February 27, 2013

Tips from TIME on "Lowering Your Medical Bills"

Time Magazine, in publishing Steven Brill's expose "Bitter Pill: Why Medical Bills Are Killing Us," added a piece titled "Tips for Lowering Your Medical Bills."

Those tips come from medical billing advocates, healthcare's equivalent of tax-refund specialists. As many as eight out of ten medical bills contain errors, they say.

When you're in the hospital, you should concentrate on getting better and worry about the finances later. But there are cost-saving strategies you can pursue before you're seen by a doctor and after you get the bill.

At the emergency room or in the hospital
  • If you're insured, ask to see a doctor who participates in your insurance plan. Even if the hospital is in your network, it doesn't mean every doctor who practices there is. If the hospital isn't able to come up with an in-network doctor, your request for one puts you in a good position to negotiate for getting the in-network discount.
  • For the same reason, if you are able to, ask to have any lab testing sent to an in-network facility.
  • If possible, ask what tests the doctor or nurses are ordering. Perhaps less expensive options are available.
My comment: Recalling my emergency-room admission after the car crash, I imagine it's a rare emergency room patient who will remember any of these tips. Even with pre-planned hospital visits, this sort of negotiating is more likely to happen if you're accompanied by a knowledgeable spouse or close friend whom you've authorized to speak for you.

Once you get your bill:
  • Ask for an itemized bill so you can see every charge.
  • Ask for a written explanation for any disputed charges. 
  • If you get to the hospital after midnight, make sure your room charges don't start until that date.
  • If you were admitted to an emergency room, be sure to check the "level" of the room for which you're charged. Hospitals charge for ER services based on the care level assigned (e.g., level one for a nosebleed, to level five for a heart attack). Challenge the level designation if you think it's inappropriate. Ask for a written explanation.
  • ER doctors also charge by level assigned. Question and challenge where appropriate.
  • The hospital level should be equal to or lower than the doctor level. If it's higher, consider it a red flag indicating a bill error.
  • Question charges for what seem like routine items, like warm blankets, gloves, and lights that should be part of the overall room charge.
  • You should be charged only once for a doctor's reading of a scan or other test unless it's a second opinion or consultation. Challenge any additional readings.
  • If you received anesthesia, make sure you're charged for only one anesthesiologist. Some hospitals use certified registered nurse anesthesiologists but require that they be supervised by an anesthesiologist. Some bills may show charges for both of them. You should be charged for only one.
  • If your anesthesiologist is not in your network ask her to accept network reimbursement.
My comment: I just Googled "understanding hospital bills and codes" and glanced at the first two pages of entries. They were all links to books or manuals about deciphering hospital bills. Brill's Time report noted that even hospital executives couldn't explain some of these charges.

When I see my next hospital bill, I might just turn it over to a medical-billing advocate. These specialists claim they help patients save from $1,300 to $100,000. They typically charge a flat 35% of whatever they recover. You can negotiate an hourly rate for larger bills.

Click here to find an advocate.

Remember, there are things the patient knows that an advocate couldn't know from simply looking at the bill. You'd know, for example, if a billed test was actually cancelled, or if you never really saw a doctor whose services appear on the invoice.

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