10 ways to avoid outrageous hospital overcharges
What's more, most insurance plans have a cap, meaning,
"Money siphoned off by errors or fraud can chip away at your
lifetime total," says Tom Brennan, Blue Cross/Blue Shield's
director of special investigations.
And your credit rating may be at risk too. "Hospitals
have become very aggressive about collecting money," says Nora
And, according to a 1998 study of hospital billing
procedures, they go to extraordinary lengths to discourage patients
from delving too deeply into their bills. "Citizens are becoming
more educated about hospital billing and taking responsibility of
ensuring that their charges are correct," said the study's
principal author, Dr. Kimberly Elsbach, of the University of California,
Davis. "Hospitals are countering that with their own efforts
to discourage people from becoming involved with challenges or audits
because it costs them a great deal of time and money."
And they waste no time turning accounts over to collection
agencies or filing liens. Some have even resorted to having overdue
debtors arrested if they don't show up in court.
experts say you can take these steps to make sure that you're not taken for a
- If your hospitalization isn't for an emergency,
check your insurance policy to find out just what it will cover and how much it
will pay. Be sure to carefully review the section on "exceptions and exclusions."
It will tell you what your plan will not cover.
- Phone the
hospital's billing department and ask them what you will be charged for the room,
and just what the room charges cover. If tissues aren't included, for example,
bring your own.
- Ask your doctor to estimate your cost of
treatment. Also, ask if you can bring your regular prescriptions from home to
avoid paying for medications administered at the hospital.
Make sure that everyone who will be treating you -- the surgeon, anesthesiologist,
radiologist, pathologist, etc. -- participates in your insurance plan.
you can, keep your own log of tests, medications, and treatments. If you are not
able to, ask a friend or loved one to do it for you.
some point you will receive an explanation of benefits (EOB) from your insurance
company (if you're on Medicare, you will receive a summary notice). It will say,
"This is not a bill." Don't toss it in the trash. Examine it. It will
tell you how much the hospital is charging, what your insurance plan will cover,
and what you will have to pay out of your own pocket in deductibles and co-payments.
Never pay your bill before leaving the hospital -- even if you're told that it's
- When you get your bill, read it carefully. Compare
it to the log you made, to the EOB, and to the estimate of costs you requested
before you were admitted.
- If there are items you don't
understand, call the billing department and your insurer, and ask them to explain.
Don't accept bills that use terms like "lab fees," or "miscellaneous
fees." Demand an itemization. If you don't get satisfaction from the hospital
billing department -- and you probably won't -- appeal in writing to the hospital
administrator or patient ombudsman.
- If you are still scratching
your head, ask for an itemized bill as well as your medical records to confirm
whether you received the treatments and medications you've been billed
for. Every state now requires hospitals to provide itemized bills.
helping sort out his late father's medical bills, Richard Clarke, the former hospital
CFO, has became founder and president of the Healthcare
Financial Management Association, an Illinois-based association of medical
finance officers who work with the American Hospital Association and other groups
to develop more consumer-friendly billing.
They're aiming for easy-to-read bills and printed
pamphlets that will help consumers understand hospital-speak. Until
that happens, however, consumers will be on their own.