Help with Outrageous Hospital Bills
Many patients in Car, Motorcycle and Trucking Accidents suffer serious injuries which require overnight stays or surgery in a hospital setting. A recent client who visited a local hospital and stayed overnight was billed over $24,000 for a one night visit even though nothing was seriously wrong with him. Clients are often startled by the high hospital bill incurred after an emergency room visit or stays at local hospitals. Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.
Changes in Medicine – Greater Transparency in Medical Billing
While medical costs have been rising for years, the field of consumer advocacy with medical and hospital bills is undergoing tremendous growth. A part of the reason this is happening is because, starting in May of 2013, the government now releases data showing what Medicare charges for common hospital inpatient and outpatient procedures, and some doctors’ charges.
Since hospitals and doctors haven’t provided this information to consumers before, market forces haven’t been able to create efficiencies in the health care provider market.
By releasing this pricing information from providers across the country to consumers, (which the government knows from paying for services through Medicare), consumers are now better able to compare among different hospitals and different health care providers. This was done with the hope of increasing price competition among hospitals and health care providers, resulting in lower prices for consumers while keeping the government out of the business of setting prices for doctors and hospitals.
Press coverage on the wide variation in hospital charges by region is teaching the public just how sloppy, and even downright fraudulent, medical billing has become.
What medical advocates understand (and the majority of individual consumers don’t realize), is that the standard for what consumers must pay for being hospitalized is not whatever the hospital charges in the bill, but what charges are “fair and reasonable” for that hospitalization.
The hospitals and health care providers don’t check to be sure their bills are correct, and so there are often problems.
Hospital and medical care provider bills are often rife with duplication, charges which are a result of hospital and doctor mistakes, and inflated charges.
Unfortunately, a majority of hospital bills contain such inaccuracies. Recent studies show 8 out of 10 hospital bills are excessive and contain errors. While there have been medical bill advocacy firms since the mid to late 1990s, now those firms are so confident they can save consumers money that cases are paid on a contingency fee basis.
Most medical bill advocacy firms agree to charge no fee up front, and not to get paid unless they find mistakes in the bill and negotiate a discount for their client. Then their fee is a portion of the savings (usually 25% to 30%). The rate of errors in hospital bills is so high there is now a mini-industry built around helping ordinary folks deal with crazy excessive medical bills.
For folks that want to review and question their medical bills without hiring someone to help, cost estimating resources are slowly coming on-line. At Healthcare Bluebook (www.healthcarebluebook.com), one can get an estimate of a fair price for hospital services, physician services and anesthesia services for specific medical procedures in a geographic area by zip code.
At Fair Health Consumer Cost Lookup (www.fairhealthconsumer.org) one can estimate the costs of medical procedures by zip code. This latter website requires knowing the CPT code for the procedure (see discussion of CPT codes below). A limited number of CPT codes can be looked up through this site. Clear Health Costs (www.clearhealthcosts.com) provides zip code based hospital pricing information (drawn from the Medicare datasets released by the government in 2013).
Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.
Please call us today at 916.921.6400 or toll-free at 1.800.404.5400, or use our online contact form for a free consultation.
A medical advocate starts off their work by obtaining an itemized version of their client’s medical bills from their client’s hospital and doctors. This is not a summary bill, which lists broad categories such as surgical supplied, radiology, pharmacy, but a detailed bill, as is required under the AMA (American Hospital Association) Patient’s Bill of Rights.
Medical advocates also know to ask for a copy of the UB-04, which is the billing form used for Medicare and is the detailed bill sent to insurers. Since doctor’s orders and nursing notes contain references to all drugs, treatments and procedures administered, those are also sought from the hospital medical records department.
Bills from outside providers, like the ambulance company, or the anesthesiologist flesh out the details and are very helpful for a complete review. A thorough review will also include examining any Explanations Of Benefits forms (EOBs) from the insurance company, if the client has health insurance.
Advocates ask clients to write down what they recall about their hospitalization and procedures: how many days they were there, what medicines they were taking, what tests they underwent, any treatments they were given, and any other details they can recall which could flesh out the picture of what happened for the person reviewing their records. Individual clients know which medications they are allergic to, what procedures or treatments they would never agree to have, and knowing this information can be very helpful to eliminate inaccurate charges that can show up in the bills.
Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.
Medical Advocates Check for Use of Proper Codes
With those documents in hand, a medical advocate reviews and questions all of the hospital’s charges, meticulously going over many pages of charges, line by line. They check the ICD codes, which describe the medical diagnosis for a condition (International Statistical Classification of Diseases and Related Health Problems). ICD codes for various conditions can be found on the web.
More importantly, medical advocates check all CPT codes (Current Procedural Terminology codes for procedures and services). It is not unusual for hospital bills to list charges for treatments and services not received by the patient and/or not appropriate for the patient’s diagnosed condition.
CPT codes were created and are maintained by the American Medical Association, which has copyrighted its CPT coding system. Most service providers who use the CPT codes pay license fees to the AMA for being able to use them. This is where medical advocates’ experience in dealing with medical codes comes in handy, as individuals can’t just look up CPT codes on the internet (although Wikipedia has a general description of what they are and how the codes are structured into categories).
All HCPCS codes (Healthcare Common Procedure Coding System codes for those health related products, supplies and services not covered in the CPT codes) are checked as well. These codes are accessible to the public, because they maintained by the government through the Centers for Medicare and Medicaid Services. However, be forewarned that searching through HCPCS codes is time-consuming and incredibly frustrating for the uninitiated. This is where experienced medical advocates are simply better at wading through the voluminous tables and other materials available on the web.
Once the client’s notes, detailed hospital bills and appropriate codes are all on hand, then the actual review of the bills can begin. Remember that about 80% of medical bills contain errors, and one can be certain that those are not errors which result in the patient paying less than what is due. Not surprisingly, the errors found in medical bills almost universally result in overcharging, with insurance companies and individuals dramatically overpaying for what services and treatment were actually rendered.
Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.
Duplicate billings are incredibly common, are easy to spot, and are also the most likely to be inadvertent accidents by a billing clerk entering coding into the computer to produce the bill. Less easy-to-spot duplicates are when patients are charged for duplicate or multiple medicines and laboratory tests. All medications and tests ordered need to be checked against the doctor’s records to restrict the charges to only what was actually done.
Reviews of hospital bills have found charges for 5 transfusions where only 3 were given, or 3 tests when there was only one administered. Another common error is a keyboard error, where 30 room kits are charged instead of 3, or 200 instead of 2 (a simple keyboard slip can become quite costly).
Duplicate or multiple billing issues can also arise in connection with being charged for more than one doctor reading tests or scans. One doctor reads the test or scan, and unless you were specifically seeking to obtain a second opinion or consultation, you should not be charged for any other doctor’s reading of that same scan or x-ray.
Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.
Billing for the Hospital’s Mistakes
Another area of duplication on bills occurs when a test is not done correctly, and has to be re-done. If an X-ray is done two days in a row, this generally means the first one was inadequate and it had to be done again. Results of tests can be lost, resulting in the tests needing to be ordered again. This is the hospital’s mistake and patients should not have to pay for this.
When there are delays that are the hospital’s fault, a medical advocate will question having to pay for a longer hospital stay. Delays can occur in scheduling necessary tests before surgery, and even scheduling the surgery itself, if the hospital has over-booked its surgical suites. The medical charts will indicate the reasons for any delays, and an advocate will challenge those that are the hospital’s fault. Take note, if in a teaching hospital, for more rare medical conditions, a patient’s release can be delayed just so all of the residents get an opportunity to view this unusual disease or condition.
The most dramatic example of being billed for a hospital’s mistake is when a patent gets a hospital-caused infection. This happens for 5 to 10 percent of all hospital patients. The most common hospital-caused infection is pneumonia. Pneumonia can get into a patient’s lungs when nearby people cough (medical personnel and other patients in intensive care wards), or from respiratory therapy equipment that isn’t properly decontaminated. Other hospital-caused infections are simply a result of medical personnel not frequently washing hands. Whatever the cause, the patient should not have to pay for their hospital stay lasting longer when it was the result of the hospital’s mistakes.
A fairly common billing mistake that can save Emergency Room patients thousands of dollars has to do with the level of room for which they are charged. Both doctors and hospitals charge for ER services by level, from 1 to 5, with Level 1 requiring the least amount of medical equipment and supplies, and Level 5 requiring all sorts of equipment and personnel for the most drastic life-threatening emergencies (usually trauma, heart attack).
The doctor’s coding for what level services he provided and the level room and equipment the hospital says it provided should agree. Doctors must apply certain criteria that establish which of the standardized levels they may bill at (see the discussion of CPT codes above). Hospitals apply their own criteria and are far less standardized. Both the doctor’s and the hospital’s reasoning should be reviewed by requesting a written explanation as to why the level billed was appropriate.
Remember, an inappropriately high ER room level equals unnecessary higher costs to the patient.
Inflated Charges
While most people have read about the extreme markups for common items ($7.00 for two Tylenol; $30 for a “thermal therapy kit” which was just a bag of ice; $20.00 for a box of facial tissues), that has not shamed the hospitals into stopping this practice. Outrageous markups for common items are a continuing problem in hospital bills. Such overblown charges should be questioned.
A less obvious inflated charge comes from a practice called “unbundling.” Hospitals are required by the laws establishing Medicare to “bundle together” all the related costs associated with an operation. So for a surgery to remove someone’s tonsils, the cost of all other goods and services (like blankets, nursing staff, etc.) the cost of all of the equipment used, and the cost of using the operating room itself must all be included in the one surgery charge. Charges must be examined carefully to be certain bundled services provided with a surgical procedure are not also separately billed.
Another version of unbundling occurs when there is a general charge on the hospital’s bill described as “room and board” or “room kit” or “room tray” but then there are also specific charges for items like toilet paper, facial tissue, soap, shampoo or toothbrushes.
Inflated charges can also occur by coding errors by the hospital or doctor’s staff. This occurs when a similar but more expensive procedure or service is mistakenly billed. This use of the wrong Diagnostic Related Grouping (DRG) can result in a higher bill. The doctor’s records are more likely to reflect the actual services performed and hospital bills and doctor’s records must be reviewed with this in mind.
Next Time You Go To A Hospital
On a go-forward basis, consumers are urged to take a notebook or journal with them when they go to the hospital for a procedure.This is to take notes about all that happens: what doctors they see, what tests they undergo, what treatments and medications they are given. If a person too ill to do this, a spouse, relative or friend should help and take what notes they can. This information is very helpful for a medical bill advocate to be able to determine what charges are excessive and which ones were reasonable and medically necessary.
Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.