Are You Being Overcharged for Medical Care?

How to Fight Back

Bottom Line Personal, July 15, 2006

By Sid Kirchheimer, AARP Bulletin

Three-quarters of hospital bills have overcharges, and the average overcharge is about $1,000, according to People’s Medical Society, a nonprofit medical consumer rights organization. Doctors, too, are handing inflated bills to patients. Good news: It’s simple to fight back.

If your health insurance completely covers hospital and doctor visits, these steps might not be necessary, though making the extra effort to eliminate overcharges can help bring down medical costs for everyone. Also, be aware that your insurance coverage might not be as comprehensive as you thing – call your insurance carrier or review the exclusions section of your policy.

DOCTORS’ BILLS

To avoid paying more than you should…

Negotiate. If you have no health insurance, ask your doctor for a discount. Only 13% of patients ever make this request, but when they do, the majority secure a lower price, according to a survey of 2,118 adults conducted by Harris Interactive.

Ask the doctor in person. Requests made by phone or to an office assistant rarely work.

Keep in mind that insurance companies typically pay doctors one-half to two-thirds of the billed amount. If you will be paying out-of-pocket, you can offer to pay somewhere in that range when negotiating a price.

Get blood tests done at a lab. When your doctor does a blood test, he/she charges you for the office visit … plus an added fee for drawing your blood … plus the amount a lab charges to run the test.

Ask the doctor to waive his fees, or go directly to a lab to have the test done and pay only for the test (ask the doctor to supply any necessary paperwork).

Look in your local yellow pages under “Laboratories – Clinical, Medical, Diagnostic” or “Laboratories – Testing” for labs in your area.

Don’t pay for the follow-up visit. When you see a doctor about a health problem, you often have to see him again a few weeks later to confirm that the treatment was successful. Chances are, your doctor will look you over for a few seconds during this follow-up, pronounce you well – then bill you another $50 to $100 for the second appointment. During your initial appointment, tell the doctor that you’re paying out-of-pocket and ask if he’ll waive or reduce the charge for the follow-up visit, assuming that it takes only a moment. Many doctors will agree to this, particularly for regular patients.

Confirm that tests are necessary. Doctors often order unnecessary medical tests out of fear that not conducting these tests might open the door for negligence lawsuits later. Unless your health insurance is picking up the entire bill, question whether recommended tests – including MRIs, CAT scans and X-rays – really are necessary. Ask what these tests will determine.

HOSPITAL OVERCHARGES

Here’s how to spot overbilling on hospital bills …

Ask for a daily itemized bill. When you check into the hospital, tell the staff member who takes down your insurance information that you want an itemized bill brought to your bed every day. Hospitals are required to provide this upon request.

When you receive these daily bills, review each listing (or ask a family member to do so for you). Were you billed for two doctor visits yesterday even though you saw a doctor only once? Were you billed for tests that you don’t recall getting? Are there vague entries, such as “miscellaneous costs” or “lab fees?” Are there listings you can’t understand? Tell the nurse you would like to speak with the hospital’s patient advocate, then ask the advocate to explain any charge that isn’t clear. You might be appalled by what you’re told.

Examples: Some hospitals have been known to call a box of tissues a $12 “mucus recovery system” and a bag of ice cubes a $30 “thermal therapy kit.”

Save the daily bills so you can reconcile them later with the final bill.

If the patient advocate won’t help remove the mistakes and reduce egregious overcharges from your bill, hire an independent medical billing advocate. He/she will examine your bill and fight to remove any overcharges, usually in exchange for a percentage – typically 35% – of the amount he saves you.

To find a medical billing advocate:

Contact Medical Billing Advocates of America (304-645-6389, www.billadvocates.com) … American Medical Bill Review (530-221-4759, www.ambr.com) … or Edward R. Waxman & Associates (877-679-7224, www.hospitalbillauditing.com).

Bypass the hospital pharmacy. Hospitals dramatically overcharge for drugs. A patient might be billed $5 to $10 for a pill that retails for 10 cents elsewhere.

If you are taking medications on an ongoing basis and are not fully covered by insurance, bring your drugs with you to the hospital.

When you consult with your doctor prior to entering the hospital, find out which drugs you’re likely to be given during your stay. Ask the doctor to write you prescriptions so that you can buy these drugs at your local pharmacy in advance and avoid the hospital markup. Even if your doctor won’t do this, you can bring any nonprescription pills you’re told you’ll need, such as vitamins.

If you must get drugs through the hospital pharmacy and your insurance isn’t footing the bill, ask your doctor to specify generics whenever possible. When you get your itemized daily bill, double-check that you weren’t charged for the brand-name drugs instead.

Watch for double billing. Hospitals often bill patients twice for certain things. If your bill lists sheets and pillows, ask the hospital’s patient advocate if these items are included in your daily room rate. If you’re billed for the scrubs, masks and gloves worn by surgical staff, find out if these were included in your bill for operating room time.

Also double-check the times on your operating room bill. Hospitals charge from $20 to $90 for every minute you’re in the operating room, so if the time you spent in surgery is padded even a little, it will add a lot to your bill. Your anesthesia records will say how long your operation really lasted.

Don’t pay for your last day. Hospital patients are charged the full day’s room rate for the day they check in – even if they arrive at 11:59 pm. In exchange, patients are not supposed to be charged for their last day, but hospitals often try to bill for the final day anyway. Sometimes these last-day room bills are simply removed when you complain, but there are hospitals that insist the last-day charge is legitimate for patients who aren’t discharged by a certain hour, often noon.

During your hospitalization, ask the hospital’s patient advocate whether you’ll be billed for your room on the final day of your stay. If the answer is, “Yes, if you’re not out by a certain hour,” ask your doctor on the next-to-the-last day of your stay to give you your final checkup and discharge the following morning, rather than waiting until the afternoon. If the doctor says this doesn’t fit his schedule, tell the patient advocate that you shouldn’t have to pay because the delay is the doctor’s fault.