As a mom of three danger-loving kids, I’m no stranger to the emergency room.
From stitches to sudden asthma-inducing bouts of croup, we have been to the ER time and time again. The worst part of these visits isn’t the wait time, the uncertainty of the diagnosis, or even that terrible hospital smell. It’s being stuck with the outlandish bills a few weeks later.
I’ve received hospital ER bills ranging from $300 to $3,000. Since I’m stuck with big bills so often, I’m hyper-vigilant about making sure that my out-of-pocket expenses aren’t being sabotaged by billing errors.
However, finding those errors and fixing them isn’t always easy. Patricia Salber, M.D., an emergency room physician and founder of The Doctor Weighs In, offers advice for patients who want to better understand their medical bills – and make sure they aren’t being overcharged.
If you don’t want to pay a professional coder to look over your medical bills (yes, this is a thing), here are some tips for the do-it-yourself patient.
Check your personal info.
Sometimes bills get mixed up and you may end up receiving one that doesn’t belong to you, especially if you have a common last name. Check all the identifiers, and be sure your health insurance policy number and medical record numbers are correct, otherwise you may be paying out-of-pocket when insurance ought to be covering your expenses.
Request an itemized bill.
Lots of medical billing companies will send out invoices with no information whatsoever about the services provided, just the amount you owe. Always request an itemized statement before you pay a dime, and double check what you’re being charged for. If you were seriously ill and can’t remember which services you received, Salber suggests having a family member who may have been present review the bill with you.
“You should be able to see what individual services were being billed for and what each of them cost,” says Salber.
Medical invoices should include the billing codes, which are typically combinations of letters and numbers, such as CPT, ICD-10-CM, DRG and so forth, which itemize the services you received. Scan these to see if you have been double-charged for any items, or charged for services you may not have received. That includes tests that your doctor ordered but later cancelled, Salber says.
Circle the suspicious.
“Make a list of any items with charges that seem way too high, such as a $3,500 for a 15-minute ER visit to evaluate an injured ankle or $20 for a single aspirin,” says Salber. If you can’t readily determine the service, but can see the code, type the code into your web browser to find the definition.
“If it still isn’t clear, call the billing office,” says Salber.
You need to be especially wary of your level of service charge, which is the code that determines the severity of your case and treatment in the ER. Up-coding (the practice of entering in a higher level charge) can drastically increase your bill — and it’s illegal.
Keep careful records of when you called, who you talked to, and the timeframe in which they were supposed to get back to you.
If you’ve found a mistake and it isn’t getting resolved, there are organizations such as My Patients Rights and National Healthcare Anti-Fraud Association that may be able to help.
If your insurance claim was denied, the same procedure applies. Make sure you get a clear explanation of benefits from your insurance company, and dispute it if you don’t agree.
“If you believe the denial was in error, you can file an appeal,” says Salber. You should receive information on how to appeal the decision along with your explanation of benefits letter.
Don’t lose hope.
If in the end you’re still stuck with a big bill, don’t give up. If you’ve seen an out-of-network doctor for an emergency visit or your plan simply leaves you with a big out-of-pocket chunk to pay, you may still be able to advocate for yourself and trim down your bill.
While hospitals won’t tell you this, you can often get a discount on your bill if you simply ask for one.
I’ve often negotiated ER bills for a fraction of the initial cost, simply by asking them to cut down the price for an in-full payment. Explain your situation to the billing office and see if you can come to an agreement on how much you can afford to pay. You can also negotiate a payment plan, often interest free, as long as you keep the payments coming in each month.
Gemma Hartley is a full-time freelance writer living in Reno, NV. Her work has appeared in The Washington Post, CNBC, Glamour, Women's Health, Redbook Magazine and more.