Under The Knife: Avoiding medical debt
For the most part, we trust that our hospital bills are correct. Yet billing errors plague our healthcare system. Luckily, there are a few things you can do to keep an eye on your medical bills, making repayment more manageable.
It is important to understand your medical/health insurance beforehand, so you don't suffer a stroke when the bill arrives. Once a hospital bills your insurance, you will receive the daunting EOB, or Explanation of Benefits. Save this and examine it, as it shows what was charged, what your insurance covers, and what your out-of-pocket costs are. Keep in mind that you may also receive separate bills for services from the surgeon, radiologist or anesthesiologist.
If you suspect your bill is too large, request an itemized bill from the patient accounts office at the hospital or doctor's office. This will clearly define miscellaneous items. You have the right to dispute any charges and ask questions about your bill. Look for errors such as discrepancies in length of stay or type of room, duplicate billings or "phantom charges." Contact the billing department immediately if you don't understand the charges. This office will be your contact for future correspondence, and open communication can make negotiations more pleasant and successful.
If you find errors, contact your hospital's billing department and your insurance company immediately. You are responsible for paying your medical bills, no matter what arrangement health insurance companies have for medical services. Keep a log of your tests, medications and treatments. Relatives and friends can help with this. When reviewing your bill, the log will help you recall events when you may have been drowsy or medicated.
As a patient, you have the right to know what's in your medical record. You can sign a release to obtain copies of this or the pharmacy ledger, which can be compared with the itemized bill. Then you can check for errors like:
- ordered procedures that were canceled
- charges for extra medications
- charged for more time in an operating room than your surgery lasted
Be your own private detective when it comes to comparing your medical records with what was charged and billed. You shouldn't pay for procedures that need to be redone due to lost test results. Also, challenge charges based on scheduling delays or errors. You shouldn't pay for hospital negligence, such as infections due to improper procedures, wrong-site surgery, or other preventable injuries, called "never events" in the most extreme cases. Refer to the National Quality Forum's list of "never events" at psnet.ahrq.gov.
Most hospitals are willing to negotiate with patients over billing. In the U.S., close to 5,000 hospitals and other providers have committed to the billing practices set forth by the American Hospital Association, agreeing to "assist patients who cannot pay for part or all of the care they receive." The hospital and billing offices should have these policies clearly outlined.
If you can't pay your bill, contact the patient financial service office as soon as possible to negotiate a payment plan. Make sure to do this before the deadline for disputes (usually up to six months after
the services were performed). If your bill is outrageous and you can't pay in full, don't be afraid to ask for a discount. A recent study found that 70% of patients succeeded in negotiations with hospitals.
If billing errors are found, discuss them with the billing department and your insurance company. If the discrepancies can't be resolved by phone, send a certified letter to both parties requesting a resolution. Keep records of what is discussed and who you spoke to. Don't be afraid to be assertive.
Also utilize the hospital's patient advocate for help on your billing issues. Contact public agencies, such as your state's department of health and attorney general's office, or medical billing advocates if you need help resolving errors.
Sources: aha.org; moneycentral.msn.com; washingtonpost.com; consumerreports.org; consumer.georgia.gov; healthconsumer.org; smartmoney.com; commonwealthfund.org; revolutionhealth.com; harrisinteractive.com; treasurer.delaware.gov; psnet.ahrq.gov; usnews.com