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How to Audit Hospital Bill for Expensive Errors

Anyone who has checked into a hospital knows that once you check out, you’ll be confronted with a staggeringly expensive, dizzyingly confusing bill. But what is not common knowledge is that many of these bills contain errors that can cost consumers and their insurers thousands of dollars.

How big and how common are the errors? The answer depends on whom you ask. Some say the vast majority of bills have errors, including both overcharges and undercharges to the consumer, but the value of the mistakes are relatively modest at about $100 each.

Others maintain that fewer bills have errors, but those that do can be doozies. One study concentrated only on high-rate and high-risk bills--those totaling at least $10,000 and containing many lab and pharmacy charges, among other things--and found errors averaging $1,300 to $1,500. But the firm that conducted the study, Atlanta-based Equifax, said most bills were not studied because they were unlikely to contain errors of consequence.

Today, consumers are finding themselves paying for an increasing share of their medical costs and health-care providers are becoming more aggressive about bill collection, so these mistakes may prove more unsettling to individuals than ever before. As a result, consultants and other industry experts frequently encourage consumers to scrutinize their hospital bills for mistakes.

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The scrutiny isn’t easy. Even a short stay in the hospital can result in a multipage bill. Hospital bills also have a language all their own, so often you won’t recognize even legitimate charges on first glance. Consumers can also be hampered because they don’t remember exactly which procedures were done and which drugs were administered at particular times. After all, the person receiving the treatment was sick, sometimes unconscious.

Nevertheless, it might be worth the time and trouble to try.

Consider the case of a Chicago man who had a back injury. He was charged for four days of traction--a procedure where the body is immobilized to prevent jarring the spine. The cost amounted to about $1,600, said John Garner, president of Garner Consulting in Pasadena. The problem was, this patient was never put in traction. Assuming 80% insurance coverage, the patient’s portion of the erroneous tab amounted to $320.

A maternity patient was charged for three nights in a semiprivate room and one night in the labor and delivery room when she was in the hospital for only three nights, Garner said. The overcharge amounted to about $400, or $320 for the insurer and $80 for the patient.

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Similar stories abound: people charged for hours in “the surgical suite” and the surgical recovery room when they never had surgery; medicine charges that were never prescribed, never taken; lab procedures double- and triple-billed.

Where do you start if you want to audit your own bill?

Ideally, if you know you are going to the hospital, you should think about checking in with a notebook. Then as services are being provided, write them down, including drug dosages and times.

Of course, this isn’t always practical or possible. Patients who are on heavy medication or are in for serious operations are frequently not in a position to take notes. But if you are--or when you are--up to it, start paying attention.

For most people, though, the auditing process will begin after they get out of the hospital and receive the bill. Your first step should be to make a copy (or two) of that bill and start highlighting or circling items that you don’t understand or services you can’t recall.

Then spend some time trying to retrace the experience. Obviously, if you have a written record this will be much easier. But even without it, it’s possible that reflection will cause you to recall that some of the questioned items were legitimate.

Other charges might require a call to the hospital billing office for explanation. When a charge cannot be explained by reviewing your medical records and talking to your doctor, you obviously want to get it taken off your bill.

Never give or send anyone your original bill, however. If are convinced that you’ve been overcharged and cannot solve the dispute amicably, you might want to take the hospital to small claims court. And courts typically require original documents.

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Other guidelines: Check simple things first. Make sure the number of nights and dates of stay are correct. If you are charged for a special room, such as for a labor and delivery room, make sure you were there and that you weren’t double-charged for another room at the same time.

Then look for duplications, such as tests run several times over. Sometimes identical tests will be taken, but in other instances consumers just get billed for one test twice.

Take special care with charges for central supply items (such as aspirin and cotton balls), lab tests and pharmaceutical supplies. Auditors maintain that these areas are most prone to error.

If you find erroneous items, particularly expensive ones, be sure to contact your insurer. As a co-payer, the insurer needs to know when the total is reduced.

Additionally, if the items that you found are significant enough, the insurer might decide to conduct a more extensive audit, where they get your medical records and bills to make sure that all items match and that all the procedures made sense for your particular illness. You should be able to share in additional savings the insurer may receive.


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