Every procedure performed by a healthcare provider has a code that allows the provider to bill your insurance company. Of course, different procedures cost different rates. The issue with coding is that the average person has no idea what the codes mean. Codes are routinely sent over to the insurance company and approved or denied without the patient ever having any review at all. On top of that, a healthcare provider bills for everything they can get away with throughout your visit.
Here are some of the errors that are made. These are great reasons why a patient should review the coding and medical bill:
- “Up-coding” – This is a medical bill that is improperly charged as a more intense treatment. This is most common when a name-brand medication (more expensive) is billed for a generic medication. This pins you with a more expensive bill. Use an internet search to double check the billing codes and/or seek help from a billing advocate who is more familiar with medical billing codes.
- “Unbundling” – This is where services that should be packaged together are split and billed apart. This leads to increased costs. This is common when multiple medical tests are ordered, but all relate to one condition. Unbundling is more common in surgery. Ask, “Should any of these items be bundled together?”
- “Balance Billing” – This is the leftover balance after the insurance company pays. All of the charges may be covered under your policy, so you may not actually owe this “leftover” amount. Uncommon, but still happens with automated billing processes. This is most common when you are treated for out-of-network, non-emergency care when doctors can set the price to charge your insurance company.
- “Duplicate Billing” or “Double Billing” – This is more common than you would expect. It is where you are billed multiple times for the same procedure. For example, this may happen when a nurse and doctor both input a bill into system without checking with each other. It also happens when there is a large number of one type of procedure and it is input in the system incorrectly, perhaps 25 times instead of 23. Also, there are only 24 hours in a day, but by error, patients are charged for more than 24 hours of treatment. Another example is when you have X-rays and there are mistakes and the X-ray needs to be done more than once; make sure you are not paying for extras. You are not responsible to pay for the mistake. Finally, no one wants to pay for one service at the price of two doctors. Ask for documentation of mystery doctors that you do not remember seeing. Per federal regulations, there are restrictions on how much secondary doctors can charge in certain settings.
- “Mismatched Coding” – This is where the treatment code does not match the diagnosis. In this situation, the insurance company then denies the claim. The bill is sent back to the provider and will either be corrected or sent down to the patient with the error.
- Days in Hospital– Check their math. Did you stay the amount of days that are listed? Are the dates correct? Overnight visits are often billed for two days, here you should request just one day be billed. Did you have surgery? If so, the bill rate should be included in your surgery price.
- Things That Were Not Done. Did you receive all the items that are listed on the bill? Did the doctor really see you for 30 minutes, or was it more like 10?
- Room Rate. Were you given an option on room choice or were you just shown the most expensive room? Check the room rates. Did you specifically request a private room? If you were not given a choice, request that the lowest room rate be billed. Also, your emergency room should already be covered in the emergency services cost. Don’t allow yourself to be caught in being charged for the same thing, twice.
- Equipment Usage Amounts. Be inquisitive about “trays” or “packs.” Routine supplies should be included in the room rate or procedure codes and non-billable. Also, equipment may be included on another bill.
- Drug Administration. Watch out for charges just for someone to hand you pills. These have clever names such as “oral admin fee.” Also, how much would you pay for one of those small paper pill-containers? Now check what the medical bill charged…
- Common Overpriced Items. Here is my collection of commonly overpriced items: Q-tips, Pillows, Teddy Bears, Tissues, Trash Bag, Bandages, Gloves, Coats, Sutures, Drapes and Staples. Watch for these.
- Administration Fees. There are “admission” or “administration” fees that are charged to cover the intake process; you know, sitting and filling out long hospital forms. Make sure these are at least reasonable. Also, this fee may cover the initial assessment, which makes the fee much more justified.
- Sample Tests. Whenever there is a test, be on the lookout for extra charges such as a “collection”, “handling”, or “transport” fee for walking down the hallway to the lab facility. If a test is done off-site, I understand a shipping fee, but not when the test is done internally.
- “Misc” or Nonspecific Descriptions. Always ask for more information. Even an itemized bill will contain “misc” or nonspecific descriptions that do little to help you understand what you are paying for. Sadly, as more and more patients are requesting itemized bills, the itemized bills are becoming less and less itemized. Refuse to pay for non-specific charges. If they cannot explain what you are paying for, you are not paying for it. End of discussion. If a treatment was not documented, then you are not paying. You should request documentation that a treatment was performed if you do not recall receiving it. Does it line up with your memory or notes?
In order to understand your medical bill, you will question all charges and make sure the bill lines up with the actual treatment.
You will be an educated and engaged patient. You will request an itemized bill and compare the itemized bill to the explanation of benefits. You will call your provider to determine what a bill and code mean. It is your right as a patient and healthcare consumer to know what you are paying for. This is not necessarily your insurance company’s issue and it is well worth your extra time to save money.
I helped the miVoyce community and training materials with the mission to educate and empower individuals on complex healthcare topics in order to save on costs. Join the community to learn more and start saving today!