Treated for Illness, Then Lost in Labyrinth of Bills - Tilted Forum Project Discussion Community

Cynthetiq · 10-14-2005, 01:13 PM

Quote:

October 13, 2005
Being a Patient
Treated for Illness, Then Lost in Labyrinth of Bills
By KATIE HAFNER
LINK

When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.

There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment.

When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00."

On the 15th page or so of each bill, a "balance forward" line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.

Another mailing, from her insurance company, clearly said, in large type, "This is not a bill." But she could make no sense of the remark codes: "G7 - Your benefit is based on the difference between Medicare's allowable expense and the amount Medicare paid" or "QN - Your claim may have been separated for processing purposes."

Mrs. Klausner's experience is shared by millions of Americans who, frustrated and confused, find themselves devoting enormous amounts of time and energy to sorting out their medical bills.

Walk into any drugstore, and the next few minutes of your life are fairly predictable. After considering the choices, you make your purchases and head for the cashier. Seconds after the transaction, you are handed a receipt that reports to the penny what you paid for each product, along with its brand, its size, and the date, time and location of the purchase. But become a patient, and you enter a world of paperwork so surreal that it belongs in one of Kafka's tales of the triumph of faceless bureaucracies. And although some insurers and hospitals are trying to streamline and simplify bills, the efforts have been piecemeal.

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.'s - are filled with unintelligible codes.

The system is so impenetrable that it mystifies even the most knowledgeable.

"I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."

Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer.

"I understand the words of diagnoses and procedures," he said. "But codes? No. Or how things are paid or not paid? I don't understand that."

Dr. Brailer said he often used an analogy to describe the current state of medical billing.

"Suppose you walk into a restaurant," he said, "and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost."

"Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe," Dr. Brailer said.

Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.

Piles Upon Piles

In the days before managed care, most insurance plans operated on a fee-for-service basis. Patients paid 20 percent of medical fees; insurers paid 80 percent. But as health care costs have continued to rise, many patients are being required to pay an ever-larger part of their medical bills, and deductibles continue to increase. And to keep the system churning, close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.

"The number of bureaucrats between the point of service and the final cash reckoning is just incredible," said Dr. Thomas Delbanco, a professor of primary care medicine at Harvard Medical School who is a leader in the field of patient-centered care.

For many people, the piles of paperwork they must contend with reinforce a simmering discontent with a system that aggravates tensions among patients, hospitals, doctors and insurers.

Insurance companies are, by and large, unapologetic.

"Even though the amount of paperwork a patient has to deal with might seem to be a lot, it would be much worse if there wasn't a unifying organization like a health plan easing that burden," said Dr. Alan Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New York.

This might come as a surprise to Ellen Mayer, an artist who lives in Chester, N.Y. Ms. Mayer, 54, has a rare type of gastrointestinal cancer that requires constant monitoring through blood work, CT scans and PET scans.

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization.

The stacks of papers, folders and Post-It notes related to Ms. Mayer's treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

"You can't just be sick," she said. "You have to be sick and be drowning in paperwork."

So overwhelming has the paperwork grown that Ms. Mayer has considered giving up and ceasing all treatment because of the bureaucratic hassle that accompanies it.

"It's comical, it's unbelievable," she said. "And I think to myself, 'What if I was an elderly person, or a single person? What if I wasn't healthy enough to handle it?' "

Dr. Michael Mustille, associate executive director of the Permanente Federation in Oakland, Calif., said medical paperwork often delivered "a double psychological whammy."

"People get these things that look expensive that they can't understand," Dr. Mustille said, "and then there's the worry that the people they've paid for insurance may decline to assume responsibility for it."

In Mrs. Klausner's case, her son bought her an elaborate paper organizer, hoping it might help her face the chaos. She never used it.

Creditors began to call. Whenever a collection notice showed up, Mrs. Klausner panicked and wrote a check or reached for the telephone to call her son for help.

In the end, Medicare and United Healthcare paid most of Mrs. Klausner's bills, which added up to more than $150,000. And although the unwelcome mail has ceased, she cannot bring herself to throw out the bags filled mostly with unopened envelopes dating back to 2002, as if doing so might violate a law.

Dr. Middleton went through something similar with his elderly mother, Dugan Middleton, a former nurse who died of thyroid cancer last February at age 79.

Mrs. Middleton, who had lived alone in Palm Beach Gardens, Fla., preferred to handle the paperwork herself.

"It went on and on, with her reconciling her accounts with a lot of different doctors," Dr. Middleton said.

He said that his mother wrote check after check and that "I'm sure she was paying many of the same bills twice."

His medical credentials notwithstanding, Dr. Middleton was at a loss. "It was ridiculously complex," he recalled.

Finally, in the last months of his mother's life, Dr. Middleton hired a social worker who knew how to navigate the system to help with the bills.

How did things get this bad?

Most health care in the United States is fragmented and profit-driven, a system in which everyone but the patient is meant to benefit financially.

"Fragmentation is a fact of life in health care, and people consider that to be one of the most fundamental problems," Dr. Brailer said. "We pay by the piece. Everybody gets paid individually to do something: to see a patient, to admit someone, to do a lab test, to do a prescription, so health care is swamped by detailed, line-item bills."

After an office visit, a physician sends a diagnostic code to the insurer, which then decides the level of payment. These codes differ from the codes the insurer uses in the E.O.B.'s it sends to patients to explain its decisions.

The billing codes used by hospitals are something else entirely.

"Each of them has their own system of paperwork, with their own billing codes," said Ron Pollack, executive director of Families USA, a health care advocacy group.

"Everyone is bogged down by this: the physicians, the hospitals, and ultimately it reverberates to the consumer," Mr. Pollack said. "And to the extent the consumer sees the bill, it's like reading hieroglyphics."

Mr. Pollack and other health care experts said they believed that only a small percentage of people end up calling their insurance company to inquire about a claim or to dispute a decision. Still fewer call a hospital to go over a bill they believe might contain errors.

The Navigator

In late 2003, Bonnie MacKellar's son Elias, then nearly 2, stopped eating. Then he stopped talking and walking. Elias had stage IV neuroblastoma, a highly malignant tumor of the nervous system.

Though pushed to their emotional limits, Ms. MacKellar and her husband, Thomas Dube, refused to buckle until the bills started to appear in the mail each day: hospital bills amounting to tens of thousands of dollars; invoices from doctors she did not remember meeting; E.O.B.'s from her insurance company that explained nothing.

"It is hard to describe what it is like to be confronted with mounds of scary claims and bills when you have a 2-year-old who is extremely ill, who needs constant nursing and doesn't have a great chance of surviving," Ms. MacKellar said. "And to sit in a hospital room, on hold with the insurance company for 30 minutes or more only to have your child start puking just as you get a rep on the line."

The E.O.B.'s seemed to serve little purpose beyond engendering fear. They were detailed enough ("radiology services 2/19/04"), but when it came to understanding the boxes listing the amounts charged, the amounts not covered, the fees allowed, the available benefit and the remark code (IT, 29, and the ever-mysterious QN ), Ms. MacKellar and her husband were at a loss.

One statement that said, "Plan pays $00.00, patient pays $56,750.00," caused panic.

The remark code "07" stated, "These charges are for services provided after this patient's coverage was canceled."

There had been no cancellation of coverage, but convincing the insurance company of that fact was an ordeal.

The breaking point came when the group number on the health plan changed, and Ms. MacKellar was unable to convince the insurance company that it was billing under the wrong number.

In despair, she consulted a social services agency, which put her in touch with Lin Osborn, a private consultant fluent in the arcane language of health care billing. For a fee, Ms. MacKellar was told, Ms. Osborn could take all the paperwork off her hands.

An expert in deciphering insurance and hospital billing codes, Ms. Osborn spent several days straight working on the case and took care of the entire mess, Ms. MacKellar said.

Still Searching

Although there is no single solution to the medical billing morass, Dr. Brailer, of the Health and Human Services Department, said that the increasing use of electronic records to enable insurers, physicians, hospitals and pharmacies to share data would help.

And in some segments of the health care system, efforts are being made to simplify and cut down on paperwork. Some insurance carriers, for example, are reducing the number of E.O.B.'s they send out, posting them online instead.

For the past 18 months, Blue Cross Blue Shield of North Carolina has been working to reduce the total amount of paper it sends out.

"When there's no remaining financial liability, then we don't send the E.O.B.'s," said Bob Greczyn, president of Blue Cross Blue Shield of North Carolina.

Blue Cross Blue Shield of South Carolina is offering physicians an electronic card reader that lets patients find out how much they owe while they are still in the doctor's office.

In another effort to improve the system, the Patient Friendly Billing Project, led by the Healthcare Financial Management Association, is working with insurance companies on a long-term project to make bills more comprehensible.

Still, Dr. Brailer said that, on the whole, "there isn't a lot under way" in terms of efforts to fix the system.

Dr. Brailer pointed out that there had been frequent calls for a standardized insurance billing form, which would sharply reduce duplication and paperwork costs and "make patient management of these as simple as online checking."

But, he said, "this has not gone beyond the wishful-thinking level because the changeover would cost a lot."

Mitch Mayne, 38, is a marketing executive in San Francisco who considers himself basically healthy.

Mr. Mayne went to his doctor three times between March and June for the same thing: recurring bronchitis.

Yet the explanation of benefits statements he received from his insurer after each office visit differed drastically in the amount he owed, varying from $10.66 to $90, with no explanation of the services provided.

"What did I do on June 27 that was different than what I did on April 6 that was different than what I did on March 4?" Mr. Mayne asked.

When he calls for an explanation of the E.O.B.'s, he said, the most tangible result he sees is a new card in the mail with no indication of the amount he owes as a co-payment printed on the card.

"I'm paying through the nose for this premium, and when I go to the doctor it's a roll of the dice as to whether or not they'll pay it," said Mr. Mayne. "It seems like it depends on the mood of whoever happens to be doing the claim that day, or on the phases of the moon."

Mr. Mayne recently grew so fed up that he decided to try to beat the bronchitis on his own. "I can't deal with all this paperwork," he recalled saying. "It's just too much of a hassle." That turned out to be a mistake. Mr. Mayne became so sick that he finally relented and saw his doctor.

What if something truly catastrophic should happen to the state of his health?

"Oh wow, I hadn't even thought of that," Mr. Mayne said. "That's actually a pretty scary proposition. If I can't manage my health care as a healthy individual, the prospect of trying to manage it and be really sick at the same time - I don't know that I could do it."

I recently had a notice put on my door for a judgement for $15,000 on a discrepancy from billing when I was hospitalized in 2003. It took them about 2 years to straighten it out, and there are still a few items that still have yet to be rectified.

One issue I had was a doctor bill (services rendered but she's not on my insurance yet she's my admitting doctor) and the radiology group inside the hospital that I was admitted to.

Both times I argue this my words are very simple,"So when I'm in the ER and admitted, as I lay in pain, each and every person that wants to touch me, stick me, talk to me, move me, bring me to another department, I need to clarify from them that they will be able to take my insurance?"

Each time I'm met with "common sense" which says, "No of course not." But each time my bill still isn't paid.

It's not gotten any easier and it's not going to in my opinion. What's yours?

hannukah harry · 10-15-2005, 01:22 AM

If I'm not mistaken, HIPAA was enacted in part to remedy this, at least in part. It was supposed to standardize a lot of what goes on in health/insurance billing and administration. Supposidly it shoudl cut down on money. All of the provisions of HIPAA are just taking effect over the last year or so or in the near future, so I guess in maybe 10 years we'll be able to tell if it helped or not. I'm placing my bets on 'not.'

Suave · 10-15-2005, 01:30 AM

Wow. No matter how long the wait times get and how much people will bitch about it, I must say I'm glad for our healthcare system up here. I have enough trouble making sure I take care of the tiny numbers of bills (credit card, etc) that I get now, without worrying about 'stacks' of medical transaction records.

flstf · 10-15-2005, 02:15 AM

Quote:

Originally Posted by Cynthetiq

It's not gotten any easier and it's not going to in my opinion. What's yours?

We have discussed healthcare and medical insurance several times in these forums so I won't go into it in great detail. Basically the healthcare industry, doctors, hospitals, dentists, drug companies, insurance companies, etc..seem to be out of control. There is essentially no competition and the only cost controls are sometimes determined by the insurance companies as far as I can tell.

Costs will continue to rise greater than our ability to pay them, both healthcare and insurance, especially with an increasing number of companies reducing medical insurance benefits. IMHO the system will continue to spiral downward and eventually we will demand that our polititians nationalize healthcare. The healthcare industry doesn't seem to be able to operate in a competitive manner and will eventually have to be provided by the government much like national defense.

I watched my father hassle with the medical/insurance paperwork nightmare when my mother died from a lengthy illness. I don't think he ever got it figured out then and it is probably much worse now.

Paq · 10-15-2005, 03:21 AM

I think that is one of the main reasons why i wish we could adopt a univeral health care system. Namely, i pay entirely too much for insurance that covers very little. I also get bills up to 2 yrs AFTER a simple service. I broke a bone in my hand that costed $1800, mainly for 3 xrays and 2 rolls of fiberglass tape for a cast, nothing had to be 'reset' even though the bones are now misaligned, and nothing was done that i wasn't already doing for it. My insurance costed me $500 every 6 months, and it covered roughly $1000 of that, so i ended up paying about $1300 for the insurance plus the bill..then 6 months later, i get another bill from the actual doctor..then another from the center where i had my xrays performed...then a 3rd that i totally didn't understand, so all in all, it was about $1800 for a simple broken bone in a hand and took 4 hrs at one place and 3 hrs at another waiting in the waiting room. I don't know of many canadians that wait 7 hrs to have a broken bone diagnosed and reset and i sure don't know of any that spent several hours on the phone haggling with insurance companies and doctors' offices...

i'd HATE to imagine if i were to have heart troubles or an appendix rupture or anything requiring an overnight visit to a hospital.

heck, my 1 emergency room trip i nthe past 10 yrs took 6 hrs and involved 9...9!!! different bills from the xray tech to the doctor's home office that is over 400 miles away...

And as for insurance, i can BARELY find 20/80 coverage that does not have a $2000+ deductible and an obscene premium, and it's still over $100/month for 70/30 with several hundred limitations for a single white nonsmoker with no past medical issues...I don't know about hte rest of you, but the thought of coming up wtih 30% of a $100K operation is ...well, scary.

lurkette · 10-15-2005, 07:30 AM

My boss had to go through this as her husband was dying of laryngeal cancer. She was getting bills from 3 different doctors, 2 different hospitals, and every time she spent an hour on each claim with the insurance company she got a different answer from a different representative. Eventually she stopped caring and spent that time by his bedside with him. It was so disgusting, I just couldn't believe it. We work for a medical center, which provides our insurance, and his treatments were provided by the medical center for which we work. So essentially they were billing themselves and arguing about it. Unfuckingbelievable.

Is it this bad in countries with universal coverage?

Schwan · 10-15-2005, 10:02 AM

It's worse - in most countries in Central Europe (most of them have universal coverage) you need to wait for a few months to get to a doctor. Basicaly, if it's something more complicated than a flu shot, you need to plan 4 months ahead. All hospitals divide their time - 50% for the non paying and 50% for the paying patients. Most people pay up front, as they don't want to wait. Thus, the coverage isn't really universal.

Strange Famous · 10-15-2005, 10:51 AM

We all complain about the NHS and the terrible standard of care in the UK (and the horror stories of elderly patients left to die in their own filth on stretchers in the corridor's and so on...) but I suppose at least it shows that the ideals are still worth something, and still worth fighting to get right.

Borla · 10-15-2005, 11:25 AM

Quote:

Originally Posted by Cynthetiq

I recently had a notice put on my door for a judgement for $15,000 on a discrepancy from billing when I was hospitalized in 2003. It took them about 2 years to straighten it out, and there are still a few items that still have yet to be rectified.

One issue I had was a doctor bill (services rendered but she's not on my insurance yet she's my admitting doctor) and the radiology group inside the hospital that I was admitted to.

Both times I argue this my words are very simple,"So when I'm in the ER and admitted, as I lay in pain, each and every person that wants to touch me, stick me, talk to me, move me, bring me to another department, I need to clarify from them that they will be able to take my insurance?"

Each time I'm met with "common sense" which says, "No of course not." But each time my bill still isn't paid.

It's not gotten any easier and it's not going to in my opinion. What's yours?

I got one even better.

Earlier this year I had a medical emergency where I was not conscious. I also happened to have no ID on me, because I was hanging out at a hotel, outside of my room, and my ID and other belongings were in my room, all I had was the key card for the room. Basically I was taken by ambulance to the hospital, had several procedures done, and woke up in ICU. I was discharged about 24 hours later, without ever having to fill out any paperwork, since I was discharged on a Sunday and the insurance office for the hospital was closed. My total bill was nearly $20k. But guess what? Since the hospital didn't PRE-CERTIFY me for the procedures, they aren't going to get paid even ONE penny on the dollar!

WTF? I asked my insurance if they could then charge me. The answer was no, because they WERE in network for my insurance. I asked how they should've precertified me if they didn't even technically know who I was, and I was unconcious. I was told there are procedures for clearing with the insurance company how to get it paid, but because they didn't do that before billing they are SOL.................and we wonder why health care is so insanely expensive today.......

ryfo · 10-15-2005, 06:20 PM

In Australia, you can have private health insurance that allows you to choose hospital, doctor that you want, or we have medicare which everyone is entitled to and it allows you to go to a public hospital and see the doctor thats working that day and have tests needed and treatment and it is for free. The only thing is sometimes you are put on a waiting list and havea to suffer til your turn, for example the waiting list for braces for kids teeth is 4 years so in those circumstances private helath cover is the way to go, but if you are in an accident or have a serious complaint most times the medicare system works ok...some doctors also bulk bill medicare too so you can see a doctor in his practice for nothing if your lucky

flstf · 10-18-2005, 02:54 PM

I guess this is the way the healthcare industry works today. There is some good advice here but I wonder how you dispute the $129.00 they charge you for a box of tissues or as the hospital calls it "mucous recovery system". I bet they have data to show that it costs them that much and you are SOL.

Quote:

10 ways to avoid outrageous hospital overcharges
Profit-hungry hospitals are overcharging consumers an estimated $10 billion a year. Some deliberately work to keep bills indecipherable. Here's how to fight back.
American hospitals are fleecing patients out of billions of dollars annually, and experts say that while some of the overcharges are honest errors, many are deliberate.

That's because hospital bills are next to impossible for consumers to understand, which means hospitals can hide improper charges behind mysterious medical terminology and baffling codes. That's what Nora Johnson found when her 56-year-old husband, Bill, underwent hip-replacement surgery in 1999. The cost of the operation was $25,000. Knowing that her family would have to pay a percentage of the costs, she requested an itemized bill.

$129 for a box of tissues
"What I got was five feet of single-spaced names and codes," recalls Johnson. Written in "hospital-speak," some of it made sense, she says, while some of it was absurd. "Like the charge for newborn blood tests and a crib mobile. That stopped me in my tracks," recalls Johnson. "As far as I know, my husband never had a baby."

Johnson, from Caldwell, W.Va., was so shocked by the overcharges she became a trained medical billing advocate. Today, she audits hospital bills for consumers and for state employees in West Virginia.

"More than 90% of the hospital bills I've audited have gross overcharges," says Johnson. Estimates on hospital overcharges run up to $10 billion a year, with an average of $1,300 per hospital stay. Other experts say overcharges make up approximately 5% of hospital bills.

"I've seen $90 charged for a 70-cent I.V. How about $129 for a mucous recovery system? That's a box of Kleenex," Johnson adds. She's also seen charges for ordinary supplies, such as towels and sheets, that should be included in the room charges. Johnson says some overcharges are mistakes, but many are deliberate. "Hospitals are huge moneymakers," she explains. "Their executives enjoy big bonuses."

As a result, "Hospitals have become highly innovative when it comes to billing, and ordinary citizens have no idea they're being ripped off," says Johnson, who is affiliated with Salem, Va.-based Medical Billing Advocates of America.

Experts baffled, too
But making sure that you are charged correctly can be a daunting task. That's what Richard Clarke found out firsthand shortly after his father died in 2000.

Despite the fact that he is a former hospital chief financial officer, Clarke admits, sorting through the bills took him a year. In the end he found $2,000 in errors. That's because bills from just one hospital stay will come pouring in, and they come from many providers: Your surgeon, anesthesiologist, pathologist, labs, as well as the hospital.

Bill Mahon is executive director of the National Health Care Anti-Fraud Association, a group of insurers and law enforcement officials in Washington, D.C. He says patients are helpless to decipher their bills. As a result, says Mahon, providers can slip in overcharges.

"The medical billing system is complicated and confusing," admits Rick H. Wade, senior vice president of the American Hospital Association, which represents most of the hospitals in the United States. On Dec. 27, 2002, he told a "Dateline NBC" investigative team, "Trying to understand all the code words and jargon can turn your brain into oatmeal."

Hospitals discourage consumers from checking bills
Because health insurance plans have different contracts with differing payment schedules, there is no single rate sheet you can consult. Nevertheless, experts say reviewing your bill for overcharges is vital. For one thing, if you are required to pay some of your hospital expenses, either as a deductible or a co-payment, overcharges will come out of your pocket.

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. Your credit rating may be at risk too. "Hospitals have become very aggressive about collecting money," says Nora Johnson.

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.

Don't be taken for a ride
Nevertheless, experts say you can take these steps to make sure that you're not taken for a ride.

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.

If 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.

At 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 required.

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 or not you received the treatments and medications you've been billed for. Every state now requires hospitals to provide itemized bills.

10-15-2005, 01:22 AM	#2 (permalink)
hannukah harry Junkie	If I'm not mistaken, HIPAA was enacted in part to remedy this, at least in part. It was supposed to standardize a lot of what goes on in health/insurance billing and administration. Supposidly it shoudl cut down on money. All of the provisions of HIPAA are just taking effect over the last year or so or in the near future, so I guess in maybe 10 years we'll be able to tell if it helped or not. I'm placing my bets on 'not.' __________________ shabbat shalom, mother fucker! - the hebrew hammer

10-15-2005, 01:30 AM	#3 (permalink)
Suave Twitterpated Location: My own little world (also Canada)	Wow. No matter how long the wait times get and how much people will bitch about it, I must say I'm glad for our healthcare system up here. I have enough trouble making sure I take care of the tiny numbers of bills (credit card, etc) that I get now, without worrying about 'stacks' of medical transaction records. __________________ "Few people are capable of expressing with equanimity opinions which differ from the prejudices of their social environment. Most people are even incapable of forming such opinions." - Albert Einstein "Wise men talk because they have something to say; fools, because they have to say something." - Plato

10-15-2005, 03:21 AM	#5 (permalink)
Paq Junkie Location: South Carolina	I think that is one of the main reasons why i wish we could adopt a univeral health care system. Namely, i pay entirely too much for insurance that covers very little. I also get bills up to 2 yrs AFTER a simple service. I broke a bone in my hand that costed $1800, mainly for 3 xrays and 2 rolls of fiberglass tape for a cast, nothing had to be 'reset' even though the bones are now misaligned, and nothing was done that i wasn't already doing for it. My insurance costed me $500 every 6 months, and it covered roughly $1000 of that, so i ended up paying about $1300 for the insurance plus the bill..then 6 months later, i get another bill from the actual doctor..then another from the center where i had my xrays performed...then a 3rd that i totally didn't understand, so all in all, it was about $1800 for a simple broken bone in a hand and took 4 hrs at one place and 3 hrs at another waiting in the waiting room. I don't know of many canadians that wait 7 hrs to have a broken bone diagnosed and reset and i sure don't know of any that spent several hours on the phone haggling with insurance companies and doctors' offices... i'd HATE to imagine if i were to have heart troubles or an appendix rupture or anything requiring an overnight visit to a hospital. heck, my 1 emergency room trip i nthe past 10 yrs took 6 hrs and involved 9...9!!! different bills from the xray tech to the doctor's home office that is over 400 miles away... And as for insurance, i can BARELY find 20/80 coverage that does not have a $2000+ deductible and an obscene premium, and it's still over $100/month for 70/30 with several hundred limitations for a single white nonsmoker with no past medical issues...I don't know about hte rest of you, but the thought of coming up wtih 30% of a $100K operation is ...well, scary. __________________ Live. Chris

10-15-2005, 07:30 AM	#6 (permalink)
lurkette My future is coming on Moderator Emeritus Location: east of the sun and west of the moon	My boss had to go through this as her husband was dying of laryngeal cancer. She was getting bills from 3 different doctors, 2 different hospitals, and every time she spent an hour on each claim with the insurance company she got a different answer from a different representative. Eventually she stopped caring and spent that time by his bedside with him. It was so disgusting, I just couldn't believe it. We work for a medical center, which provides our insurance, and his treatments were provided by the medical center for which we work. So essentially they were billing themselves and arguing about it. Unfuckingbelievable. Is it this bad in countries with universal coverage? __________________ "If ten million people believe a foolish thing, it is still a foolish thing." - Anatole France

10-15-2005, 10:51 AM	#8 (permalink)
Strange Famous follower of the child's crusade?	We all complain about the NHS and the terrible standard of care in the UK (and the horror stories of elderly patients left to die in their own filth on stretchers in the corridor's and so on...) but I suppose at least it shows that the ideals are still worth something, and still worth fighting to get right. __________________ "Do not tell lies, and do not do what you hate, for all things are plain in the sight of Heaven. For nothing hidden will not become manifest, and nothing covered will remain without being uncovered." The Gospel of Thomas

10-15-2005, 10:02 AM	#7 (permalink)
Schwan A boy and his dog Location: EU!	It's worse - in most countries in Central Europe (most of them have universal coverage) you need to wait for a few months to get to a doctor. Basicaly, if it's something more complicated than a flu shot, you need to plan 4 months ahead. All hospitals divide their time - 50% for the non paying and 50% for the paying patients. Most people pay up front, as they don't want to wait. Thus, the coverage isn't really universal.

10-15-2005, 06:20 PM	#10 (permalink)
ryfo Psycho Location: melbourne australia	In Australia, you can have private health insurance that allows you to choose hospital, doctor that you want, or we have medicare which everyone is entitled to and it allows you to go to a public hospital and see the doctor thats working that day and have tests needed and treatment and it is for free. The only thing is sometimes you are put on a waiting list and havea to suffer til your turn, for example the waiting list for braces for kids teeth is 4 years so in those circumstances private helath cover is the way to go, but if you are in an accident or have a serious complaint most times the medicare system works ok...some doctors also bulk bill medicare too so you can see a doctor in his practice for nothing if your lucky