Lower Your Medical Bills By Finding Medical & Hospital Bill Errors
By Philip L. Franckel, Esq.
If you have been admitted to a hospital and find yourself owing a substantial amount of money there are a few things you can do to substantially reduce your bills. With a little perseverance and investment of time, you can uncover costly overcharging errors you're not responsible for. After you're done, you can negotiate what you legitimately owe and the payment terms.
Here's what to do:
Request both the hospital and your insurance company to audit the hospital and doctor bills.
Demand an itemized bill (you are legally entitled to an itemized bill if you request one) and review your self for the following:
Duplicate Billing: Make sure you haven't been charged twice for the same service, supplies or medications.
Number of Days in the Hospital: Check the dates of your admission and discharge. Most hospitals will charge for your admission day, but not for your day of discharge. If you have been charged for the day of discharge, ask the hospital to waive the charge for that day.
Incorrect Room Charges: If you were in a semi-private room, make sure you're not being charged for a private room.
Operating Room: It's not uncommon for hospitals to bill for more operating room time than you actually used. Compare the charge with your anesthesiologist's records.
Unbundled Charges: This is when a group of tests are billed individually, when they should have been billed together. Surgical procedures and tests frequently consist of several parts. For instance, you could have received a cervical MRI and a lumbar MRI. A hospital or MRI facility can bill $1,200 for each MRI if they were done at different times, however, if they were performed on the same day the total amount that the facility will be paid by an insurance company may be only $1,400 or $1,800 instead of $2,400. Many times, MRI's will be scheduled on different days, frequently one day after the other, in order to bill at the higher rate. Do not allow a hospital or MRI facility to charge you the full price if they did this. An example of a procedure could be where you fractured two fingers or two ribs and you were charged the full price to set each finger or rib individually, instead of the full price to set one finger or rib and a discounted price for the second finger or rib.
Up Selling: This occurs when a doctor orders a generic drug which is readily available, but the hospital provides you with a more costly brand name drug without your knowledge or consent and bills you for the more costly medication. Since you are not an expert at determining whether or not a drug use generic and you may not have even been in a mental condition to make that determination; your doctor ordered the generic drug; and it was readily available in the hospital drug store, you are not responsible for the increased charge.
Fraudulent Coding Also Called Up Coding: Hospitals may change the charge for a lower cost service or medication to one that's more costly. For instance, a doctor may order a generic drug, but the hospital "accidentally" bills the patient for a much more expensive brand name drug when the generic is actually provided. If done intentionally, this is fraud. Where this occurs several times on one bill or occurs with multiple patients, this could constitute intent.
Fraudulent Coding/Weird Charges/Fake Language: Hospitals may invent confusing language to cheat patients. They use medical sounding names for everyday items and charge you an astronomical price. For example, an "oral administration fee" is really a charge for the nurse handing you pills. You do not have to pay for that because it is part of the room and board. Other items that have been reported as appearing on hospital bills are: "disposable mucous recovery systems" (a box of Kleenex tissues); "Thermal therapy" (a plastic bag filled with ice); "Gauze collection bag" (a trash bag); and finally, a patient who was given a teddy bear by the hospital and charged for a "cough support device." Not only is this fraud, but if it wasn't requested, the teddy bear was a gift.
Keystroke Error: A computer operator accidentally hits the wrong key on a keyboard which can result in an incorrect charge or a charge for a service you didn't get.
Canceled Services: You may have been charged for expensive services or tests which your physician ordered and then canceled or for some reason was never rendered.
Assignment: Check to see if the hospital or doctor accepts assignment of your insurance payment. This means that the hospital or doctor is allowed to bill your medical insurance and to receive payment directly by your insurance company, without a check going to you. This is a good thing. You can find out if the medical provider accepts assignment by asking your insurance company. When a hospital or doctor accepts an assignment, you are assigning to the hospital or doctor, your right to the reimbursement check from your insurance company. By accepting assignment, the medical provider is now in your position and has whatever legal rights you had to collect the payment, and no more. When accepting assignment, a hospital or doctor may not legally seek any payment from you. This means that if the medical provider bills your insurance company for $3,682 and you were only entitled to be reimbursed $1,136, the medical provider must accept this amount and you are not responsible for the remainder of the bill.
Why do hospitals and doctors accept assignment? Because when the check goes to the patient, many patients keep the money which requires the hospital or doctor to sue the patient. Accepting assignment allows the medical provider to know that they will be paid and to avoid the costs of litigation if the medical provider must sue the patient to recover payment for services rendered.
Negotiating: Finally, after eliminating all of the errors you can find, try negotiating your bill. If you are able to pay a lump sum settlement to the hospital, you can usually negotiate the amount you owe. You should be able to deduct at from one third to one half of the bill, which is probably the amount that the hospital would have to pay a lawyer to collect a fee from you. Keep in mind, that collection agencies routinely settle bills for 50%. Depending upon your income, you may even be able to settle for as little as 10%. If you are unable to pay a lump sum settlement, you should be able to negotiate a payout over a period of years. If you do not earn much money, you can remind your medical provider that if they obtain a judgment against you, the court may award as little as $25 per month, even if the bill is thousands of dollars.
About The Author
Philip L. Franckel is President of 1-800-HURT-911,Inc. which has an accident and injury research web site for people hurt in an accident