Years ago, when I would visit with my in-laws, after the initial pleasantries, my mother-in-law would bring out a shoebox full of paper and say, “Edward, do I owe anyone any money?” In the box were dozens of undecipherable pieces of paper, many of which were marked, “This is Not a Bill,” even though they looked like bills. Things have not gotten better.
Medical billing is notorious for being very hard to understand and full of errors. The average person, faced with a gigantic bill, is likely to throw up their hands and pay it, but do not be in too much of a hurry to do so.
The first step is to request an itemized bill, to which you are entitled. This will list all the things the doctor or hospital is charging you for. While the bill should list the items, sometimes you will just get a listing of CPT (Current Procedural Terminology) codes – 5-digit numbers that are medical shorthand for the things done. It is very easy to use Google to get the English translation of, say, 99285 into “Emergency Visit, high complexity.” Very often you will see things listed that were simply not done, and a call or letter should ask to have these removed.
You should also use your common sense to evaluate how well the service for which you are billed matches the service you received. Using the same example, if you are being charged $800 for a 99285 and you went to the Emergency Department with a swollen ankle that was wrapped in an elastic bandage, you should insist the charge be reduced. A “high complexity” visit is meant to cover caring for a victim of a major auto accident or a patient in coma, not a 10-minute visit for a simple problem.
If the billing department will not reduce the charge, demand a copy of your visit. If the notes reflect a simple visit, repeat your demand and threaten to take the issue to your insurance company or the state department of consumer affairs.
Finally, it is always worth asking for a discount. Uninsured patients are usually charged the “list price” for a service while Medicare, Medicaid and every commercial insurance company gets a substantial discount off these prices. You will very often get a discount of 25% or more just by asking.
It is your money. Don’t part with it without a fight.
Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.
What Does The Doctor Say?
By Dr. Ed Hoffer