Hospital bills need close examination, too

On The Money

Your Money

February 20, 2005|By Lorene Yue

As if going to the hospital weren't unpleasant enough, getting socked afterward with complicated and financially burdensome bills could send you scrambling for painkillers.

Before you take out your checkbook, find out if you're actually on the hook for the entire amount.

Medical claims advocates estimate that eight in 10 bills contain some kind of mistake, ranging from data-entry errors and duplicate charges to failure to provide group discounts for related services.

"Any time a consumer with health insurance gets a bill, they should consult with their insurer," said Mohit Ghose, spokesman for America's Health Insurance Plans, a Washington-based association of health insurance providers.

Your best bet is to find out if your insurer has a department or person that specifically handles medical claims and contact them for assistance.

Mistakes can crop up for several reasons, particularly if you make an unscheduled medical visit.

"In an emergency room visit, you are seen by several people throughout the hospital," said Rich Rasmussen, a spokesman for the Florida Hospital Association.

The billing is based on codes sometimes hurriedly entered into the medical record, and, "If you have one digit off, it could be an entirely different service," Rasmussen said.

And sometimes you're caught in the shuffle, as providers present, or fail to present, bills to the right place for payment.

There are experts you can hire to clear up the mess, but they'll charge $25 to $150 an hour, or they'll take a cut - as high as 50 percent - of the money they save you.

If you want to tackle the job yourself, here are three things you can do.

Get an estimate for scheduled services. "Have a conversation to make sure you know what is covered," Rasmussen said. "Ask for a cost estimate. It's not a guarantee, but it will be a benchmark."

Take action immediately. Don't ignore an apparent error in the hope someone else will straighten it out. Procrastinate, and next thing you know you're getting notices from debt collectors hounding you for money you might not owe. And ignoring it could rattle your credit score if it's reported to a credit-rating agency. (It's a good idea to periodically check your credit report for any kind of error, including medical bills.)

Get a detailed invoice. If that $5,000 bill for an emergency room visit to stitch the cut on your hand looks suspiciously high, ask for a bill that breaks down every charge. Health care providers should provide you with a detailed statement of the care you received. That's when you have to do some detective work to decode billing jargon and determine if there are any frivolous or mistaken charges.

"Pay attention to what you're billed for - use of gloves, the drapes, gowns or the paper cup they handed you the pills in," said Pat Palmer, founder of Medical Billing Advocates in Salem, Va. "Look at those statements, because there may be charges that don't belong to you. Most people don't know how to question it, or they are too intimidated."

Some favorite overbilled items among the medical claims community are the $1,000 toothbrush, the $150 disposable mucus cleaner (a box of tissues) and the $140 Tylenol. Sure, health care providers can charge a healthy markup for products they use to care for you, but you have a right to question it.

Lorene Yue is a Your Money staff writer.

Common errors

Here are types of overcharges to look for in hospital bills:

Excessive charges for routine admission process.

Private-room charge for a patient who had a semiprivate room.

Charge for medication that was not administered or was declined by the patient.

Charge for services that a physician did not order or that were not administered.

Double-billing.

Charges for items covered in the room charge, often including toothbrushes, combs or slippers.

Source: AARP

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