Insurance, Personal Finance 

Fight Big Businesses: Hospital Billing Errors or Insurance Claims

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Hospitals screw up billing all the time and have you ever noticed it’s never in your favor? Nora Johnson, a medical-billing auditor, claims that “More than 90 percent of the bills I review are either wrong or padded beyond belief.” She even said that her own husband was “once charged for blood tests for a newborn as part of his hip-replacement surgery.”

1. Review The Bill, Know The Codes
There are two kinds of codes on that medical bill, a diagnostic code and a procedural code. The diagnostic codes are ICD-9 codes which diagnose the problem, i.e. figure out what’s wrong. The procedural codes are CPT codes which provide the treatment, i.e. make you feel better. As you can imagine, anything from fraud to a typo could result in higher charges. Ask for a thorough explanation from the hospital or doctor.

2. Be prepared
When your doctor prescribes something, it’s recorded in their standing orders and you have a right to it. So when you’re done with the visit, be sure to request those orders from the billing office and keep them in your own files. The article also recommends getting these documents as well:

  • Reports by any technician handling a procedure, as well as the nurses who administer medication or shuttle you around in your paper gown
  • Itemized bills (request these from your doctors or hospital, possibly after your treatment visit)
  • Your insurance paperwork
  • Your own notes from each doctor visit

3. Use certified mail
When you send letters to anywhere, use certified mail. Use it to request a corrected bill and use it to describe the problem to your insurer. Get as much documentation as possible because your claim will depend on that. It creates that paper trail that you’ll need if it ever gets real ugly.

via CNN Money.

{ 9 comments, please add your thoughts now! }

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9 Responses to “Fight Big Businesses: Hospital Billing Errors or Insurance Claims”

  1. FMF says:

    If businesses ever do make a mistake in your favor, they ALWAYS manage to find it quickly. Funny how it takes a bit longer when the mistake is in their favor.

  2. John Koontz says:

    We’ve had a few months of continuous doctor and hospital visits for my son. It’s amazing how many errors we’ve found with our EOBs and bills. The most frustrating thing of all is that bills from the same visit are spread out over multiple claims. It makes it close to impossible to account for everything. For example, for one hospital visit, we recieved four different bills from three different departments of the same hospital. To top it off, they sometimes come weeks apart. At no time have we ever recieved an explanation of the entire cost of a visit. It’s madening.

  3. Amanda says:

    When my fiance had hernia surgery last year, we knew that his insurance would only cover 80%, but when we got the bill, yikes! It was around $6,000 – I knew something must be wrong.

    Turns out the third-party company who takes care of the company’s billing had mistaken my fiance with someone else of the same name who did not have insurance…

    It just goes to show you should always double check these things, because if you don’t catch it no one will!

  4. jim says:

    I don’t really think it’s fair that hospitals can just send you a bill without any sort of oversight whatsoever because hospitals inherently come with a sense of authority and most people will pay a bill, esp. if they don’t know, from a hospital without question. Let’s say a family member went in for some surgery and you’re their power of attorney, the bill comes, you pay it because you figure that’s what it is. You would question it if it’s $6,000 more than what you thought, but what if it’s $300 more? Depending on the surgery that’s a drop in the bucket.

  5. The use of a Diary to record and monitor services and procedures is an easy way to monitor the bill for over charges.


    Samuel P. Fleischer

  6. Phyllis Ramos says:

    At the time of the ER visit we provided an insurance card, for some UNKNOWN reason, this same bill is being charged to my husbands Tricare, even better, the date of service was 11/2006- 1 1/2 years after he returned from Iraq and the insurance ended.

    I have requested the papers from the ER visit SEVERAL times, all of them, I KNOW we filled in the homeland job insurance information. Only the homeland insurance information and a COPY of the card. I know my insurance charges $50.00, I have the first bill from them saying billed : Tricare. I have faxed, I have mailed and I have phoned. Now I get a letter they have a collection agency after us. Now what? All for $90.77- who gets in trouble for insurance fraud.

  7. Bhatt,G. says:

    Going to the emergency of Good Samaritan Hospital Baltimore Was My Biggest Mistake
    Last year, I took my son to Good Samaritan Hospital for an emergency treatment. I filled the forms correctly and gave the medical insurance cards. However, after about one and half month, I started receiving phone calls from HRRG (a collection agency) for an amount of about $672. However, I never received the bill. After calling several numbers at Good Samaritan Hospital, I was told that Physician’s Emergency bills are processed at Pennsylvania (PA) and I was given a number to call. When I called the Billing Department, I was told that the bill was sent, but it was returned to them because of wrong address. When I verified the address, I knew that the billing department sent the bill to the old address that I left about 5 years ago. It shows how the billing department was so negligent in changing my address while I filed the correct address. However, when I asked them why the bill is not being sent to the insurance, I was told that it was not paid. When I tried to give the detail of my secondary insurance, the billing department refused to take information, which it appears it already had. I was told I should contact HRRG. As usual, I sent all the details of secondary insurance to HRRG through certified mail with return- address. However, HRRG did not stop calling. In the mean time, I received a letter from the Insurance that $622 has been paid. I again sent a copy of this payment to HRRG through certified mail with return-address. In the mean time, I also started getting the bill of $672 from Physician’s Emergency Services from PA on the correct address, as I initially corrected it when I first contacted the Billing Department. It was so frustrating that on the one side, the billing department would say I should deal with HRRG and on the other hand I was being billed from the Emergency Physician’s Billing. During this period, I also sent a money order of $50 to HRRG toward the balance of the money remained. When I called the Billing Department and told that I already paid $50 to HRRG and rest $622 was paid to you by the Insurance Company. The Billing Department wanted a proof via Fax. I told them I do not have a fax machine, then the billing department started saying, “do you want us to believe you?” Finally, I sent the proof to Billing Department by a letter. Thus the bill was paid and I did not receive the phone calls from HRRG anymore. But wrong, after 2 month gap, I started receiving phone calls from HRRG again in April 2009 for $622 payment. When I told that I already sent you the proof of $622 paid by the insurance via registered post with return receipt, HRRG people would not listen. The person on the other side would say “call your insurance company, and pay through the credit or debit card.” When I called after a few minutes, the other person on the HRRG side would–say it must have been paid to the hospital, we are affiliated with emergency billing. When I told that I already sent you the proof with registered post of this payment. HRRG would not listen; rather argue that I should pay this bill of $622, because it only received $50. I again called Emergency Physician’s Billing and I was told that the account is paid in full. However, when I told why is HRRG is still calling? I was told they would send the information to its billing investigative team. Should I believe that HRRG would not call me now onward? I do not think so, because it will call since it can receive some money from unsuspecting clients. On the other hand, I suspect that Good Samaritan Hospital is going to send me some more bills for the hospital charges; while it has also received some money from my insurance (beyond the emergency physician’s bill). A large chunk of it will be overinflated phony overcharges. I would be happy for a news media to investigate this matter in detail, including the phony overcharges that I am expecting to receive from Good Samaritan Hospital. I guess it was my biggest mistake to take my son Good Samaritan Hospital Baltimore. I could have taken him to some other place. If new developments occur on my story I will post it soon.
    Bhatt, G., April 24, 2009

  8. Ivy says:

    I’ve been taken to collection 5 times in the last two years for errors in either the billing department or somewhere along the way. I paid my co-pay on some and still got sent to collections while others were typos on the doctor’s name and the provider didn’t recognize the name and kept denying the bill. One collections I wasn’t even notified about until I provided them with supporting data that I had paid the $100 co-pay.
    One I paid the collections just so they would stop calling every day and now I can’t get my money back from the hospital that sent me to collections and where I paid the co-payment in the first place. It is frustrating! It is a waste of my time for somebody else’s incompetence.

  9. bob says:

    Methodist Hospital in Des Moines Iowa did not correct an incorrect and incomplete adress. That patient moved 20 years ago, I live here now. I communicated to them 3 times. CBE Group Inc. , one of their 2 debt collections agencies did not correct the adress and police had trouble finding that patients old house. On the computer I can easily check that the adress doesn’t exist or that there are no residents there. Police stopped by 4-5 times and said harmful statements to neighbors and landlords. It is illegal for CBE to not sent a validation letter. Methodist should say sorry to me and to law enforcement and not pay the debt collector for that account. Bullying cororate thugs! Mercy Hospital does not sue.

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