13 INVESTIGATES: Medical Billing Errors - Alabamas13.com WVTM-TV Birmingham, AL

13 INVESTIGATES: Medical Billing Errors

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Shannon Stephens daughter, Audrey, was just 2 years old last September when she made her first and hopefully last visit to a hospital emergency room.   Stephens says, " I had a cold and had some sudafed on the counter, Audrey came in kind of spitting something out.  I assumed she might have put some in her mouth."  

After a few hours in the ER, much to the relief of this worried mom, doctors determined that Audrey was fine and could go home. But the stress of that hospital stay returned when Stephens got the bill.   The insurance company told her they wouldn't cover the costs because it had been coded incorrectly as a non-emergency.  

Stephens is apparently in good company. Medical Billing Advocates of America is a for profit company that helps customers find medical billing errors and get them resolved. They charge a percentage, usually about 25%, of the amount they get taken off your bill.  Pat Palmer says her company finds a lot of errors.  "Being very conservative, 8 out every 10 bills we look at someone is billed improperly."

According to the American Medical Association, in 2012, 9 1/2% of the claims paid by health insurers contained errors. But that's an improvement from more than 19% in 2011. Palmer says they most often find errors on hospital billing. Usually there are a lot of charges during a hospital stay from various departments, with many billing separately.  According to Palmer, "They're charging you for anesthesia when you have a colonoscopy which includes conscious sedation."

There are items on a hospital bill that you can't check on, you probably would have no idea how many cc's of a medicine was used during a surgery, but you can look at other things. For instance you may be charged by the minute for your time in an operating room, and it can run up to 200 dollars per minute. Your family would most likely know about how long you were in the OR, so you can check to see if that's close to what you're being billed.

Rosemary Blackmon with the Alabama Hospital Association says mistakes do happen, but not always at the patients expense.  "There tends to be errors going both ways, an overcharge or an undercharge.  Most of the time we find its a communication problem, it wasn't coded correctly or the person didn't understand it."

Medical codes are complex and confusing, much like tax codes. There are tens of thousands of them and they're constantly being updated and changed. So it's not surprising many lay people have a hard time understanding everything on their bill.  Blackmon says, "Hospitals really try to make the billing process as easy as possible. A lot of times they will print a name and a phone number on the bill and it will say if you have any questions call this person." 

Most of the cost of hospital medical services go to pay the doctors, nurses, administrators and staff who work there.  Blackmon says that accounts for 60 to 70% of your bill. She says an average of up to 10% of a hospital's cost goes to caring for people who don't have insurance. In Alabama on average hospitals make just a 1% margin a year, what you might consider profit.

Aubrey Bolack had a billing issue that took months to resolve. She went to the emergency room not long after having surgery fearing she was having a reaction to a prescription drug.  She says, " My doctor finally ended up showing up about five hours later and I hadn't been seen by anybody other than the lab nurse."  Bolack says she checked out and went home. But that's not how she was billed. "I got a letter from the insurance company saying I left against medical advice and the insurance wasn't going to cover it.  They told me that my doctor was going to have to contact them himself to prove that I didn't leave against medical advice."

Bolack finally got everything straightened out and her $900 bill was paid by insurance. Her part was just $52.

Most billing errors are discovered when the patient is the one responsible for paying. Palmer says bills to your insurance company often get processed without being audited and mistakes can slip by.  So no matter who's paying, it's the patient's responsibility to make sure everything is correct. And you probably won't get a detailed bill unless you specifically ask for one. Most often what patients receive is a summary which makes it tough to spot mistakes.  According to Palmer, "It may just say or $20,000 or lab $18,000, that doesn't tell you what you're being charged for.  When you receive that bill it should be scrutinized before you ever pay the charges that they're asking you to pay."

And Rosemary Blackmon suggests calling if you have any questions, "If something looks amiss they should always feel free to call the hospital and ask questions."

After almost 6 months of dozens of calls and letters to doctors, the records department, the billing department and insurance company, Shannon Stephens' health insurance finally covered her daughter's ER visit.  "I got several past due letters but I did send them all to the insurance company and also wrote a letter I was like this is not acceptable, it never went to collections thanks goodness but it was almost there it took so long."

If you see an error on a medical bill you have to be vigilant about getting it corrected and in a timely manner. If the bill is turned over to a collection agency it'll most likely affect your credit and that damage is difficult to undo even after you get your billing issue resolved. @


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