Tips for Lowering Your Medical Bills

Medical bills can be intimidating, but that doesn't mean they are always accurate.

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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.”

11 comments
uggugg
uggugg

The best thing that could happen to the medical industry is the following:

Basically, the drug industry has the greatest control over the medical doctors and hospitals, so the best way to keep them honest is to demand that we have holistic doctors competing working along side of medical doctors and at the same time do not allow them to get in bed with one another so that the can control profits. I have been reading news letters form holistic doctors all my life and I am well insured but seldom see a medical doctor. I know how my body feels, I eat food which is similar to food produced in the early 1950's before it is processed to death and I am very healthy. If people went to the doctor no more than I, doctors would be looking for work elsewhere and hospitals would become empty for lack of customers. Many people are scared into being sick, and some are really sick from bad habits they acquired over the years. If you tell someone how to be healthy and they refuse to med his ways, not even medical doctors can save them. God gave us all a free will, If your free will is killing you, so be it. You can lead a horse to water but you can't make him drink. Know when to let go before you go broke and die anyway.


Kathoid
Kathoid

It seems to me as a courtesy by the hospital that they should let you know the extra things they charge you for  so you have a choice whether or not you want to use it.

Kathoid
Kathoid

I was charged for 21 hours at 119.90 per hour for TV, almost 3000.00!! I had never been charged for TV in any hospital I was in. If I would have known this I would have never watch TV there at all. That is outrageous!

JackieStamperTichy
JackieStamperTichy

Why take advantage of people at any time but during this economy?  People aren't working but still need medical care and should never be refused. Unbelievable how the hospital can charge 100% - 150% more for any item or service.  This is a great article, "Bitter Pill".

DrNeilGarland
DrNeilGarland

I am holding my first delivery, my own daughter in N. Cambridge, Boston. Even the dam ed midwife tried to train her assistant on my wife, trying to perform an episiotomy. Luckly my hands were quick and stopped it.

DrNeilGarland
DrNeilGarland

These type of articles lose their accuracy after the 4th or 5th paragraph. unless one has seen it from experiece and the Inside, it is hard to know, period. Even great Journalism has limits, unless one is 'one of them', too. In England almost everyone likes their system of national Heqlthcare. Whereas, here in the U.S.A., only Doctors and lawyers, like our Healthcare system.

sharond
sharond

you state the following: “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”.This statement reveals a gross lack of research. It’s quite common, and acceptable, to receive anesthesia care from both an anesthesiologist and a certified registered nurse anesthetist.There are 3 ways to bill for an anesthesiologist’s services:as personally performed, medically directed, or medically supervised.The scenario you refer to above is “medical direction” --- when a nurse works under the “medical direction” of the physician.Medicare and some other insurance plans require two separate bills for the anesthesia provided during the surgical procedure --- one for the doctor and one for the nurse.In instances of “medical direction” the total charge for each provider is divided in half of what it would have been for a sole anesthetist.Therefore, there is no difference in payment by the insurance payer in either scenario --- it is “split” billing, not double billing!Anesthesia practices across the country who are carefully following the regulations set forth by Medicare and other insurance plans for billing anesthesia services will no doubt be adversely affected by the erroneous statement in your article. 

AndrewWeiss
AndrewWeiss

The following statement is erroneous:

"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"
.

It is not double billing at all.  The correct coding guidelines permit supervising physicians to bill in addition to the physician extender.  The allowed amount is split between the two providers.  The amount paid by the insurer or the individual is the same as if the anesthesiologist performed the service independently.  To suggest that the split charge between the two providers is double billing is simply not true.  I find this kind of reporting to be sloppy and sensationalistic.  

AlexxMarsh
AlexxMarsh

Any tips for affording my insulin?

jovdad
jovdad

@AlexxMarsh  depending on your income there are some companies that will send you your medicene for free.  Check the website for the maker of your insulin. good luck.

DuckBeach
DuckBeach

@AlexxMarsh

I love that -- "good luck."  Hey bud, why don't you just jump off a cliff.  Seriously, stick your "good luck" where the sun doesn't shine.