It doesn’t happen often, but occasionally you can catch a mistake on a restaurant check or a miscalculated receipt from the grocery store. Hospital bills, however, are another matter: as many as 8 out of 10 bills for health care services contain errors, according to Medical Billing Advocates of America. Since Americans spend nearly $7,000 per capita on health care every year — and since these expenses climb steadily, at an average annual rate of 6.5% — it’s probably worth scrutinizing the remittance from your last hospital visit. It just might save you hundreds, if not thousands, of dollars.
(FULL COVERAGE: Why Medical Bills Are Killing Us)
According to medical-billing advocates, who are the health care world’s equivalent of tax-refund specialists, there are ways to protect yourself from huge health care expenditures both before you’re seen by a doctor and after you receive your bill. “When you are in the hospital, you should concentrate on getting better,” says Kevin Flynn, president of HealthCare Associations, a company that helps patients decipher their medical bills. “Do what is best medically first, then worry about the finances second.”
At the emergency room or in the hospital:
- If you are insured, ask to be seen by a doctor who participates in your insurance plan. Just because a hospital is considered in-network by your plan doesn’t mean that all the physicians who work there are as well. This may not always be possible, but if your preference is noted in your file, once you receive your bill, you may be able to negotiate with the hospital to accept your insurer’s higher in-network reimbursement rate, leaving you with a smaller financial responsibility, even if you are seen by an out-of-network doctor.
- For the same reason, if you are able to, ask to have any lab testing that is sent outside the hospital to be sent to facilities that participate in your insurer’s plan.
- If possible, ask about the tests the doctor or nurses are ordering. If a less expensive test can provide the same information, then request that option. In some cases, for example, less expensive ultrasound tests are just as effective as costly CT scans.
Once you get your bill:
- Always ask for an itemized bill so you can see every charge.
- Ask for an explanation, in writing, from the hospital’s billing department for any disputed charges.
- If you go to the hospital at night and end up being admitted after midnight, make sure your charges for the room start on the day you start occupying the room.
- Check the level of room for which you were charged. Hospitals charge for ER services by level, depending on the amount of equipment and supplies needed, with Level 1 requiring the fewest (e.g., a nosebleed) and Level 5 representing an emergency (trauma, heart attack). Question the level indicated on your bill and ask for a written explanation of why that level was billed. Hospitals have their own criteria for determining levels and should make this available upon request. “They don’t freely hand this information out, but they will send it to you if you ask for a written response,” says Pat Palmer, founder of Medical Billing Advocates of America.
- Doctors also charge for ER services by level, also ranging from 1 to 5. Their levels are standardized, and physicians are required to meet three criteria to justify billing at each level. Question the level listed on your bill and ask for a written explanation of why that level was billed by your physician.
- The hospital level should be equal to or lower than that of the doctor-billed level; if it’s higher, that’s a red flag that there may be a billing error.
- Question charges for what seem like routine items, such as warm blankets, gloves and lights. These should be included as part of the facility fee.
- Question any additional readings of tests or scans. You should be charged only once for one doctor’s reading of a scan, unless it is a second opinion or consultation.
- If you received anesthesia, check that you were charged for only one anesthesiologist. Some hospitals use certified registered nurse anesthetists (CRNAs) but require that an anesthesiologist supervise the procedure, so some bills will contain charges from both, which amounts to double billing.
- If your anesthesiologist is out of your insurer’s network, ask him or her to accept in-network reimbursement.
- You can also ask your insurance company to send reimbursement for anesthesia services directly to you, and then you can resolve the bill directly with the anesthesiologist. In most cases, the anesthesiologist will accept the in-network rate rather than engage in a protracted negotiation with you about payment.
By scrutinizing these types of charges on bills, advocates have helped patients reduce remittances by anywhere from $1,300 to $100,000. Most groups take a flat percentage of about 35% or negotiate an hourly fee for larger bills.
While a medical bill can seem intimidating, Palmer says it’s important for patients to remember that there are a lot of things they can do for themselves as well. Medical-billing advocates can help, Palmer says, “but there are things that a patient is going to know that an advocate may not know, such as ‘I did not take this medication because I am allergic to it’ or ‘I never saw this doctor’ or ‘This test was canceled because my blood pressure went too high.’ Patients can help themselves by questioning and reading their bills carefully.”