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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.

Detecting errors

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.

Make a deal

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.

Treatment

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.

The Bottom Line

Don't become one of the 79 million Americans who have medical debt problems. By simply taking the time to review your bills for errors, asking for discounts and paying bills on time, you can save hundreds of dollars.

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

Anonymous

Always question anything you don't understand, especially if you think you're entitled to more in benefits. A relative of mine recently had surgery. The anesthesiologist billed the insurance company which did not pay the bill in full, and the EOB said the patient was responsible for about $700 of the cost. My relative called the insurance company, and the representative restated what the EOB said. When my relative said she would file an appeal, she was connected to another representative. It turned out that the claim had been miscoded, and she was entitled to full coverage for the procedure. The insurance company sent her a check for the rest. If she hadn't questioned it, she would have paid the balance out of pocket for no reason. Always check the EOB very carefully, and if you need a major procedure like surgery, make sure you know going in exactly what you're covered for. That way, you won't have surprise expenses, and you'll know if something is wrong when the procedure is billed and submitted to insurance.

by Anonymous on June 28, 2009
jenniebartlemay

Hi there. That's an excellent story! It's absolutely necessary to read your hospital and doctor's bills carefully. Also, a friend of mine mentioned that she used to have a health insurance provider that split the money saved with patients who found errors on their bills. What an awesome added incentive. I don't know if any companies are currently doing this, but I definitely plan on asking my insurance provider if they have a similar policy.

by jenniebartlemay on June 29, 2009

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