Surprise hospital bills or bogus charges are more frequent than you might think. Here are some ways to push back when you discover a problem.
Surprising hospital charges can be either intentional or accidental.
Nearly one-third of Americans who are insured learn after the fact, that their health insurance doesn’t cover a hospital visit as they expected.
In fact, past-due medical bills are why 59 percent of Americans are contacted by a debt collector. 16 percent of American credit reports contain medical debt — approximately $81 billion.
Charles Silver, co-author of Overcharged: Why Americans Pay Too Much For Health Care” and endowed chair of civil procedure at the University of Texas at Austin School of Law, said that hospitals and doctors continue to send patients to surprise bills as they make money.
Hidden care costs – A complex system
Hospitals can contract with insurance companies to offer their members a discount on services. Prices will vary depending on the contract. Prices that are “out-of-network” can rise to unimaginable heights if there is no contract.
However, even if the hospital you visit has “in-network”, the doctor who sees your case might not have that network.
Yale researchers examined more than 8.9 million ER bills and discovered that 22 percent were treated out-of-network by doctors.
Over 60% of hospitals outsource their ER physicians. The firms that hire them have an incentive not to let doctors “out of network” in order to charge higher prices.
According to the Yale study, patients who were admitted by hospitals that had EmCare as their physician staffing company were more likely than others to have their imaging done and be admitted. They also were charged under the most expensive (and most expensive) procedure codes.
Let’s suppose that an ER doctor asks you to undergo a complete blood test, called a full metabolism panel.
The cost might be listed as $1,000 in your explanation of benefits. Your insurer might subtract $900 from the cost if it has a contract with the hospital. You may also pay as little as $5 if your deductible is met.
A study looked at 2012 data regarding severe pneumonia treatment in hospitals across the country. Anaheim, California’s medical center was the lowest at $59,134. The highest was $59,134 at an Anaheim, California, medical center. The highest? Over $99,000 at Tampa, Florida hospital — an $40,000 difference.
A study last year in Health Affairs found that these list prices, also known as “chargemasters”, are often three times more than what a hospital receives for providing care. This gives them leverage when they negotiate with an insurer.
However, paying more for hospital procedures does not mean that you are getting better care. Doctors may also be aware of the potential for patients to go into debt.
An error in as high as 80 percent of hospital bills can lead to costly medical bills. It’s no surprise, considering there are almost 70,000 procedure codes and 71,000 diagnosis codes to sort through.
The wrong code could result in a charge of hundreds or even thousands of dollars. According to the National Academy of Medicine, $210 billion in unneeded and overpriced treatment is being spent.
While Americans lost $2,300 in median household income between 2010 and 2013, healthcare prices increased by more than $1,800.
Only 23 percent of Americans can afford an unexpected medical bill exceeding $2,000 and out-of-pocket costs continue to rise.
What can you do to prevent or combat your surprise charges?
• Speak up You may feel that you are at the mercy of the attending physician’s orders in the ER. But, your condition may not be listed. Isn’t Life-threatening conditions can be life-threatening. “It’s okay to ask why I’m getting this?” or “Can I have this scan next week with the regular doctor?”
• Shop for Prices Calls around to compare prices if you are certain that you will need to visit the hospital for a procedure.
• Request an itemized invoice Ask your hospital billing department for an itemized bill. It will include as many details as a restaurant receipt.
• If you spot a problem, push back. The hospital billing office can be contacted if the charges do not match the story you have in mind.
• Negotiate. 57 percent Consumer Reports surveyed 81 percent of respondents to its survey. They said that they had successfully negotiated down hospital bills. Do you feel that you cannot bargain? You can hire a professional to handle your medical billing.
Booth, S. (2019, May 21). Hospital Bills and Overcharging. Healthline. https://www.healthline.com/health-news/80-percent-hospital-bills-have-errors-are-you-being-overcharged.