Medical Billing Advocates of America, a national association that checks bills for consumers, says 8 out of 10 hospital bills that its members scrutinize contain errors.
The National Health Care Anti-Fraud Association, a Washington, D.C.-based group of health insurers and state and federal law-enforcement officials, estimates that $68 billion is lost to fraud. Mistakes can result from “typos or deliberate overcharges,” according to ConsumerReports.org. Deliberate overcharges? Could someone, somewhere be cashing in on the misfortune of ailing consumers? Could this happen to you?
Having experienced first-hand some discrepancies in my own medical bills and listening to several friends rant about their medical billing nightmares, I started to wonder how many others might be experiencing this great medical mystery and wondering what recourse, if any, do they have. Well, here are some suggestions.
Call your insurance company’s toll-free number to ask for an estimate of the amount your plan will cover and what you’ll be responsible for paying. Ask if the company pays a reward to patients who find errors on their bills; some do. Hospital billing departments must send you a free, detailed bill at your request under the Patient’s Bill of Rights adopted by the American Hospital Association.
If you still can’t understand some of the charges on your hospital bill, ask the medical-records department for a copy of your doctors’ orders and the nursing notes. They will include all the procedures, treatments, and drugs you were given. Also ask for a copy of the UBO4, which is the detailed bill the hospital sends to insurers.
If you discover an error, call your provider, explain the error, and ask someone in the billing department to make the correction. For each call you make, keep a record of the time, the name of the person you spoke with, and what you were told. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections. Those may be the only steps you have to take to get the matter resolved.
Pat Palmer, the founder of Medical Billing Advocates of America, told the Los Angeles Times, “You can’t be billed if they can’t tell you what they are charging for.” The April 5, 2013, article added, “If you meet with resistance, don’t waste time by calling back the customer service line or billing department. Go straight to the top. Address a certified letter to the chief executive or chief financial officer of the hospital or medical group explaining that you have tried to resolve billing issues but have hit a brick wall. ‘The CEO and CFO will take it very seriously,’ Palmer says.”
If that doesn’t work, call the fraud department of your insurance company. Next, appeal to your state consumer-protection agency or your state attorney general’s office. If you find the disputed bills showing on your credit reports as unpaid accounts, write to the credit bureaus to explain the ongoing dispute. The bureaus must review your complaint and correct your report.
If you don’t have the time or feel too sick to audit your bills for errors, you can obtain an expert through a medical recovery service such as Medical Billing Advocates of America, HealthCPA and Medical Bill & Claim Resolution. Most of their work will be done by phone, so they do not have to be nearby to help you resolve your medical billing issues.
Many consumers are also using a free website called simplee.com., which automatically scans all your medical claims for billing errors, problems with coverage and money-saving tips. It also provides one centralized dashboard where you can manage your health care expenses, securely pay your bills online and understand the charges before paying.
Trying to straighten out a billing problem can be time consuming, frustrating, costly and hazardous to your blood pressure, if you are not careful. Even if you are careful there are no guarantees. Medical billing errors is a lucrative business to someone.
This billing confusion is profitting someone and there is no end in sight. It appears that as long as there are medical bills there will be medical billing errors because humans are prone to make mistakes and others are prone to take advantage of those mistakes. Sad.
One day, however, God’s wonderful promise at Isaiah 33:24 will be fulfilled worldwide, “And no one living there will say, ‘I am sick.’ The people who live there will be forgiven of their sin.” — New Life Version.
No more sickness. No more medical bills and no more billing errors! This costly epidemic has a cure. The cure involves God’s Kingdom and a new system where righteousness is to dwell. That glorious time will introduce the end of an “error” — all errors.