Fight Big Businesses: Hospital Billing Errors or Insurance Claims
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.
6 responses to “Fight Big Businesses: Hospital Billing Errors or Insurance Claims”
FMF responds:
Posted: February 14th, 2006 at 10:02 am
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.
John Koontz responds:
Posted: February 14th, 2006 at 12:24 pm
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.
Amanda responds:
Posted: February 14th, 2006 at 12:38 pm
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!
jim says in reply:
Posted: February 14th, 2006 at 11:25 pm
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.
Samuel P. Fleischer responds:
Posted: April 28th, 2006 at 7:24 pm
The use of a Diary to record and monitor services and procedures is an easy way to monitor the bill for over charges.
Regards,
Samuel P. Fleischer
http://www.jorleycomm.com
Phyllis Ramos responds:
Posted: September 13th, 2007 at 11:31 pm
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.