Charged twice? How to find and remove duplicate charges

The same charge shows up twice on your bill. Maybe it's a mistake. Maybe it's 2 doses of the same drug. This guide shows you how to tell the difference and how to get a true duplicate removed. It's part of our guide on how to lower medical bills.

You'll need an itemized bill, which lists every charge. If you have insurance, you'll also want your explanation of benefits (EOB) for the same visit.

What does a duplicate charge look like?

A true duplicate is the same service billed twice for 1 event. On an itemized bill, look for 2 lines that match on all 4 of these:

• The billing code
• The date of service
• The quantity
• The description and price

If all 4 match and you got the service only once, it's likely a duplicate. If any of them differ, look closer before you call.

When 2 lines aren't a duplicate

Some care really does repeat. These are common reasons for 2 similar lines that are both correct:

• 2 separate tests. You might have an x-ray before a procedure and another one after it. Check the times or your visit summary.
• Both sides of the body. Care on both knees or both eyes can be billed as 2 lines. The codes may be marked LT and RT, for left and right.
• Daily charges. A hospital room is charged by the day. Compare the number of room charges with the length of your stay, and ask about any gap.
• Several doses. A drug given 3 times can show up as 3 lines, or as 1 line with a quantity of 3.

If a repeat doesn't fit any of these, ask the billing office to explain it.

Why a facility fee and a doctor's fee aren't duplicates

A hospital visit often creates more than 1 bill for the same day. The hospital bills for its rooms, equipment, supplies, and staff. That's the facility fee. The doctors who treated you bill for their own work.

So an emergency room visit can appear on the hospital's bill and on the emergency doctor's bill. An x-ray can appear on the hospital's bill for taking it and on a radiologist's bill for reading it. Medicare explains that for outpatient hospital care, you usually pay the doctor and also pay the hospital a copayment.

These aren't duplicates. But each bill should charge for its own part only once.

What code 18 on your EOB means

Your insurer checks claims for repeats. If it decides a line is an exact copy of one it already processed, it won't pay it again. Your EOB may then show claim adjustment reason code 18, "exact duplicate claim/service."

Code 18 usually comes with the letters OA, for other adjustment. Amounts you owe are marked PR, for patient responsibility. So code 18 means your plan caught the repeat, and the amount isn't listed as your share.

That's good news, as long as the provider doesn't bill you for the line instead. Check that it isn't on your bill as something you owe. Our guide to denial codes on your EOB explains other codes you may see.

Why do duplicate charges happen?

Duplicates can come from simple slips in a busy billing office. For example:

• A charge was entered twice by hand.
• A test was ordered twice but done once.
• A claim was sent again, and its charges were posted a second time.
• A late charge was added after the first bill went out.
• 2 accounts for the same visit were merged.

None of this means anyone did something wrong on purpose. It does mean a quick check can save you money.

What to do about a duplicate charge

1. Get the itemized bill. If your bill shows only totals, ask for an itemized one. See how to get an itemized bill.
2. Mark the lines. Circle both lines and note the code, date, quantity, and price.
3. Check your records. Look at your visit summary, test results, or discharge papers. If you have insurance, compare the lines with your EOB. Our guide to the EOB vs. medical bill shows how.
4. Call the billing office. Name the lines that look doubled and ask them to check your medical record. Ask them to hold your account while they check.
5. Put it in writing. If the call doesn't fix it, send a letter. Our duplicate charge letter gives you the words.
6. Ask for a corrected bill. If you have insurance, ask them to send a corrected claim too. Then check the new EOB.
7. Ask for your money back if you already paid. Our guide to getting a medical bill refund explains how.

If the provider won't remove a charge you believe is doubled, see how to dispute a medical bill. A duplicate is just 1 of the common medical billing errors, so check the rest of the bill while you're at it.

Say Priya had knee surgery at an in-network surgery center. She had already met her deductible, so she paid 20% coinsurance. Her EOB listed 3 lines.

Service	Amount billed	Allowed amount	Plan paid	You may owe	Code
Knee surgery (facility)	$9,800	$4,200	$3,360	$840
Knee brace	$250	$120	$96	$24
Knee brace	$250	$0	$0	$0	OA-18
Total	$10,300	$4,320	$3,456	$864

Her bill from the surgery center asked for more.

Line	Amount
Total charges	$10,300
Insurance payment	−$3,456
Insurance adjustment	−$5,730
Amount due	$1,114

The bill asked for $250 more than her EOB. The adjustment covered the plan's discount on the surgery and the first brace: $5,600 plus $130. Nothing covered the second brace. Her plan had marked it OA-18, and the surgery center billed it to her instead.

Priya got 1 brace. She called the billing office, pointed to the OA-18 line, and asked for a corrected bill of $864.

Her surgeon's bill for the same day wasn't a duplicate. That was the doctor's fee for doing the surgery.

When to get help

You can often fix a duplicate charge with a phone call and a letter. It's worth getting help when:

• The billing office won't remove a charge you're sure is doubled.
• The bill has many repeats, and you can't tell which are real.
• The account is already in collections.
• You're managing someone else's bills and you're short on time.

Your insurer's member services team can confirm what it paid and why. The number is on your insurance card. A medical bill advocate can review the bill and make the calls for you. If the bill is already in collections, our guide to a medical bill in collections explains your rights.