Medical bill errors can be costly

I’ve quoted before a study where it is estimated that 8 in 10 medical bills contain errors.  Below is an example of the type of error in a medical bill and  how much that it can cost the payer if they are not found.

I recently reviewed a hospital bill which was for an outpatient surgical procedure.  There was nothing special about the bill, it was printed on a UB-92 form and had 8 line items.  The bill totaled $19,111.71, which is not an obscene amount of money for a hospital to be charging for the use of its surgical facility.  Below is a portion on the bill:

Pharmacy                    $130.75

Sterile Supply              $152.21

OR Services                 $6,030.50

Anesthesia                  $283.50

Drugs/Detail                $39.00

Drugs/Detail                $61.50

Drugs/Detail                $30.75

Recovery Room           $12,383.50

Total                           $19,111.71

What if did find somewhat out of the ordinary was a $12,383.50 charge for the use of the recovery room.  I contacted the hospital to negotiate a discount for my client and was given the standard response that the hospital will discount the bill 10% if the claim is paid within 10 business days.  With a 10% discount, the recovery room charge still seemed a bit excessive.  I inquired into the billing rates for the recovery room.  Most hospitals have a flat rate for a recovery room, which usually includes a 30 minute stay, and then the have another rate for each 15 minute interval the patient remains in the room.  By my calculations, this patient spent nearly 10 hours in the recovery room.  Something was clearly done in error.

I requested a review of this patient’s file and it was determined that indeed a billing error had occurred. The recovery room line item on the bill was modified to $2,186.50.  With the finding of the billing error and a  negotiation, my client realized a savings in excess of $11,500 on this bill.

My client was fortunate that this facility was out of network.  If it had been in network, chances are that the claim would have sailed through the claims adjudication process and been paid less the ppo discount.  As the claim was out of network, it was sent to me for review and the error was found, in addition to a negotiated discount.

Anytime you get a medical bill you should go through it carefully to make sure it is accurate.  If you need assistance feel free to contact INSNET.  We will review and negotiate your medical bills risk free.

It helps to have a friend in the business

My health insurance no longer covers dental visits.  Last week I took my daughters for their semi annual cleanings. Like most dentists, mine has that little sign stating that payment is expected at the time services are rendered.  Since I negotiate medical bills for a living, I was prepared to ask for a lower price when it came time to pay the bill.

Well, when my daughters were finished getting their cleanings and x-rays, they immediately went to get their coats on to rush back to school (one of them had a project to share with her class). At the desk, the billing clerk told me that the cleanings and x-rays for both girls would cost $212.00.  So what did I negotiate the price to you ask…I didn’t, I just froze and wrote out a check.

I’m not sure why I just froze and wrote the check. I think it was a combination of needing to get my daughters to school, embarassment of discussing a lower price with the billing clerk in front of the girls, or the anxiety over speaking to the billing clerk in person instead of over the telephone. What ever the reason was, at that time I found it easier to simply write the check and leave.

This experience did get me thinking about who others must feel when asking their doctor of hospital about lowering their fees for services rendered.  I really do think it is easier to sometimes let others (especially professional people you know) handle some tasks for you. Many people think nothing of paying someone to change the oil in the car, color their hair, clean their house or mow their grass. When it comes to your health and the rising  cost of healthcare, maybe it is best to let a professional represent you and try to get a lower price.  After all, our service is RISK FREE, if we don’t save you money you pay nothing! If you have any questions. please visit www.myinsnet.com.

The High Cost We Pay For A Sale

Perhaps you’ve heard that retailer Linen’s & Things is going out of business and that they are in the process of selling off their inventory.  Currenty they are running a massive sale with most items between 15-40% off.  According to this story and others, before the store put the items on sale, they raised their prices by putting price stickers on top of the already marked merchandise.  Shoppers are reporting seeing an item with a sticker tag of $14.99.  Once they peel back the sticker, they see the original price of $12.99. This got me thinking about how many medical providers employ similar tactics even though they are not going out of business.

Before preferred provider organizations (ppo’s) were formed, each medical bill over a certain dollar threshold submitted to insurance was reviewed for accuracy and necessity.  PPO’s were formed with the idea that the insurance company could save money by negotiating the prices of services before they were rendered.  Today, many ppo contracts are written that reimbursement is a certain percentage (say 30%) off of billed charges.  A 30% discount seems like a wonderful savings and the price of heatlhcare should decrease.  Actually, the cost of healthcare has skyrocketed to almost $7,500 spent per person a year.  By 2017 that figure is expected to almost double.  For comarision sake, in 1970, well before ppo’s were formed, yearly per capita spending on healthcare was $356.00.  Why has this occurred?

As mentioned earlier, many ppo contracts are written that the insurance company can take a percentage off the amount billed.  The amount billed is set by the medical provider.  In order to stay in business, many medical providers have had to join ppo networks in order to get new patients. In doing so, they agree to accept the discounts the ppo network takes. To stay profitable, many medical providers have increased they billed amounts.  For example, a pediatrician has a rate of $115.00 for an office visit.  He joins a ppo network which reimburses at a 30% discount.  When the pediatrician sees a patient belonging to this ppo, he receives $80.50; $34.50 less than his normal rate.  If the pediatrician were to raise his billing rate to $140.00, he would receive $98.00 which is much closer to his normal rate.  The pediatrician will make up much of this loss by seeing an increase in new patients who are enrolled in the ppo network.  Much like Linen’s and Things, the pediatrician is raising his fees and having a sale, which is increasing the amount we all pay in healthcare costs.

7 Reasons why you need a Medical Bill Advocate

Healthcare costs continue to skyrocket. If you have health insurance, your deductible has increased; meaning you’re paying more out of your checkbook before your insurance does. In these rough economic times we need to save money any way we can.

People hire lawyers to help them with legal matters, accountants for their taxes and mechanics to change the oil in their cars.  Using these professionals saves us time and money.   Since you’re spending more of your own money on medical bills,  don’t you want to make every dollar count?

There are many more than seven reasons to seek out a medical bill advocate, but these should make you stop and think.

1. 8 out of 10 medical bills contain errors

2. Medical providers often balance bill consumers for money they don’t owe

3. 1 in 3 Americans has trouble paying their medical bills

4. In 2004 almost half of all Americans under age 65 spent more than $2,000 in medical expenses. This is the latest published rate, which has surely increased due to rising healthcare costs and deductibles

5. The healthcare industry, like others (automobile, hotel, airline) has different rates depending on who pays the bill

6 Lasest published data shows per person healthcare spending at $7,435.00 and in 10 years it is projected to almost double

7. Medical bills are difficult to read and understand.  Plus who has time to wait on hold calling the hospital, doctor or insurance company

INSNET, LLC has experienced, trained professionals who will negotiate a lower price with your medical provider or there is no fee, its RISK FREE.

As home values decrease, medical bills increase

A recent Wall Street Journal article references a correlation between home mortgages and medical bills.  In the current economic times, the drop in home values is negatively affecting the healthcare industry.  Many people borrow against the value of their homes to pay off medical bills.  With the values of their homes dropping, consumers have less equity to pay their bills.

According the the New York Times, hospitals are already feeling the economic downturn. Many patients with insurance are passing on knee surgeries, hernia repairs and weight loss surgeries; among the most lucrative procedures for hospitals.  At the same time, greater numbers of people are showing up in emergency rooms who are unable to pay their bills.  The hospitals are concerned because the money making procedures usually offset the charity care and unpaid bills.

When we come out of the current economic crisis and home values are re-established, what will the outcome be for the healthcare industry? In 2005, well before the stock market fall took place, California hospitals had $5.8 billion in bad debt and charity care.  In 2007 that figure rose to $7.1 billion and is expected to exceed $8 billion in 2008.

Given the hard financial times that the healthcare industry is also undergoing, now may be the perfect time for consumers to take matters into their own hands and work with hospitals and doctors to reduce their medical bills.