IF YOU HAVE EVER EXPERIENCED a hospital stay, you have probably been confused by the bills.
Surgery that requires several days in a facility can result in a line-item bill that will make your head spin. And even a quick emergency room visit can involve multiple tests and medical professionals — some possibly outside your insurance network — that will make deciphering the bills even more difficult.
If you have a medical bill that is incomprehensible, you certainly won’t know if it contains mistakes or overcharges. Eight in 10 medical bills involve errors that can be costly to patients, according to the Medical Billing Advocates of America (MBAA, billadvocates.com), an industry trade group.
And according to a recent study by NerdWallet, which examined 34 hospitals based on data compiled by the U.S. Office of the Inspector General, 49 percent of Medicare claims had errors, leading to overpayments of as much as 26.4 percent.
While hospitals offer assistance through their billing offices, and some have consumer advocates or ombudsmen who help patients, you still may need to bring in an outsider — a medical billing advocate.
Maybe you don’t have the time to spend communicating with health care providers and insurance companies. Maybe you find it confusing, or perhaps you’re trying to help an elderly loved one who is unable to manage their bills on their own.
That’s when you will want to call in an expert who will make sure charges are correct and help confirm that the insurance company has paid for the care it’s supposed to cover.
“Generally, the (patient) would say, ‘I don’t understand this bill, nor do I understand why the hospital bills me so much,’ ” says Katalin Goencz, co-president of the Alliance of Claims Assistance Professionals (ACAP, claims.org).
Using a medical billing advocate isn’t much different from hiring a tax preparer or a financial planner. These pros help patients “achieve true and accurate medical bills by eliminating non-compliant charges that should not be billed to a consumer or to an employer,” says MBAA spokeswoman Tina Pashley.
Pashley says consumers should never accept a medical bill without a detailed, itemized statement. Even if you don’t understand medical jargon, she says, you can look for discrepancies on your own.
These can include charges for a drug you know you did not receive, a longer amount of time charged for the operating room, or a test the doctors decided not to perform, she says.
And some procedures may involve two charges, such as one for an X-ray or MRI and a second for a professional to interpret the findings.
If you find discrepancies or there are parts of a bill you don’t understand, start by asking your health care provider for an explanation. If you’re still not satisfied, consider hiring an advocate.
“You may also need help if your insurance company denies any claim or reimburses very little on a claim,” Pashley says. “An advocate can help ensure that the insurance company fulfills its obligation.”
She recommends looking for a person with expertise in coding, compliant billing rules and regulations, an adequate background in nursing, and knowledge of insurance rules and regulations.
MBAA professionals don’t charge upfront, saying they don’t want to add to a consumer’s expenses. Instead, they charge a percentage of the savings they find. If there are no savings, there is no charge.
ACAP’s Goencz says most of its members charge by the hour, and some will offer other arrangements. Depending on the complexity, she says, the cost can be as low as a few hundred dollars.
Is it worth the cost?
That’s for you to decide. But don’t just accept the bills that come your way. Ask questions and get answers that you truly understand.