6 Common Surprises in Your Medical Bill

To be honest, I usually have no idea what to expect when I open up a bill from a hospital or doctor’s office. I can’t even predict a range that the charges will fall within. But there is usually a maximum amount that I’m hoping my responsibility will fall beneath. I’m also endlessly surprised by the cost of medical procedures versus what I end up owing. Thus far, it’s been happy surprise (knock on wood), probably since neither my husband nor I have ever had to undergo anything too serious. But I’m sure the day will come when I’m left with a medical bill replete with exorbitant charges that I don’t understand.

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Finding a surprise charge in your medical bill could produce this kind of response.

If you’ve had the wind knocked out of you by a hospital or doctor’s bill, start by asking for an itemized bill, so you can verify that each charge is warranted and accurate. For hospital stays, request a copy of your medical record and pharmacy ledger as well for comparison to your bill. The shock factor may be due to one of the following scenarios.

Here are 6 common surprises in your medical bill:

Data entry errors – An errant zero could mean you’ve been charged for 10 X-rays instead of one. Or, a charge for a procedure could mistakenly be duplicated on your itemized bill. While not common, these mistakes do happen.

Incorrect coding – Your insurer will bill you based on the code they receive from your doctor’s office or the hospital. If your doctor’s office mistakenly codes your annual preventative care visit (free with your insurance) as a typical doctor visit (requiring a co-pay), you could end up owing money. The same thing can happen if codes are listed out of order. Unfortunately, these errors won’t always be visible to the patient.

Inconsistencies between the bill, medical record, and pharmacy ledger – Your medical record and pharmacy ledger list every procedure you underwent and medication you received during your hospital stay. If you’re billed for something that doesn’t appear on these records (e.g. a test was ordered, but never completed), you have the right to dispute the charge.

Charges for hospital’s errors – It’s common practice for hospitals to pass on the cost of their own mistakes to the patient. For example, if they lose your test results and have to redo the test, you’ll be charged twice. This is disputable.

Balance billing and facility charges – Balance billing is when you’re charged for the balance left on your bill after your insurance company pays their part. This happens when you (perhaps unwittingly) receive care from a doctor who is not in your network or when your doctor may be in-network, but the hospital where you were treated isn’t. For example, maybe your surgeon and the hospital where your surgery took place are both in-network, but the anesthesiologist isn’t. Contact your insurance company for information on whether these charges can be negotiated.

New patient fee – Some hospitals and doctors are now charging “new patient fees” to patients they haven’t seen in a specified period of time. Healthcare providers say that the fee reflects the time and effort necessary to get back up-to-speed with a patient they haven’t seen in a long time. Check to see whether your insurer covers these fees.

If you’re uninsured, contact the hospital or the doctor for an explanation of charges. They could potentially spot any errors, or agree to negotiate the payments. If you’re insured, contact your insurer and ask for a senior claims examiner to check the bill. A professional bill reviewer also has the expertise to identify coding errors that lead to unwarranted charges, but they do charge for their services. If your insurance claim is denied, you do have the right to appeal (read “When and How to Appeal Your Denied Insurance Claim” for more info).

Have you ever been surprised by a medical bill? What was the outcome?

Sources: healthconsumer.org, guides.wsj.com, and cbslocal.com