HOW TO FIGHT HOSPITAL NEGLIGENCE IN OVERCHARGES ON YOUR BILL

Part 1

Are you willing to pay $25.00 for a single aspirin? It may sound outrageous, but many hospital bills contain outrageous charges for items that are marked up over 1,000 percent! The majority of people believe that hospital bills are accurate, and the hospital does everything possible to dissuade patients from challenging errors on their bills.  However, recent studies indicate that over 80% of hospital bills contain errors (according to Medical Billing Advocates of America)!  The odds are overwhelmingly stacked against your receiving a correct hospital bill.  And ironically, less than 5% of patients even look at their billing invoices, they just go ahead and pay, or make arrangements to pay exhorbident fees and charges, many of which are grossly inflated, or even for items or services not actually provided, or which have already been paid for through insurance.

On top of this, our offices have seen an increase in hospitals becoming more aggressive and wasting little time sending people to collection agencies, or filing liens against them for outstanding medical bills. The Federal Reserve reported in December, 2012, that medical bills account for over half of all debts in collection.  If that happens, your credit score can be seriously damaged.  Did you also know that if you don’t have insurance and pay your own health care costs, you may be paying over 33% more than discounts given to insurance providers for the same services?

To protect your health and your wallet, here are steps to avoid, or to help  identify medical billing errors:

1. Make sure that your personal information is correct before being admitted. Make sure that all personal and insurance information the hospital collects is correct and up-to-date.

2. Make sure you understand the procedures that will be performed.  If you are unsure ask to speak with hospital staff to find out exactly what will be taking place.  Make sure to check with your insurance provider that the procedure being performed is covered by you insurance plan.

3. When checking into the hospital for any procedures, take a friend or family member along. You might not be thinking clearly the day of entering the hospital, which is why it’s important to have someone there on your behalf.  Have the person accompanying you closely record the treatment(s) you are getting during your hospital stay.

4.  After your stay at the hospital, no matter what type of procedure, surgery, emergency room visit request an  “itemized” bill.  This cannot be overemphasized.  You should never pay the total summary bill without reviewing in detail an itemized account of the charges. Also, never pay the total bill when you leave the hospital, even if you are told it’s mandatory. Instead, inform hospital personnel that you require an itemized bill before making payment.  In a summary bill, you won’t be able to see if the individual services are really the one you received, nor could you spot duplicates.  Always ask for the itemized bill.

If you received the summary bill in the mail, call the hospital or clinic and request to speak with the billing department and request that they send the itemized bill to you. Larger hospitals and clinics often have dedicated staff for accounting and auditing bills, so use them.

If it’s a co-pay or coinsurance that should have already been paid at the time of a doctor’s visit, you may still accidentally get a bill.

5. Look for duplicate charges.  Every little item has a different charge, and code that the hospitals and doctors use to identify the service, this varies from the tools on the surgical tray, to the thread used in stitches.  There are a variety of individuals who record what was used, and what the charges within a hospital or clinic should be, which creates the 80% rate on inaccurate billings. If your see a charge for a procedure, then see additional charges for the individual items, chances are these are duplicate charges. Now that you have your itemized bill, these are easier to spot.

HOW DO I PROTECT MYSELF FROM HOSPITAL NEGLIGENCE IN OVERBILLING

Part 2

Although billing errors probably aren’t the first thing that comes to mind when you think of hospital negligence, it’s something nobody wants to have to deal with after going through a medical procedure.

Coding is the process of assigning numerical codes to a patient’s diagnoses and procedures for the purpose of billing.  Thereafter billing is done in order for the hospital and health care providers, like physicians, to obtain reimbursement for the services provided to patients. Once the codes are billed to the payer, the insurance company reviews the claim and makes reimbursements based on the code assignments.

There are literally numerous books with thousands of pages to describe billing codes and procedures.  These have been put together for the benefit of the hospitals and care providers so they don’t overlook charging a dime.  With literally thousands of codes to choose from, it is no wonder that errors are present on 80% of bills sent to patients. In cases where the insurance company denies a claim, additional documentation or correct code assignments may be warranted and should be requested.

There are many sources who can help guide you through the maze created by the voluminous codes, procedures and explanations which are oftentimes more complicated than the actual procedure.  Companies such as Advantage Medical Review have built entire businesses out of helping consumers decipher hospital invoices.

Hospital, or acute care coding, is reported mainly through a classification system known as ICD-9-CM code assignment. For outpatient procedures and some payers (like Medicare and Medicaid), an additional coding classification called CPT is used.  A much greater detailed guide of CPT codes can be accessed on the American Medical Association web site, www.ama-assn.org.

Some of the most common errors: Bundled items…

Say you get charged for a surgery. Then you get charged for the tray being used for the surgery. You are probably being overbilled. Hospitals are notorious for doing things like this.

Beware of items such as:

-Shampoo

-Soap

-Toothbrushes

-Toilet paper

-Kit

-Tray

If you are charged for these items and also billed for “room and board” or “doctors office visits” fee, then you’re likely being double charged.  Call the hospital or clinic to ask what amenities are covered under those vague terms.

Look for upcharges.  Sometimes your hospital or practitioner bills for a more expensive service than was actually performed.  These are called upcharges and are often clerical mistakes made from office staff when entering procedure codes. This can often include services that you didn’t receive at all.  By contacting your physician, you can confirm if these services were truly the ones performed.

Compare charges on your hospital bill against your health insurance coverage. In addition to the medical bill, you will also get an explanation of benefits (EOB) from your health insurance company.  Compare the two documents to make sure each has matching charges.  If they match, but you believe the bill is too much, then contact the hospital or clinic. If the EOB doesn’t match the bill, then your insurance company may be overcharging you.  If you have a co-pay, this will not matter much to you since you are paying a flat fee regardless, but if you have a co-insurance, you are paying a percentage of the services and will want to keep the total cost of care as low as you can.

How to get a reduction in the charges.

Now that you have your checklist of services you identified as being questionable, here are three steps to take that will help save you money.

1. Request a review

If the error is on the medical bill, a telephone call to your doctor or hospital asking for a review of your bill may clear things up. Among larger clinics or hospitals, this is sometimes called an “internal audit,” and they have in-house auditors who are there to do this.  Obviously, if they have internal auditors, this is not the first billing error they have encountered.  Additionally, some offices have ombudsman office who can assist in decoding your bill.

If you notice different charges on your insurance explanation of benefits (EOB), you should call your insurance company to ask the reason for this difference. It may be an error and easily corrected.

2.  Ask your physician if they ordered the service

Check with your doctor whether the services in question on your bill were indeed requested for you.  You can’t be charged for a service that your physician didn’t order…in writing.  When your doctor orders treatments or services, they send them directly to the labs or other facilities where your treatment takes place.  Often times you will never see this order, so if you are unsure about a treatment, call your physician and ask that they confirm in your medical records.

3.  Challenge health insurance denials

For any case where your health insurance has denied coverage, you should always challenge it. It could be a clerical error, wrong diagnosis code, missing modifiers.  At best it will be approved, at worse you will have lost nothing by trying.  Calling your insurance company could resolve the issue over the phone. If that doesn’t work, look over your insurance plan to understand the appeals process, including timelines.  Request a letter from your physician explaining why it was necessary to use that facility or treatment (e.g. the only hospital with that equipment; the only specialist; etc.). Write a detailed letter of your own as to the reason why you are appealing, any details about the service charge, claims numbers, dates, doctor name, and so on.  When you submit your appeal, include both of these letters to your insurance company’s appeals address. I’d recommend photocopying them, and mailing them with some type of confirmation (certified mail or equivalent), as proof you sent it if required in the future. You should also follow up if you don’t hear a response after 30 days.

Alert:  Beware of 30-60 day markers

If you are not able to resolve the charges in question by the time the medical bill is due, then you should consider paying the itemized charges you are not challenging. Some hospitals or clinics have 30-60-90 day notices, but it’s best to watch them closely. After 60 days, if things are not resolved, your unpaid bill could be sent to collections, and this could hurt your credit score. If you suspect this of happening, run a credit report to see if your unpaid medical bills show up. If so, contact your credit card company to inform them of the dispute, which often will lead to them reviewing or even correcting the report.