8 Unfair Medical Billing Practices and How to Fight Them
Posted by MarkWith healthcare costs rocketing toward the stratosphere and about 14% of Americans wandering around without health insurance, you'd expect hospitals and insurance providers to make it easier to receive reliable care. Well, that’s not necessarily the case.
Among the millions of dollars the medical industry charges patients each year, it’s easy for patients' medical bills to become artificially inflated without anyone noticing -- especially the patient. Some instances of overcharging can be chalked up to honest mistakes in billing, but it seems many times there are deliberate attempts to mask charges, inflate prices, or otherwise dump unnecessary costs on the patient.
Here are some of the tricky tactics healthcare providers use to inflate medical bills, and some ways to protect yourself.
1. Adding "invisible" charges -- Often medical bills come in lump form, without showing exactly what is being charged for. But if you have the foresight to ask for an itemized bill, you may see charges that seemingly come from nowhere – treatments you don’t recall receiving, or services you were told were included. For example, one patient received a bill for her husband's hip surgery that included charges for newborn blood tests and a crib mobile. Another patient reported having $142 added to a bill, for a set of x-rays that had supposedly been left off the first bill. The patient pointed out the x-rays, clearly accounted for on the lower bill, and was simply referred again to the higher one. The tricky part is that the technical language on the bills makes it easy to overlook such charges, so most patients just pay.
How to avoid it: If you rack up a large medical bill from surgery or an extended hospital stay, ask for an itemized bill and make sure you understand everything that's on it. Those charges add up quickly, so you probably only want the ones you're responsible for.
2. Charging large sums for small items -- It's not uncommon to see large amounts charged for cheap, everyday items on a hospital bill. You may have heard the example of the $12 "mucous recovery system" -- a box of tissues. A 10-cent pill can sometimes cost $5 or $10, or a bag of ice cubes can cost $30 as a "thermal therapy kit." In one example, a 70-cent I.V. cost one patient $90. Haven't they ever heard of Target?
How to avoid it: If you foresee a need for things like tissues or ice packs, bring your own or have a friend bring you one, rather than pay mind-boggling fees for them. You can also contact a medical billing advocate, a company that negotiates hospital bills for a fee.
3. Double-billing -- Often a medical bill can include separate charges for items that were included in other bills. For example, hospitals sometimes charge separately for the sheets and pillows on a hospital bed, a cost that is usually included in the price of the room. It's also possible to see a charge for the scrubs, masks and gloves worn by an OR staff on both the surgery bill and the bill for the operating room time.
How to avoid it: Sometimes the only way to avoid these charges is to ask questions about your bill. Ask what was included in the room charge and other vague charges, and don't pay the bill before you know what's there. They might think you're annoying, but at least you won't be bankrupt.
4. Balance billing -- If you're lucky enough to have health insurance, you may notice that some doctors are "in-network," meaning they have a contract with your carrier, while some are "out-of-network." The insurance carrier has pre-set rates they will pay the in-network doctors, but sometimes you will wind up being cared for by a doctor who doesn't have a contract with your carrier. Often these doctors want to be paid much more than the insurance companies are willing to shell out. Then, when the carrier denies them their full payment, the doctors have a tendency to ungraciously dump the balance on the patient. This, of course, means patients are paying a lot more than they owe by their insurance plans.
How to avoid it: Thankfully, balance billing is already viewed with scorn by the general public. It is illegal with regard to Medicare, and California has even made it illegal in general. If you do end up being referred to another doctor, make a point of asking if they'll take your insurance, and if you can, wait until you find one who does.
5. Charging more for the uninsured -- It seems backwards, but hospitals charge much less to insurance companies than they do to patients without insurance. According to AlterNet.org, prices for uninsured patients can be up to 70% higher than what insurance companies pay. And since the low-income population makes up the largest portion of Americans without health insurance, you can see how this is a problem.
How to avoid it: If you're uninsured, find out about your hospital's patient discount program, or try to negotiate your bill. Only about 13% of patients ask for a discount on their bill according to BottomLineSecrets.com, and oftentimes they get some kind of price reduction. Asking in person helps.
6. Charging for charity -- Many hospitals are registered as nonprofits, which allows them to get some big government tax breaks. Part of the deal is they're required to offer free services to needy and low-income patients, but unfortunately in a lot of cases they charge these patients just like everyone else. For example, in 2003 the Illinois hospital chain Advocate took heat in the press for underserving needy patients and inflating their charity figures, despite being a nonprofit, and religiously affiliated.
How to avoid it: The only thing needy and low-income patients can do to avoid this practice is to be aware of a hospital's nonprofit status, and ask about discounted or free services for the poor. Simply not paying the bill is another path many underfunded patients take, but that leads us to the next tactic on the list...
7. Relentlessly pursuing debts -- Hospitals can be friendly on the inside, but once you're in debt to them, you can see how pushy they can be. Hospitals will often go to extreme measures to collect on money owed them, including hounding the patient with debt collectors, suing, garnishing wages, placing liens on property, and even pursuing the patient's spouse. Hospitals have even been known to refuse care to patients who still owed previous debts.
How to avoid it: Paying for medical bills on a low-interest credit card is a good way to avoid being indebted to them. Also, don't use home loan money to pay for medical bills, because it can put your home at risk. Asking about payment plan extensions is another good method.
8. Denying reasonable reimbursement -- It's almost expected that insurance carriers would try to avoid paying medical costs, but some carriers have been known to go to greater lengths than others. In theory, insurance companies use independent research to determine their patient reimbursement rates. In reality, several carriers were using Ingenix, a research company owned by the carriers' parent company, UnitedHealth Group. Ingenix would report skewed figures in order to save the carriers money, resulting in claim denials for common, reasonable treatments, including chemotherapy.
How to avoid it: Fortunately, agencies like the New York Attorney General's office have been investigating insurance companies for practices like this, so instances of reimbursement denial should diminish as cases like this are uncovered. For now, it will pay to know what is covered by your insurance carrier and what isn't, so you can avoid falling into a reimbursement trap in the future.
It's also helpful to know that medical billing advocates (for example, the Medical Billing Advocates of America) exist to help clients reduce or eliminate unreasonable medical charges. Companies like this negotiate with hospitals to remove unnecessary or unfair charges from patients' bills. If you are stuck with a medical bill you can't pay, this can be another helpful option.
Posted by Eloina LeBuhn on 13/3/09
I canceled a mouth-piece (night mouth piece) from my dentist and they still charge me for it. i have NOT pick it up nor I siged any papers assuming responsability for it at the time he advice me to order one. They send the $349.00 dollars to a collection agency for something that I do not owe. Could you advice me how to have them stop the charge?
Posted by Oslo on 13/3/09
@ Eloina:
Personally I would try to take them to small claims court. But to be more sure of success, you might try a billing advocate in your area. They try to take everything you don’t owe off of the bill, for a smaller fee than you would have paid otherwise.
Posted by John Griffiths on 23/4/09
On April 03, 2009 I received a statement from my heart doctor’s office listing 25 items either paid or unpaid dating back to July 04, 2008. (Unpaid balances back to July 06, 2008.
Time elaspes since supposed service to date of advise to me = 9 months.
NO PREVIOUS NOTICE OF ANY KIND WAS RECEIVED.
They has that unpaid items, weather I was previously notified or not = $390.50
Let alone have received no billing whatsoever prior to this April 03 statement, I have no idea 9 months ago what was provided (if anything).
Their attitude to date has not been anything except a demand for payment “or collection procedures will commence in 60 days”.
Posted by cindy on 19/6/09
I have been contacted numerous times over a bill for $300 from a pediatric’s office. Every time they have called they claim I have no insurance coverage (they keep quoting my old policy) and each time I have given them the new insurance information. The company even ended up sending the account to an attorney with out first sending a claim to my insurance company (When I recieved the attorney’s letter, I contacted my insurance- they verified that it had never been filed and told me that what was happening was illegal and negated the provider’s right to collect any payment). After talking to the insurance , I called the attorney’s office and informed them of the entire situation (they even had me give them the correct insurance information). Now, I am recieving statements from the provider once again for this bill (still claiming that I don’t have insurance), but to top it off, now they are sending it to my old address!!! (luckily it was forwarded to me, or I wouldn’t even know! All I want to do is get them to update the darn insurance so that this bill can be covered- what is my best course of action?
Posted by Oslo on 22/6/09
@Cindy: That sounds like a real mess you have there. First, it might be a good idea to ask for an itemized bill — even if you know your insurance is going to pay for everything, the interaction might get you talking to the right people. Once they respond to that inquiry, inform those people of your insurance situation. They might actually do something about it. And keep their contact info, so when the other guys send you the bill again, you have someone else you can contact. It might help.
Posted by amy on 22/7/09
Can I be charged two copays on the same day? For example, I when to my gyn’s and had a well women visit. They billed the ins co for the well womens visit and also a “problem” visit. I paid my copay at the time of service and still got billed for a copay for the “problem visit”
Posted by richard sluder on 6/8/09
I have insurance through my job. my issue is june 27th i got married july 22nd i called and had her put on my policy. since then the insurance cimpany has been overbilling me claiming “ i owe for her back insurance” when i asked what back insurance they claim her coverage started on our wedding day even though that was 3 weeks befor i told them i had gotten married….. can i send my wife back in time to go to the doctor? how is this legal? in the last 2 pay periods my insurance deductions have gone from $73 every two weeks to over $220 when this happened the first time i called and they told they wouldn’t take any extra in the future.. i have now paid (or had TAKEN from me) $550 in just 2 pay periods. and of course it was all WITHOUT prior notice. they never told me they would do this or offer me a way to work this out. they just did it like i have no option to fight them. need guidance please.
Posted by Blanca R on 18/9/09
My insurance, which I paid $700 a month for family coverage, never had to use it for the past 5 years. Until this year. We took my daughter to the emergency room because she was having a mental breakdown. Well turns out it was something serious. The insurance denied EVERYTHING, as diagnosis is not covered. I called and was told I didnt have mental health coverage. Why wasn’t I told that when I purchased the insurance? Not that I had any idea I would need it. I owe about $4,000 in medical bills now because of “diagnosis not covered” I tried asking for a discount with the hospital, they didn’t give me any reasonable offer. What can I do to try and get the insurance to pay? Thanks
Posted by Kathy on 22/9/09
I would like to know if I am responsible for the balance on a dental bill that is 14 mo. old. I never received a statement until now and was told by the new office manager that the previous girl never sent out bills
Posted by Lise on 3/12/09
I am insured with an insurance company through my work. My primary care provider has always requested a $15 co-pay for regular office visits, as is specified on my insurance card. I recently learned that the insurance company is no longer listing my doctor as a PCP, and the primacy care provider has been billing me an extra $20 per visit. The PCP’s office didn’t inform me of this matter, and said the problem was with the insurance company. I thought I had resolved this matter with my PCP’s billing office, but they referred the latest additional $20 charge to a debt collection agency.
Who is liable in this case? What legal recourse do I have?
Posted by Elyse on 11/12/09
I have a friend who has injuries and we believe undiagnosed Fibromyalgia as well (I have that, but am diagnosed). She currently sees a pain clinic Dr. But this Dr. is suddenly changing her meds, that were WORKING for her for like 5 years. He just one day said, we’re weaning you down & off that now. But she has totally uncontrolled pain now. I see a great Dr. at a Pain Management office. When she called, they turned her down because they didn’t take her Medicaid insurance. Well after a week or so, her Grandfather saw the pain she was in, & said, “I’ll pay the cash for you to see this Dr.” But when she called back to see if she could be seen now, they told her no, that it would be insurance fraud, and even if she was a millionaire it wouldn’t matter, it’s illegal.
Now, I understand that they don’t take Medicaid, but why can’t they see her for cash?
I’m thinking it’s because if she HAS it, they would legally have to bill the insurance (but they don’t take it). But this woman is certified in Medical Billing. If she would agree to fill out the paperwork and bill her Medicaid insurance first herself…. wouldn’t she be able to then pay cash legally if the insurance denied her? She really needs to see a Dr. like this. And this guy is good! But we need to figure out how we can actually get her SEEN by them. What do we do?
Posted by Susan Young on 20/12/09
While vacationing in Charleston SC, my 2 year old daughter got sick with a fever. Since I was out of town, I had to take her to the urgent care facility. They took her temperature, tested her for strep throat (which she tested negatively for) and sent me a bill for $983.00. I asked several times for the bill to be re-rated as this is completely outrageous billing for the service provided but they refuse to adjust the billing. I want to make sure other vacationers are aware of this in the event they find themselves in a similar situation. Any suggesions on how I can make this situation known to others?
Posted by Laura Dove on 29/12/09
My son was air lifted by helicopter to the hospital. The total charges were $14,486.35. My insurance paid $6,762.03 leaving me with a bill of $7000.00 What can I do about these charges? They are excessive
Posted by Tony on 5/1/10
Mayo Clinic, Rochester sent my bill to a debt collection agency but my bill payment had met the maximum out of pocket. I want to know how I can deal with that.
Before they sent to the debt collection agency, I had telephone notified them my case and told them my insurance should cover 100% of the bill. I also had faxed their claims’ detail to my insurance company a few times. What can I do about this? Any advice would be appreciated.