News

Hospital Overcharge Self-Defense
Keep Records... Keep Track... Keep At It

Charles Inlander
People's Medical Society
reprinted from Bottom Line/Health, April 1, 2000

Ninety percent of hospital bills include mistakes -- three-fourths of which favor the hospital. These aren't small errors, either. One study found that the average overcharge totals $1,400.Overcharges affect your wallet even if your HMO or insurance company pays most of the bill. Your copayments mount up... and future premiums may rise as a result of the hospital costs you incur.Here's how to avoid paying the hospital more than you owe...

Keep a treatment log. During your hospital stay, list every doctor's visit, procedure and medication in a notepad kept within easy reach of your bed. This will give you a clear record to check later against your itemized bill.If you're too ill to maintain the log -- or too groggy from anesthesia or medication -- ask a family member or friend to keep it for you.

Question any service you suspect isn't okayed by your attending physician. While you're in the hospital, your attending physician -- the doctor who admitted you or the specialist assigned to your case -- is the only person authorized to approve consultations, procedures and medications.Nonetheless, the hospital may initiate services on its own to boost revenues or reward affiliated doctors.

Examples: A quick "drop-by" visit from a staff psychiatrist... an "assistant surgeon" drawn from the hospital's roster... a visit from your own family doctor, who may bring the hospital many referrals.Patients are legally entitled to refuse to pay for any such unauthorized services. But it's usually easier to take preemptive action to prevent them in the first place.While hospitalized, insist that your attending physician outline his/her treatment plan so you know what to expect.If a nurse or another doctor announces an unexpected visit or procedure, ask to see the hospital record indicating the attending physician's approval. If you have any doubts at all, politely decline the service and insist on talking with the attending physician.

Insist on a fully itemized bill. Don't settle for bills that list broad categories like "pharmacy" or "surgical charges." Hospitals are required to provide a detailed account of all charges. The bill should list each...

Procedure you underwent.
Doctor's visit to your hospital room.
Dose of medicine that was given to you.
Facility used -- X-ray suite, operating room, etc.
Supply provided for your care -- bandages, IV lines, etc.

If you're hospitalized for two or more days, ask for a new itemized bill daily. That makes it easier to keep track of your charges and to start questioning any suspect items right away.

The hospital's operator can give you the number of the billing office. Call and request the update directly from the department head.

If he/she balks, talk with the hospital's patient representative (ombudsman). If this doesn't work -- or if there's no patient rep -- calling the hospital's chief administrator almost always brings a fast response.

Scrutinize your bill. Even with the help of your detailed log, the abbreviations on the bill may be hard to decipher. If any items on it stump you, call the billing department for clarification.

Also check with your attending physician if any charges on the bill seem suspect.

The most common overcharges are for services and/or procedures that you didn't actually receive. The second most common overcharges are for duplications of service.

Examples: A charge for use of the radiology suite for an X ray taken at your bedside... a charge for six blood tests when you actually had only three.

Have your bill audited. If any of the listed charges seem erroneous to you, ask the billing department to check your bill against hospital records to make sure all itemized services really were performed.

The department should conduct this audit willingly and at no charge... and promptly correct all mistakes.

Alert your insurer. If you dispute the billing department's finding and the dispute can't be resolved, contact your insurance company or HMO.

Taking this action doesn't mean you're accusing anyone of a crime. But it is the surest way to get prompt action.

Your best bet is to contact the company's fraud division directly. Bypass the customer service department.

If you are covered by Medicare, contact the Inspector General of the Federal Health and Human Services Department.

For greatest efficiency when you call your insurer...
Have all pertinent documents on hand when you call.
Be prepared to detail exactly which charges you feel are fraudulent, and why.

If the insurance company agrees with you, it will generally take over and resolve the case. That might even involve going to court.

The bill typically goes on hold while matters are disputed.

Bottom Line/Health interviewed Charles Inlander, president of the People's Medical Society, Allentown, Pennsylvania. He is author of This Won't Hurt (And Other Lies My Doctor Tells Me) (People's Medical Society).

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