{"id":2476,"date":"2019-05-21T20:19:59","date_gmt":"2019-05-22T03:19:59","guid":{"rendered":"http:\/\/hospitalbills411.com\/?p=2476"},"modified":"2022-06-15T18:58:04","modified_gmt":"2022-06-16T01:58:04","slug":"up-to-80-of-hospital-bills-have-errors-are-you-being-overcharged","status":"publish","type":"post","link":"https:\/\/hospitalbills411.com\/index.php\/2019\/05\/21\/up-to-80-of-hospital-bills-have-errors-are-you-being-overcharged\/","title":{"rendered":"Up to 80% of Hospital Bills Have Errors. Are You Being Overcharged?"},"content":{"rendered":"\n

Surprise hospital bills and bogus charges are more common than you might think. Here\u2019s how you can push back when you find a problem.<\/p>\n\n\n\n

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In November, J.R. Duren\u2019s wife gave birth to their son. Concerned about a possible infection, doctors monitored the newborn in the neonatal intensive care unit. After four hours, he was declared well enough to return to a regular hospital room, where new baby and mother stayed two more nights.<\/p>\n\n\n\n

Yet when Duren received the bill, he was shocked. Not only had the hospital charged $55 for saline spray that his wife never received, but his son had been billed nearly $3,500 for one night in NICU and an additional $2,226 for another night\u2019s stay in a regular hospital room.<\/p>\n\n\n\n

Duren pointed out the two errors to the hospital billing office. An employee promised to look into the mistake.<\/p>\n\n\n\n

\u201cWhat they ended up doing was auditing both my wife\u2019s and my son\u2019s accounts, and our charges actually went<\/em> up<\/em> around $1,000,\u201d said Duren.<\/p>\n\n\n\n

What should have been a happy time to celebrate the birth of their child turned into a back-and-forth battle that lasted months, even though, as Duren said, \u201cthe hospital was clearly in the wrong.\u201d<\/p>\n\n\n\n

Duren\u2019s experience isn\u2019t unique. Whether intentional or due to careless mistakes, \u201csurprise\u201d hospital charges are common. Similar stories have also recently grabbed headlines, including a family who was charged $18,000 for a nap and a bottle<\/a> of baby formula after taking their 8-month-old son the emergency room when he hit his head, and a woman who was charged nearly $6,000 for an ice pack and bandage<\/a> when she ending up in the ER after she fainted and cut her ear during the fall.<\/p>\n\n\n\n

Nearly one-third of insured Americans learn after the fact<\/a> that their health plan doesn\u2019t pay as much for a hospital visit as expected.<\/p>\n\n\n\n

In fact, past-due medical bills are the reason 59 percent<\/a> of Americans are contacted by a debt collector and 16 percent<\/a> of Americans\u2019 credit reports include medical debt \u2014 about $81 billion total.<\/p>\n\n\n\n

\u201cHospitals and doctors keep sending patients surprise bills because they make money by doing so,\u201d said Charles Silver, endowed chair of civil procedure at University of Texas at Austin School of Law and co-author of \u201cOvercharged: Why Americans Pay Too Much for Health Care.\u201d \u201cThey face little risk of losing customers.\u201d<\/p>\n\n\n\n

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Hidden costs of care<\/h2>\n\n\n\n

In July, a video<\/a> of a woman whose leg became trapped between a Boston subway train and platform went viral \u2014 not just because of the high drama or how fellow passengers worked to pull her free.<\/p>\n\n\n\n

What resonated on the internet was the woman\u2019s panicked reaction when someone tried to call an ambulance.<\/p>\n\n\n\n

\u201cIt\u2019s $3,000,\u201d she reportedly pleaded. \u201cI can\u2019t afford it.\u201d<\/p>\n\n\n\n

Why is getting medical care from a hospital, even when you\u2019re severely injured, and even when you\u2019re privately insured, so prohibitively expensive?<\/p>\n\n\n\n

There are several reasons.<\/p>\n\n\n\n

A complicated system<\/h2>\n\n\n\n

Hospitals contract with insurers, offering their members a discounted price for services. Different contracts result in different prices. And having no contract at all results in \u201cout-of-network\u201d prices that can be sky-high.<\/p>\n\n\n\n

But even if the hospital you visit is<\/em> \u201cin network,\u201d the doctor who sees you might not be.<\/p>\n\n\n\n

When Yale researchers<\/a> reviewed more than 8.9 million ER bills, they discovered that 22 percent of privately insured patients were treated by out-of-network doctors.<\/p>\n\n\n\n

More than 60 percent of hospitals outsource their ER doctors, and the firms they hire have an incentive to keep physicians \u201cout-of-network\u201d so they can charge higher prices.<\/p>\n\n\n\n

The Yale study noted that each time a physician staffing firm called EmCare was hired by a hospital, the patients were more likely to have imaging tests done, be admitted, and were billed under the highest (most expensive) procedure codes.<\/p>\n\n\n\n

\u201cPeople have gotten better at gaming the system and now, there are many more of them,\u201d said Silver.<\/p>\n\n\n\n

Opaque prices<\/h2>\n\n\n\n

Let\u2019s say an ER doctor wants you to have a comprehensive blood test called a full metabolic panel.<\/p>\n\n\n\n

Your explanation of benefits might list the cost as $1,000. But because your insurer has a contract with the hospital, it might deduct $900 from that cost. And if you have a deductible, you may end up paying as little as $5.<\/p>\n\n\n\n

That may sound like a great deal, but list prices \u2014 what a hospital charges for a typical procedure \u2014 are \u201cnonsense,\u201d according to Akshay Gupta, co-founder of CoPatient, a medical bill advocacy service.<\/p>\n\n\n\n

\u201cThe prices are completely egregious and have no connection to reality,\u201d Gupta said.<\/p>\n\n\n\n

A study<\/a> compared 2012 data on the treatment for severe pneumonia at hospitals across the country. The lowest was $59,134 at an Anaheim, California, medical center. The highest? Over $99,000 at a Tampa, Florida hospital \u2014 a $40,000 difference.<\/p>\n\n\n\n

According to a study<\/a> published last year in Health Affairs, these list prices (also called \u201cchargemasters\u201d) are typically three times higher than what a hospital is paid for providing care \u2014 and gives them leverage when negotiating with an insurer.<\/p>\n\n\n\n

Yet paying more for a hospital procedure doesn\u2019t mean you\u2019re paying for higher quality of care, or that doctors are aware the procedures they\u2019re ordering may push patients into crippling debt.<\/p>\n\n\n\n

Silver once asked a liver transplant surgeon what her procedure cost. She had no idea.<\/p>\n\n\n\n

\u201cMost doctors don\u2019t think about cost and are just doing their job,\u201d said Silver. \u201cAnd the people who do know \u2014 like administrators \u2014 are just doing what comes naturally, maximizing profit.\u201dShare on Pinterest<\/a><\/p>\n\n\n\n

Billing mistakes<\/h2>\n\n\n\n

As many as 80 percent<\/a> of hospital bills contain errors<\/a>. And no wonder, since there are nearly 70,000 diagnosis codes and over 71,000 procedure codes to sift through.<\/p>\n\n\n\n

\u201cTo make sense of [a bill] and figure out what\u2019s right and what\u2019s wrong \u2014 it\u2019s not easy,\u201d said Gupta.<\/p>\n\n\n\n

Yet the wrong code can lead to an overcharge of hundreds \u2014 or thousands \u2014 of dollars. A National Academy of Medicine report<\/a> estimates about $210 billion is spent on unneeded or overpriced treatments.<\/p>\n\n\n\n

A bumpy ride ahead<\/h2>\n\n\n\n

Simon Haeder\u2019s wife barely made it to the hospital before she delivered their son. \u201cAt least they can\u2019t charge us for delivery,\u201d Haeder joked at the time.<\/p>\n\n\n\n

Yet the hospital did \u2014 and other charges piled up, too. $7,000 for a delivery room. Over $4,000 for the doctor who hadn\u2019t even been at the birth. $25 for two Tylenol, and more.<\/p>\n\n\n\n

\u201cWe had a bill for our baby before he even got a Social Security number,\u201d Haeder said.<\/p>\n\n\n\n

Frustrated, Haeder wrote about the experience for The Conversation<\/a>, detailing the extravagant charges as well as the stress of dealing with new bills arriving each day.<\/p>\n\n\n\n

\u201cI was tired of not saying anything because [similar experiences] are happening to a lot of people,\u201d said Haeder. His friend, for instance, was charged twice for an imaging test because the technician scanned the incorrect body part the first time.<\/p>\n\n\n\n

Haeder, who is a professor of political science specializing in healthcare policy at West Virginia University, thinks a tipping point is near.<\/p>\n\n\n\n

\u201cPeople are paying larger premiums, but wages aren\u2019t getting larger,\u201d Haeder pointed out. \u201cPeople on Medicaid are insulated from the costs, but more and more of the cost goes to the middle class.\u201d<\/p>\n\n\n\n

Between 2010 and 2013<\/a>, Americans households lost $2,300 in median income, yet healthcare prices rose over $1,800.<\/p>\n\n\n\n

Only 23 percent<\/a> of Americans are able to afford an unexpected medical bill that\u2019s more than $2,000, yet out-of-pocket medical costs keep rising.Share on Pinterest<\/a><\/p>\n\n\n\n

What you can do<\/h2>\n\n\n\n

After three months of battling with his hospital and insurer (and calling them both out on Twitter), Duren received a surprise call from the CEO of the hospital billing company. Not only was the extra NICU charge removed, but the hospital forgave Duren the $2,800 still owed for his son\u2019s account.<\/p>\n\n\n\n

\u201cIt was an incredible moment,\u201d said Duren. \u201cI got goosebumps.\u201d<\/p>\n\n\n\n

To fight \u2014 or prevent \u2014 your own surprise charges:<\/p>\n\n\n\n