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.
