Recently I went through surgery. I couldn’t believe it when the hospital billed me for way too large a sum. What’s even worse is that my insurance company refuses to pay for over $5,000. I’ve spent hours on the phone with the hospital’s billing department with no success. Do I have any choice but to pay the remainder of the charges? — Hysterical Henrietta

Dear Henrietta: Whether you realize it or not, the answer actually involves two different topics. One is the amount the hospital actually billed you following your stay, and the second concerns what to do when your insurance company balks at payment. Because each issue is fairly complex, I’d prefer to answer in two parts. I’ll concentrate today on your billing problem.

After credit card debt, medical-related debt ranks second among causes for personal bankruptcy in the United States. Even if we’re insured, we still may have to pay 20 percent of our out-of-pocket bill and, worse, a single error could cost an individual hundreds or even thousands of dollars (or, in your case, $5,000).

First, as I’ve suggested in the past for any sort of bill, make sure you obtain an itemized list of charges. There are two kinds of codes on that medical bill, a diagnostic code and a procedural code. The diagnostic codes are ICD-9 codes which diagnose the problem (in other words, figure out what’s wrong). The procedural codes are CPT codes, those treatments to make you better. Ask for a thorough explanation from the hospital or doctor. This is especially important for a hospital stay, as it’s not unusual to be charged $15 for one Tylenol and $5 for a box of tissues — seriously! Even if you don’t discover any mistakes, it’s still a good idea to check with your insurer if any particle of information seems questionable. Sometimes honest human errors occur when a person accidently punches in the wrong code. Even the simplest medical procedure can cost tens of thousands of dollars. One error could add several thousand dollars to an already hefty bill. “So what?” you ask. Even if your insurance does cover the entire bill the excess cost eventually is passed along to you and other insured persons as higher insurance premiums. (Ever notice how insurance premiums rise — sometimes yearly?) Therefore, it’s imperative we detect and correct hospital billing errors.

Statements in hand, carefully pour over each and every charge and mark all services you think need an explanation or the ones you don’t recall having received. (Earlier advice for a family member or friend to stay with you in the hospital as an advocate/guard is especially applicable here, because this person may remember procedures that may or may not have occurred when you were at your groggiest.) Even though lots of potential errors can occur, experts agree upon the most common billing areas: 1) Duplicate billing charges for the same service, supplies or medications. 2) Number of days in the hospital — Be sure to check the dates of your admission and discharge; most hospitals will charge for admission day, but not for day of discharge. 3) Incorrect room charges — If you were in a semi-private room, make sure you’re not being charged for a private. 4) Operating room time — Hospitals commonly bill for more or time than you actually used. Compare the charge with your anesthesiologist’s records. (This was a new tip for me.) 5) Up coding — This billing mistake occurs (more often than we know) when a doctor switches a high cost medication or expensive service for a cheaper alternative or generic, then charges for the more expensive item. In some cases, Doc Distort — hopefully through carelessness only — charges for both! 6) Keystroke error — Computers aren’t infallible, especially when human hands input the data. I regularly make this mistake myself if in a hurry. 7) Canceled work — Sometimes a procedure was ordered and later canceled but still appears on your final bill. 9) Services rendered — Were you billed for medications, treatments, and the like but didn’t receive them?

Kiplinger’s Retirement Report (October 2008) tells us that the full hospital bill amount we receive is lots more expensive than the hospital’s actual costs! Yep, I almost fainted, too, before I saw red, but then realized this larger amount actually gives the payer leverage. The article suggests finding out what Medicare pays for a comparable procedure; then visit the hospital’s chief financial officer or the head of the billing department. Ask for the same billing amount the government pays, plus 25 percent.

However, when you contact the medical providers but some or all turn a deaf ear, I urge you to request help from trained professionals who can analyze the bill for and negotiate the charges for you. One of the best organizations around is the Medical Billing Advocates of America (www.billadvocates.com). Even though it costs $50 yearly to join, the firm (and others like it) really saves people money. To find other specialized professionals, google “hospital bill review.”

Next week’s column will concentrate on Part 2 of Ms. Hysterical’s question: insurance company appeals.

Editor’s Note: Ellen Phillips is a retired English teacher who has written two consumer-oriented books. Her Consumer Watch column appears on Saturdays in the Business section of the paper. An expanded version is at www.timesfreepress.com under Local Business. E-mail her at consumerwatch@timesfreepress.com

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