According to recent studies, up to 80% of hospital bills have errors. Most of these errors lead to overcharges to the patient. Overbilling can be a result of bad training, innocent mistakes or more sinister reason of trying to hike up charges to increase revenue.
The good news is you can do something about it.
If you are comfortable in having a heated discussion or 2, you can negotiate lowering bills on your own. To reduce your bills you will need to be armed with the facts and sometimes it helps knowing your local law. Always ask for an itemized bill and your chart so you can see exactly what you are being charged for. Your greatest asset is the knowledge that providers want to be paid and they don’t want to be taken to court and identified as a fraudulent biller.
Top Reasons for Overcharge:
- Out of Network Charges
- Incorrect Diagnostic Codes Applied
- Charges for Services not Performed
- Unbundling
- Upcoding
Out of Network Charges that happen when you go to an in-network hospital, in many states, is considered fraudulent. Many hospitals and medical facilities can outsource departments triggering the insurance company to reject your claim for in-network billing.
What You Can Do
Call the hospital directly and explain to them because of their outsourcing policy you were overcharged via an out of network bill. Ask them to correct the mistake and you won’t be forced to take further action. In many states and municipalities this is actually illegal. Look up your states regulations on out of network charges while visiting in network provider.
Incorrect Diagnostic Codes Applied this can be an innocent mistake or can be utilized to gain a higher claim.
What You Can Do
This one is tricky and is mostly only caught be professional medical billers. However, you should review your bills closely and if a codes description seems “off”, request a full description of the services and coding definition. Most often times you will only see the abbreviated code on your bill and the full descriptions can be made available upon request.
Charges for Services not Performed this can happen for a number of reasons. One of the most common reasons is that you may have been scheduled for a particular service and they didn’t take it off your chart after the service was cancelled.
What You Can Do
Call the hospital and explain that the service was cancelled and they need to remove it from your bill.
Unbundling this is generally done to make more money off a single service. There are certain services that are “bundled” due to their nature. Unbundling can increase costs because 2 individual services are more costly than the 1 bundled service.
What You Can Do
This one is also tricky and is mostly only caught be professional medical billers. To catch this you will have to use some common sense knowledge about the service you had and also speak with your physician or the hospital indicating that you feel that it was a bundled service and you shouldn’t be charged separately.
UpCoding is the process of utilizing higher cost codes as primary to increase the billing rate.
What You Can Do
Identify your primary medical condition. Make sure you condition is not exaggerated. Also verify that all treatment areas and services are exact. Charging can vary greatly for the same condition but different severity.
Armed with your person history charts, itemized billing and some common sense, you can negotiate your bill on your own behalf. If you do find yourself in a situation where you hit a wall, there are patient advocate billing specialists that have experience and success with nearly every scenario. Don’t just accept a huge bill, negotiate.
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