It's no secret that healthcare costs have been rising in recent years and are projected to continue to climb for years to come. This is why it's so important to be proactive and take measures to keep healthcare costs low. There are several vital steps your employees can take on their own to ensure that they only pay charges that are true and accurate and prices that are fair and reasonable on their medical bills.
The Itemized Bill
The vague bill that you initially receive from the hospital does not give much information, aside from amounts of money that the facility wants you to pay. However, this summary bill is not the only document that you can receive to show what you owe.
The first thing you should do after a hospital stay or any medical procedure is to request a detailed, itemized statement. What's the difference between a summary bill and an itemized statement? A summary bill gives a vague "umbrella" description of services and a lump sum charge and looks something like this:
An itemized statement breaks down everything that you are being charged for in a way that makes it easy to see. An itemized statement will look something like this:
Although both look similar at first glance, once you look at the descriptions, the itemized statement sample is much more detailed than the summary bill sample, which gives you a better opportunity to scrutinize your charges.Look at the charge on the summary bill for "sterile supply". The facility is asking for more than $9,000 with a very vague description.
What items and services are included in "sterile supplies"? Are these items billable? How do you know that these charges are not included in another vague "umbrella" charge? What charges are included in "OR Services"? How about "Inpatient Services"? You will not know the answer to any of these questions until you review a detailed, itemized statement.
Many items should be included in the price of procedures, if these items are an integral part of performing the service. For instance, the surgical blades and drapes charged for in the itemized statement are integral parts of performing the surgery. Therefore, the facility cannot charge separately for these items. However, without the itemized statement, the patient would not have known that they were charged for a non-billable, routine item.
Scrutinizing for True and Accurate Charges
Routine items that are not billable do not just occur in the operating room, they can occur anywhere in the hospital. But one area that is notorious for tacking on non-billable items is the ICU, or Intensive Care Unit. It's fairly common knowledge that rooms in the ICU are typically more expensive than most other rooms in a hospital. The reason the room charges are so much higher is because they are accounting for the special equipment and having more staff available to assist the patient.
However, it's not uncommon for ICU patients to be charged for items that are readily available on the unit - meaning that the cost of these items has already been included in the patient's room charge. Ventilator charges are commonly seen on an ICU patient's bill. This is a piece of equipment that should be included in the price the patient has paid for the ICU room.
Nursing services such as finger sticks - when the nurse pricks the patient's finger to check his or her blood sugar level - are commonly seen on patient's bills. This is a routine service and cannot be separately billed. Employees should look for double and even triple billing on his or her itemized statement. During a procedure, a "kit" is often used.
This kit will contain supplies that are integral for performing the procedure. Because the surgeon or doctor cannot perform the procedure without these items, the cost of the kit should be included in the cost of the procedure. However, all too often, the charge for the kit shows up on an itemized statement, meaning the patient has been double billed for the items in the kit.
Additionally, a patient might see a third charge for the items contained in the kit when these items are unbundled and listed separately on the itemized statement. The patient is the best person to review their own charges because they know what they received and what they did not. Once the employee receives the detailed, itemized statement for his or her stay, he or she should scrutinize every line item to make sure that they agree with every charge.
Perhaps a procedure was scheduled but later canceled. There might be a charge for a medication that the patient is allergic to, therefore he or she could not have taken. If there is a supply, medication or procedure listed that the patient does not remember receiving, the patient should contact the facility's billing department and question the charge.
How Do Hospitals Do This?
So how exactly do hospitals get away with inflating the price of their bills? Many of the items a patient will see on an itemized statement make no sense to a lay person. With service descriptions like "Drape C-Arm/Mobile Univ 44X74," it takes a hospital administrator to sift through all of the jargon. This is how hospitals can get away with billing a patient for "thermal therapy" for $15 when it is nothing more than a plastic bag full of ice or a "disposable mucus recovery system" for $11 that is just a box of tissues.
This massive price inflation-you can buy eight boxes of 120 count Kleenex tissues on Amazon for $9.73-is not uncommon. By labeling the services given with complex jargon, hospitals are able to hide what patients are really paying for. This overcharging extends beyond making confusing names for household objects. Hospitals also charge the patient for reusable supplies like surgical gowns, scalpels, warming blankets and table straps.
These are also prime supplies to be double charged, appearing in both the itemized summary and under the umbrella term of "facility fees". Why then, do hospitals feel the need to charge their patients so much? Medicare and other forms of government reimbursement negotiate prices with hospitals, much like insurance companies do, but the prices Medicare receives are orders of magnitude below what the insurance company receives.
For example, a hospital might charge a patient not on Medicare $283.00 for a chest x-ray, but will charge the Medicare patient only $20.44. It is estimated that because of this, hospitals lose $35 billion a year. So to make up the difference, they charge everyone else based off of the "chargemaster." A chargemaster is a list, specific to each hospital, of all of the services that hospital offers with the starting price for that procedure. It is from these prices that insurance companies negotiate their prices, not the Medicare price.
What Does this Mean for Employers?
Having a medical problem is a stressful time for both the patient and their families. This is compounded when the bill $80,000 and insurance only covers half of that. It's no secret that healthcare costs have been rising in recent years and are projected to continue to climb for years to come. This is why it's so important to be proactive and take measures to keep healthcare costs low.
There are several vital steps your employees can take on their own to ensure that they only pay charges that are true and accurate and prices that are fair and reasonable on their medical bills. For self-funded employers, these extra costs are paid by the employer themselves. These are funds that could be used to pay essential medical claims for other employees that are instead spent on a $57.50 "cough support device" which is nothing more than a teddy bear.
Fair and Reasonable Prices
If a patient feels that he or she has been charged prices that are higher than what seems fair, this can be approached a number of ways, most of which require extensive research. A less time-consuming approach involves a few phone calls and a willingness to negotiate. The patient can contact other area healthcare facilities and ask for a quote for the same procedure. If other area facilities offer lower prices, this can be a bargaining point.
However, it is best to negotiate for a lower price before having the procedure. If the employee decides to receive a quote prior to having the procedure performed, he or she should make sure to get the quote in writing and to have it signed by an appropriate member of the facility's staff.
It might not be easy for your employees to research and prove that they are not being charged fair and reasonable prices. A reputable medical billing advocate who specializes in compliance billing is your best bet if your employees want to be assured that they are paying what they truly and fairly owe on medical bills.
About the Author
Pat Palmer is the Founder and CEO of Medical Billing Advocates of America and Medical Recovery Services. MBAA and MRS' mission is for all healthcare payers to only pay medical charges that are True and Accurate and prices that are Fair and Reasonable.