Keith is a former TV investigative reporter. People often called him to help resolve their problems. Some complaints were baseless. Some he resolved behind the scenes. Others led to on-air special reports. Now we sometimes share our consumer experiences, knowing others likely have faced similar situations. We also believe sharing these stories is part of the essence of social media.
A family member unexpectedly went to the hospital for three days. Afterward, it wasn’t the hospital that sent us the first bill. Instead a medical group we were not familiar with mailed us an invoice for hundreds of dollars. We assumed the medical group had provided a service in the hospital, but the invoice did not itemize the services. It listed a total price.
After making two phone calls, I reached someone at the medical group and explained I did not understand what the bill is for. She said she would mail me an itemized statement.
Why didn’t the medical group send me an itemized statement in the first place? Will the itemized statement provide enough details to help me understand the bill? How will I know if someone actually provided the services stated on the bill? I took some notes while visiting the hospital, but I wasn’t there 24 hours a day keeping track of everyone who walked in the patient’s room.
Matters turned more complicated when the hospital itself sent its own bill, which also was not itemized. We asked for an itemized bill and visited the hospital to get doctors orders and nurses notes. The hospital told us we need to visit another office if we want someone to decipher our bill line by line.
Spending money to ensure a loved one is healthy may be the most important money anyone can spend. Good doctors and nurses provide one of the most important services on the planet. But while working as a TV investigative reporter, viewers called me with complaints about billing errors and other hospital disputes. A hospital may provide great service, but how do you know if it’s charging a fair price?
For insight, I interviewed Lisa Zamosky, a consumer healthcare columnist for the Los Angeles Times and the author of WebMD’s Health Insurance Navigator blog. She also is working on a book about health insurance and reform. Click here for more information.
Q. How well are hospitals doing when it comes to sending patients accurate bills and bills that patients can easily understand?
A. I don’t have any statistics or studies to offer a true assessment of hospitals’ performance with regard to bills. Generally speaking, however, patients are baffled by the bills they get, including the volume of bills and paperwork they receive, as well as their complexity. It’s hard for people to figure out what they actually owe.
Q. What steps should people take to negotiate their hospital bills?
A. Probably the best thing to do is to be proactive about bills. If your procedure is elective, do your legwork in advance and try to understand what your costs will be before you step foot in the hospital. Here are some other steps to consider:
- Be aware that some sites of care are pricier than others – hospitals generally cost more than outpatient centers, for example.
- Talk with your insurer about where you’ll get the best price and confirm that both the facility and the doctor are in your plan’s network.
- Be clear in advance about your co-pays, deductibles, what is and isn’t covered. Talk with your doctor about who else will be treating you in the hospital, and that you’re concerned about receiving treatment and bills from providers not contracted with your insurance company.
- Check your bills carefully to make sure each service was actually performed, that you weren’t double billed and that it generally appears to be accurate.
- If you have a dispute, put it in writing, and clearly outline each item you’re disputing and request that the inaccurate charges be removed or that a written response with documentation to support the charges be sent to you.
- Get your insurance company involved, if you have coverage. Ultimately, mistakes cost them as well, so see if you can get their assistance in fighting the errors.
- Get your doctor involved. Ask him/her to walk you through the charges. If your doctor has admitting privileges at the hospital, he or she may be able to advocate on your behalf.
- If you are a self-pay patient, you should be aware that a handful of states have laws limiting how much hospitals can charge patients who pay for care on their own. Check with your state’s department of insurance.
- Negotiate: unpaid medical bills are frequently sent to collections agencies by hospitals and physicians. At that point, the provider accepts about 25% of the total cost of the bill. If you can pay cash, you can use this knowledge to your advantage to lower the price. Just don’t ignore your bills. Once they go to collections, they can ruin your credit. Most hospitals will give you about 90 days to pay up before taking action.
- Contact a patient advocate organization such as Health Advocates or Medical Billing Advocates of America if you have a huge bill and need help. Also, if you get your insurance at work, talk with your benefits department. They may be able to help and there may be other work-based resources you’re not aware of.
Q. Why are hospital billing errors common?
A. There are a number of possible reasons. One is that there are many different people involved in taking down information and documenting your treatment– doctors, nurses, intake workers, etc. There is a lot of opportunity for coding and other mistakes to occur. Also, there are often different doctor groups treating people while they’re hospitalized, each with different responsibilities and different billing departments and different insurance contracts. Coordination among all the moving parts is generally lacking.
Q. What should patients know about hospital bill review companies?
A. I assume you mean patient advocate organizations that work with consumers to help sort through bills and negotiate for a better price. If that’s the case, there are a few things I would suggest:
- First, it’s good to know that they exist and that there are experts available to help – many people aren’t aware that they can get assistance negotiating hospital bills and fighting charges.
- Many large and mid-sized companies offer these services to employees as a part of their benefits package. If your company does offer patient advocate services, you can get help sorting through your bills and fighting inaccuracies free of charge. Ask your human resources/benefits department about it.
- If you approach one of these organizations on your own, be aware that they take a portion of the amount they save you – I believe 30% is common. If you have a big bill or multiple bills, it’s often well worth spending the money. It may not be, however, if your bill is not that large. You have to weigh the pros and cons of paying for help.
Q. What’s your take when some people in general label hospital bills outrageous and unfair?
A. I think sometimes they’re right. It depends on the situation, of course, but no doubt hospital bills are often outrageous. And, all too frequently, they contain errors.
Q. Can patients look up the going rate in their areas for medical services and if so, what exactly should they do with such information?
A. Yes, consumers can look up cost information and use it to negotiate for the best possible price on care.
Just keep in mind that prices of medical procedures, doctor visits and surgeries have been historically tough to get. And because of the fragmentation I mentioned in my earlier answers, it can be difficult to truly pin down a price. Doctors, for example, often don’t even know what they’re paid for a procedure because the price varies depending on the type of insurance a person has.
But there is a big emphasis these days on making costs more transparent, particularly as a growing number of people are covered by high deductible health plans and are paying for more of their own care out of pocket.
Insurance companies and large employers offer price comparison tools that you can use before going in for a particular procedure, and they’ll tell you which hospital and/or doctor will give you the best price. Remember that prices for the same procedure among health care providers can vary greatly.
And there are a host of free cost calculators.
Here are some sources for looking up medical procedure costs:
· Fair Health (fairhealthconsumer.org).
· Healthcare Bluebook (healthcarebluebook.com).
· Health in Reach (healthinreach.com)
· Hospital Compare (www.hospitalcompare.hhs.gov).
Among the data this tool offers is Medicare rates for a number of procedures. Add 25% to 50% to get a fair private market rate.
· New Choice Health (newchoicehealth.com).
People should first understand what a fair price is for the procedure they need. Then, ask up front what the price for your care will be. Unfortunately, this isn’t often an easy question for providers to answer, but try to pin down a price as best you can. Then use the amount you find on the cost calculators to negotiate for a fair price. If you can pay cash, you may be able to get the best deal.
A. When patients request an itemized statement for medical services, how do they know those services were actually provided? It isn’t practical for some patients to write down notes every time someone walks in their hospital rooms. Can patients request doctors notes and other records to ensure they received all the services on a statement?
A. You’re right. It is hard. You can ask a friend or loved one to help keep track (although I realize this isn’t always practical). But after a hospital stay, you should always request an itemized bill that outlines each individual charge that comprises the total cost of your stay. Compare that against what you know took place in the hospital.
For example, in the case of an operating room charge, check the length of time stated against the anesthesiologist’s records. People are often charged for more time than the room was actually used.
Q. Are medical groups and hospitals open to providing records? Are they required to? Will they charge a fee? In hospitals, patients often don’t have personal relationships with “hospitalists” and other personnel and can’t discuss these issues directly.
A. These are two distinct issues. One is an itemized bill from the hospital, which outlines each item and service for which you’re being charged. Often you’ll get a bill that isn’t itemized, so you need to request that so you can see exactly what makes up the charges.
Then there is the issue of medical records. It is your right by law to gain access to your medical records, and yes, you can be charged a fee for it, within reason. A good resource for learning the details about your rights to gain access to your records and how to get a hold of them can be found at Georgetown University’s Center on Medical Record Rights and Privacy.