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Cheating, Lying, Stealing: What are Hospitals Up To?

Is the whole world going to pot? If you can’t trust those whose main job is suppose to be looking out for our wellbeing, then what are we to think? The thought of corruption in a hospital isn’t pretty, but reassuringly the people who are actually caring for us are not directly responsible. You can breathe a small sigh of relief now.

The truth is American hospitals are over-charging consumers an estimated $10 billion a year. But that’s not the worst part; experts say that while some of the overcharges are honest, many are deliberate. In fact, some facilities work hard to keep bills indecipherable. And according to Consumer Reports, of 11,000 respondents surveyed who had reviewed itemized hospital bills, 5% found major errors. Respondents with out-of-pocket expenses of $2,000 or more were twice as likely to have found billing errors.

Leave No Stone Unturned
Rest assured, there are some very simple measures you can take in the feat of not being taken advantage of by the hospital that treats you or someone you love.

• First, if you can, keep a log, or have someone you know keep it for you, of all the tests, medications, and treatments you receive.
• Never pay your bill before leaving the hospital — even if you’re told it’s required.
• Ask for an itemized bill as well as your medical records. Every state now requires hospitals to provide itemized bills.
• Question everything you don’t understand or anything you feel is inaccurate. Call the hospital billing department, as many times as it takes, to get a clear, responsible answer that you are happy with. You have the right to ask for full descriptions of “loose terms” such as lab fees and miscellaneous services. If you don’t get the answers you are looking for from the billing department you may have to put your appeal in writing and go up the corporate ladder to the hospital administrator.
• If your insurance sends you an explanation of benefits (usually labeled “This is not a bill”) keep it and examine it. It will tell you how much the hospital is charging, what your insurance plan will cover and what you can expect to pay out-of-pocket.

Performing a Hospital Bill Autopsy
Unfortunately, complaints about hospital billing are about as common as complaints about hospital food… and neither one seem to be getting better. But bad billing can leave more than just a bad taste in your mouth. It can try your patience, test your nerves and even damage your credit.

Although it’s no easy task, examining your hospital bill with a fine-toothed comb is vital. If your insurance requires you to pay any part of your hospital bill, any overcharges will cost you. And according to Consumer Reports, your credit rating may also take hit if you are not diligent. Health maintenance organizations (HMOs) and other managed-care plans have squeezed hospitals for every dime by limiting payment for services. As a result, hospitals are becoming more aggressive towards consumers. They are requesting payments for things that in the past have been overlooked. They are turning accounts over to collection agencies and filing nonpayment information with credit-reporting firms in as few as 30 days.

To protect yourself from inflated hospitals bills, you have to pay attention to the hospital charges you incur from the minute you enter the building until the nurse wheels you out the front door… don’t be surprised if they charge you for that ride!

Wanted: Translator Fluent in “Medicalese”
Again, decoding your bill is no simple task. Even blatant errors are often hard to uncover. Errors such as:

• A couple being billing for circumcision of their newborn, even though the couple gave birth to a baby girl.
• A man being billed $186,000 for heart valves… all 200 of them!
• A 56-year old man being billed for newborn blood tests and a crib mobile when he was in for a hip replacement.

These mistakes, intentional or not, took hours of work to uncover. If it weren’t for the intense scrutiny of these former patients and their family, these absurd costs would have been paid.

So what do you do if you feel unqualified to review your hospital bill? Start by calling your insurer. Tell the customer-service representative that you suspect an error and ask to speak with someone who reviews questionable charges. It is in the insurers best interest to help you being they will probably benefit more than you will on any error found. If your insurer can’t help, look for a not-for-profit local group that reviews consumer invoices a no charge. If no such group exists in your area you may have to pay for services. There are companies out there that will agree to take a percentage of the money recovered.

Simple Strategies & Common Errors
When you get your hospital bill you can start by identifying the major charges. Once these have been labeled and accounted for, you can move on. Consumer Reports recommends starting at the top, where the invoice lists the basic information such as your name, address, social security number and insurance company. From there, look for the following common mistakes:

• Dates of service. Check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals charge for the day you were admitted but not for the day of discharge.
• Duplicate billing. Make sure you haven’t been charged twice for the same service, supplies or medication.
• Operating-room time. It’s not uncommon for you to be charged for more time than you actually spent there. Compare the hospital bill with the anesthesiologist’s records.
• Up coding. Hospitals often shift the charge for a lower-cost service or medication to one that’s more costly.
• Services never rendered. Did you get every test, medication and service you were billed for? Here is where that personnel log will come in handy.
• Keystroke error. The people doing the billing are human, keep that in mind. All it takes is for a computer operator to hit a wrong key and you could be charged hundreds of dollars for a service you didn’t receive.

Ultimately, it’s a tricky business. Until better billing comes along, all you can do is try your best to stay healthy and avoid the hospital stays.