Want to know why medical care costs so much today? According to Money Magazine, more than 90% of the 31 million hospital bills processed each year contain at least one error. Those errors, most of which are overcharges, account for more than $10 billion dollars inappropriately billed to you, the unsuspecting patient.
Hospitals are well aware of the problem. The American Hospital Association even stated, “If we sat down to invent a billing system to frustrate the public, we couldn’t have done a better job.” Hospital errors often occur because they charge patients for treatments, services and supplies BEFORE they are actually received by the patient. For example, when a patient is admitted in the hospital, it is routine for a whole series of lab tests and /or x-rays to be ordered. In turn, these tests are automatically put on the bill. However, many times the treatment or service is not given because the doctor’s orders changed or the patient was discharged early. Yet, these charges stayed on the bill.
When the patient is in the hospital for more complicated service, such as surgery, then the likelihood of errors and overcharges increases greatly. The more complicated the service, the more accompanying supplies, treatments and therefore, charges.
But its not just hospitals that send bills with mistakes. You’ll find errors on doctor bills, dentist bills, and clinic bills? Why? Errors can be broken down into five main areas.
The first is human error. Most errors are due to computer entry errors. The billing office of a hospital or doctor’s office is often characterized with having tons of paperwork and inefficient billing systems. Furthermore, those doing the entry work have little training and there is high turnover. Human errors might be a wrong entry code, wrong quantity, wrong patient, etc. Rarely, if ever, is the bill audited before it goes out to the patient.
Duplicate billing is often seen because a lab test may be ordered by a doctor and two departments both enter the test into the patient’s chart. You might find charges for the operating room listed twice for different days. Any department in the hospital can duplicate a charge for supplies, admission kit, blood pressure cuffs, etc. A third area where you’ll find errors on your bill might be unrequested items. Those items might be personal items such as a toothbrush, slippers or shampoo. The patient is often automatically charged for such items even if they didn’t use them. Insurance almost never pays for personal items.
You may find you have been billed for a service you refused. An example could be when a physical therapist might stop by to help a patient walk down the hallway. If the patient refuses, and the therapist never provides the service, the patient should not be charged. Or what If the hospital puts a certain piece of equipment in the patient’s room, but the patient never uses it? The hospital may try to bill for it just because it was in the room.
Always check your bill for supplies and services never received. That might include medications, therapy, dressings, injections, bedpans, humidifiers, or even thermometers.
Bulk charges can be another area common for billing errors. Hospitals sometimes lump together charges for a group of services and supplies. The bill should break down charges for each item. You might even find a department simply listed miscellaneous categories, with no details. You want to get an itemized bill which describes each item, the cost of the item and how many times it is billed. Some components of bulk charges may have never been received, but are automatically billed to the patient.
Inaccurate charges might turn up on your bill. One example may be the type of room you occupied. Was it private or semi-private? Two rules to remember are: the patient pays for the day they were admitted, not the day of discharge. And, the patient pays for the room they occupy at midnight. Inaccurate charges may also stem from services billed hourly or daily, such as oxygen or being in a specialized unit such as ICU.
Few people have the knowledge or time to check all of their medical bills for such errors and they end up paying millions for inaccuracies. Even those who do choose to audit their medical bills find the task daunting. One in three Americans reported having trouble understanding their EOB. EOB stands for “explanation of benefits”. That is the statement your insurer sends you after you have received health-care services. The majority of people polled rank health insurance forms as second only to IRS forms as the most confusing forms.
How can you guarantee yourself and your loved ones that you are not being over-charged with that medical bill in your hand? Other than doing the audit yourself, a solution may be to hire a Billing Advocate or a Claims Assistant Professional. These are trained professionals who have experience auditing medical bills. They know how to decipher EOBs. They know how to compare your medical records to charges for services and supplies. They are comfortable dealing with hospital billing departments straightening out overcharges and obtaining reimbursements for you or a reduction in the bill.
The good news is that most of these trained auditors work on a contingency basis. You pay nothing until they have recovered the overcharges or were successful at having the bill reduced. Payment is usually a percentage of that recovery. You can find a listing of these auditors on the internet.
