Correcting medical billing snafus
Dear Money Helps: I have sleep apnea and signed up for a study at the Stanford Hospital Sleep Disorders Clinic. I paid a $15 fee, answered questions and was checked out by the staff. The whole process took 30 minutes.
I was told I couldn’t proceed to the next phase until my health insurance was verified. My insurer told me later that week I wasn’t covered. Much to my surprise, I got a bill for $420 for the consultation. I called the customer complaint number on the bill but was told that the charges were final. I paid the $420 but feel like I was ripped off. – Christopher Camba, Hayward, Ca.
Answer: You’re not the only person to lose sleep over a medical billing snafu. According to medical bill auditor AMBR, 85% of hospital bills contain errors.
Yours was one of them. When the manager of the clinic reviewed your record at our request, he found that you were charged a co-pay for the consultation, as they assumed your insurance would cover the rest. (Yes, that 30-minute appointment goes for $420; the study itself would’ve cost thousands.)
He admitted it was their failing - that they should’ve checked with your carrier before naming the price - and agreed to refund your $420.
You did the right thing trying to dispute the charge, but you didn’t go far enough. The clinic doesn’t have any written record of your inquiry. Consumers have to be vigilant when it comes to unraveling billing mistakes, says Nora Johnson, associate director of Medical Billing Advocates, a trade group that trains people who represent patients in disputes. Should you notice something amiss in an invoice, she says, don’t pay it.
Instead, initiate a dispute by phoning the billing office, making sure to write down the time, date, name of person you speak with. Follow up with a letter, sent via certified mail, to the highest person in the department. (Once they have a written complaint, most providers halt the collections process until the case is closed.)
If you still get the runaround on a sizable bill, consider hiring an advocate. You’ll be charged, hourly or by a percentage of what’s recovered, but at least you’ll rest easier knowing you have a professional red-tape cutter on your side.
Next time, talk to your insurer before going for any procedure or service. If you know what’s covered, you’ll be less likely to end up in a billing nightmare.
TIP: If you want to dispute a charge, act fast. Medical providers are
aggresssive about unpaid bills and many will send delinquent accounts to collections in less than 90 days.
“I disagree vehemently with syoders about the patient is solely responsible. There is usually a contract between the insurance and the medical provider. And, in some states, the State’s code defines a lot of the legal interaction between the parties. From my history of medical billing/procedures, all parties seem to be in varying degrees of incompetence (hence the need to legislate and create all that code). ”
This is incorrect. The insurance company *usually* does not have a contract with the provider. They have a contract with the PPO (preferred provider organization) EPO (Exclusive provider organization) HMO, etc. The PPO,EPO,HMO, etc. has a contract with the provider. The contract does not specify anything with verifying benefits prior to rendering service, or billing procedures. (Come on folks! How many docotrs and insurance companies can you think of? Do you really think they all have contracts with each other?!) Ultimately is the customer’s job to verify what is covered & any policy provisions that may apply to the services they may be recieveing-not the doctors, not the insurance company’s-YOURS. In this case the facility that rendered services should have refunded the patient. They should have verified the insurance covered prior to rendering and advising of what will be covered. However, I believe, legally they did not have to (I’m not a lawyer!) It is unfair to the medical community that, as a consumer, most American’s can’t figure out what kind of coverage they have. Or, at the very least, how to pick up the phone and call the customer service department at their insurance & find out from a trained insurance specialist!
(By the way, I do not currently work in the medical insurance field, but did for quite some time as one of those previously mentions insurance specialist… and guess what- I call my insurance company prior to ever going to the doctor, even now!)
Ok…we all know it’s a scam.
Health Insurance is a scam.
so..we call in the big guns to take care of the issues.
Medical Bill
I disagree vehemently with syoders about the patient is solely responsible. There is usually a contract between the insurance and the medical provider. And, in some states, the State’s code defines a lot of the legal interaction between the parties. From my history of medical billing/procedures, all parties seem to be in varying degrees of incompetence (hence the need to legislate and create all that code).
I’ve dealt with a lot of medical billing errors this year. Nearly every firm I’ve came into contact had an error. One actually was mediated by the Attorney General.
The system is broke and in my opinion the consumer is paying the price. It’s really unfortunate because people deserve to get paid and make a living, but as a lot of research suggests the medical field is terrible at getting their processes correct.
All this medical billing sounds like a real nightmare. I live in Canada and I sleep with ease.
more info on health insurance here:
http://tipconnection.com/category/health-care/
Over the past 30 years, I have had several cases where medical bills were incorrect or the payments were incorrectly applied. Everytime, the billing office has tried to stonewall me when I have tried to get them to understand. The best tactic is to request a copy of the complete billing record. This generally forstalls the escalation to a collection agency.
What I have found:
1) one visit/procedure billed twice. the insurance payment applied to one bill and my copay was applied to the other. I was getting two bills a month , one for the copay amount, the other for the insurance payment amount
Two errors on one billing.
2) My son was in therapy with the same dr at the same office for 5 years. I paid my copay for each visit and the insurance payed the rest. I was being threatened with collections until I asked for all the payment records. Seems they started a new account for each year and applied all 5 years of the insurance payment to the first account. When all was said and done, there was more than enough credit on the first account to pay the other four in full.
3) My son and daughter had their tonsils removed on the same day, one right after the other. My son also had “tubes” put into his ears. My daughter was in the operating room for 15 minutes, my son took 30 minutes.
Whose bill was larger? My daughter’s! Twice as much! When I took it to my companies insurance people, they looked at me and said “They (the insurance company) paid it didn’t they?”.
Part of the medical cost problems we face is the incompetance, non-caring and all but indecipherable paperwork of the billing offices.
I own a medical billing company. While we do contact insurance carriers and try to collect the appropriate copays/coinsurance/deductibles from the patients, it is the patients responsiblity to know what their policy covers. When we call your insurance carrier they will not give a guarantee of payment until a bill is received. If more patients would take charge of their policies monitor what the insurance company is paying for, call them when an error is found and find out what is a covered expense most of these problems can be solved prior to the appointments. Insurance is a contract with the carrier between the patient or the patient’s employer. It is the patients job to make sure that the contract is enforced.
Frequently patients who enter a clinical research study are not charged for treatment specifically related to the study including consultations. Usually this is clearly stated in the informed consent that you would have signed before entering the study. This should have been explained to you before you agreed to enter the study. I suggest you contact the Stanford Institutional Review Board (IRB) to look into the matter on your behalf.
Noting the name of who you spoke with doesn’t always work. St. Lukes’ Roosevelt has outsourced their billing, and they admit they had recieved numerous complaints that the “customer service” department had often used false names. And they are turning over accounts that are in dispute to credit agencies without trying to resolve the problem. I’ve had a log of calls for over six months and despite being told the matter had been “corrected’ I cannot obtain a statement showing a zero balance.
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I understand your pain, I am in a fight right now with my Dr’s office because they refuse to send me a paper bill of any kind. I can’t even check my bill for errors.