Re: Deciphering the Accuracy of the Hospital Bill

[Guest guest]

Heidi, accuracy

This is definitely a topic that most of us have a personal interest in. Prior

to Pancreatitis, I never worried about my lifetime max, but as you have

referenced, with a CT @ $5K a pop, those benefits can be eaten up quickly. We

certainly do not want to give them up freely.

Good for you for reviewing your medical bill. It is true that many hospitals

have quit providing an itemized bill unless requested. There should be a

phone number on the bill you received that states " if you have further

questions please call.... " If there isn't simply call your hospital billing

or business dept. It varies depending on the size of the hospital. Either

way, have the dates of your stay, hospital number, SS#, and insurance name

and number handy, and then call them to request an itemized bill. I have

spoken to dozens of people and they have never had a problem with this

request.

The two problems frequently encountered are

1) You will have difficulty reaching a human voice and

2) They may say, the itemized bill is not in yet. What this means is that

often times a hospital will prepare a bill based on your dates of stay,

diagnosis, and large procedures performed. After decades of practice, they

feel that they are always within a standardized % of accuracy of the itemized

bill. Any large miscalculations will be corrected. (If the patient raises a

concern).

For future reference, on the day of discharge, when you go to the business

office to check out, ask them to print out a preliminary bill. The reality is

that all charges are sent to the business office every night at midnight.

Take all the time you want to review the bill and compare it with notes you

have taken. If you have any questions raise them immediately with the

financial assistance office before you check out. As an FYI, note that you

generally should not pay for a room on the day you check out. However, there

is usually a " check out time, " similar to hotels, so make sure you don't hang

around longer than you need to. This is where others choose to use your

healthcare benefits. They'll say, " Sure, it's okay if you stay until your

husband gets off work " , but don't say " You will just have to pay an extra

room charge, which the insurance won't pay for since it wasn't medically

necessary "

Another note about the itemized bill. I have interviewed some billing

departments that have admitted they never use the charge stickers the staff

keep putting on your charge sheet because most insurance companies are now

doing what Medicare does and they are billed for and pay a flat rate for a

DRG (Diagnosis Related Group).

Remember that even with Medicare, Medicaid, any insurance, and private pay

every patient is entitled to an itemized bill.

Most of the times, the patient receives an " Explanation of Benefits. " Pay

close attention to this form. It explains about how much your insurance has

paid, not paid because they said it was above the reasonable and customary

rate, or not paid because it was not a covered service. There will be a

statement by the insurance company that you are responsible or not

responsible for that certain amount.

It has been known that a hospital will bill the insurance, receive payment,

and then bill you for everything not paid by the insurance company. You are

not necessarily, responsible for that amount. Particularly because an

insurance company usually has a preexisting agreement with a hospital to

accept a reduced rate. That reduced rate is passed on to you, and the

hospital is required to honor that and " eat " the difference.

You asked, " How do I go about obtaining an itemized list of 'services

rendered " and medications used? " .

To how to know what medications were used, this will be documented in two or

three places. We have often spoken about the need to get a copy of your

medical record. (Our member, Kaye Fortenberry, Medical Records

Transcriptionist, has graciously volunteered to write up a procedure to help

us with this). Included in the medical record is a copy of the nurse's

Medical Administration Record (MAR). Compare your bill to this. Every

medication given will be on this record. There are a few exceptions. Insulin

and blood glucose checks may be documented on the Treatment Sheet (TAR).

Intravenous Fluids (IV Fluids) are often documented on the IV Flow Sheet. It

may be that you may need to cross reference these entries in the nurse's

notes.

It is a timely activity to ensure the accuracy of your medical bills, but

worth it. There are people who can help. The hospital or doctor's office are

not usually the ones to ask, though. They are swamped. Patty Hurst, Maine

State Representative was right when she said that the insurance companies

will often compensate you for identifying inaccuracies in billings statement.

They call this fraud.

If you are not able to handle this complex task (taking notes during your

stay is helpful), you can often find people who do this for a living. [This

is something I have thought about it doing since it can be done out of my

home and via the computer and phone.] Most of these people or groups work on

a contingency basis or by assignment, which means they take their pay from

the money they retrieve from over billing. They don't get paid if the bill is

accurate. They haven't found one yet!

Another option to contact <A HREF= " www.Myvesta.org " >www.Myvesta.org</A> a

financial corporation dedicated

to stopping medical billing fraud.

One more consideration is that when you have two sources of coverage, i.e.,

Medicare and a private insurance, that requires a completely different

approach to ensure that there is no " double dipping. " If anyone has any

questions regarding this, please let me know.

The last is that I try to do is to act on the premise that everybody and

every institution is inherently good. It doesn't help to approach them with

blazing guns and hot tempers. I have learned that from experience. In fact,

the person you are dealing with is usually just the messenger. That doesn't

mean they don't have the authority to make adjustments on the bill. The

approach you take can make the difference between their advocacy or

alienation.

I will post my article on the home site when it is complete.

Karyn

Karyn E. , RN

Founder / Executive Director

Pancreatitis Association International

Corp. Office: Indps, IN, USA 1-

[Guest guest]

Karyn...this is an incredibly thorough message and is filled to the

brim with accurate information ! Having been in the medical field

for 30 years now I have been on all sides...working in medical

records, on the wards, in outpatient clinics and of course I have

been a lifelong patient...in military, civilian and VA hospitals and

outpatient clinics.

I have been fighting over my bill with the VA for YEARS!! Several

weeks ago my husband called billing at our hospital billing office

(we both work there as well as are veterans receiving our care there)

to find out why he had not received a bill for his last prescription

refill...he was told he didn't have to pay because his insurance was

paying ! HUH? Wait just a minute here, Back up !?! Then how come

*I* am paying month after month...His insurance is also MY insurance

....funny how things work that way when you're married and all....

SO...you can bet your sweet bippy (oops...telling my age!!! <smile>)

that *I* called billing the next morning to find out what was up with

this !? After all...with Dave's bill we were talking about *seven

dollars* but mine was close to $2000 (I have been paying dribs and

drabs, just enough to keep us out of collections, but fighting with

them all along!)!! It took the man in billing several weeks to go

through my bills (we're talking four years of outpatient visits and

numerous prescriptions to the tune of almost $100 a month!)...I have

several chronic conditions.

He wrote to me earlier in the week and after much figuring and

calculating all I owe them is $105.47 !!!! I told him I could pay

this with my eyes closed! I am so thrilled! My boss said it was like

getting a pay raise and I agreed with her but then when I remembered

our annual raises are around $900 a year I decided this was like

getting a double pay raise...so the moral of this story is it pays to

stay on top of them !

It is like a huge weight has been lifted from me...I no longer have

to dread the monthly bill ! yay !

Hang in there Heidi...and for the days you might have been " out of

it " when you were so sick, you're hubby might be able to help you

remember what you used and didn't...

Hugs, Jeannine