DEFINITIONS

BACK TO THE TOP

ARE YOU SURE YOU OWE THAT MEDICAL BILL?

UNDERSTAND YOUR BILL TO SPOT MISTAKES

CHOOSE YOUR COVERAGE TYPE AND LEARN MORE

STAY IN THE KNOW!