What Happens If an Insurance Bill Is Inaccurate?

Inaccurate insurance bills are more common than you might think, and they can lead to significant headaches if they aren’t managed properly. So, what actually happens when you get an incorrect insurance bill? Let’s break it down step-by-step.

What Happens When You Get an Incorrect Insurance Bill?

Step 1: Identify the Inaccuracy 

Typically, your client will notice the error and reach out to you for help resolving it. Common issues include being billed for an ineligible employee or seeing an inflated total that doesn’t match your employer client’s records. Pinpointing the mistake is essential so you can start the resolution process. 

Step 2: Contact the Carrier

Once you’ve identified the issue, your next step is to contact the insurance carrier. Typically, you will reach out to their client service team on behalf of your client, explain the error, and ask for a correction.

Step 3: Carrier’s Response

Most of the time, the carrier’s response is straightforward but less than ideal—they’ll tell you to have the employer pay the incorrect bill for now, with a promise to adjust it on the next invoice or issue a reimbursement later. While this might address the immediate concern, it adds work on your employer’s end.

Step 4: The Employer Will Make Adjustments on Their End

Until the correction is reflected in their billing, the employer will need to track that overpayment in their accounts payable system, noting the amount and setting reminders to verify that future bills include the promised adjustment.

Step 5: Follow-Up

Unfortunately, billing errors often require more than one call to fix. Following up with the carrier might become necessary if the adjustment isn’t processed as promised, and this process can stretch on for months, consuming time and resources.

Why Do Insurance Bill Inaccuracies Happen?

One primary reason for insurance bill inaccuracies is a lack of synchronization between eligibility and billing systems. 

Here’s how it usually goes wrong:

When an employee leaves your client’s company, or they’re no longer eligible for coverage for another reason, you inform the carrier to terminate their benefits. But while the coverage is ended, the billing department might miss this update, leading to ongoing charges for someone no longer with the company or needing coverage. This disconnect is especially common when eligibility and billing operate on separate systems, leading to errors that frustrate you and your employer clients.

Risks of Inaccurate Insurance Billing

Incorrect billing can create several issues:

• Overpayment or Underpayment: The employer could end up paying for an ineligible employee or face coverage lapses that may lead to denied claims if the payment doesn’t match the correct amount.
• Administrative Burdens: Fixing these errors requires time and resources to track adjustments, communicate with carriers, and manage any payroll impacts.
• Eroded Employee Trust and Morale: Inaccurate billing affects employees directly, potentially causing paycheck deduction errors or even coverage interruptions, which can hurt their trust in the company.
• Increased Claim Disputes: Delays in updating eligibility with the carrier can lead to claim denials, sparking potentially lengthy disputes.

How BernieBill Can Help

BernieBill is an integrated billing solution that keeps your insurance bills accurate by directly connecting eligibility data from your BerniePortal benefits administration system to billing.

Here’s how it works: When an employee’s eligibility changes—whether they’re added or removed from coverage—BernieBill updates in real time, so your bill is always correct. This eliminates the need to manually update information, make follow-up calls, or manage separate systems. Your employer clients will no longer pay for ineligible employees or deal with surprise charges, and you’ll save yourself the hassle of tracking adjustments or worrying about costly errors. And– we’ll never ask you to pay an inaccurate bill. 

With BernieBill, you can trust that your insurance bills automatically reflect the latest eligibility data. It’s an easy, efficient way to prevent billing headaches for you and your clients—ensuring accurate bills every time.

Additional Resources: 

• Brokers’ Corner Podcast—watch and subscribe to the Brokers’ Corner podcast, which dives into the topics that affect your agency and industry and identifies strategies so you can protect and grow your book of business 
• BerniePortal Brokers’ Council—a council of benefits brokers from across the country that advises BerniePortal on industry concerns, trends, and the ways technology can best support their agency and employer groups 
• BerniePortal for Brokers—leveraging technology to increase your agency valuation and support your employer groups is easier than ever with BerniePortal’s software solution, built for brokers by brokers