We recently received the itemized bills from our son’s birth and noticed that the hospital charged twice for a hearing test that we know was only done once. We got it fixed on the bill but it makes me wonder what other mistakes are on the medical bill? There are a lot of line items listed and for most of them I have no idea what they are for.
If you have insurance, then let your carrier analyze and process the claim first. They will find duplicate billings, inclusive or non-billable charges and will adjust the claim to the contracted rate.
If you are a self-pay patient, you might need to get the bill reviewed by a professional coder or patient advocate specializing in billing. Hospital bills are notorious for overbilled, erroneous charges, and for billing items such as supplies which should not be. Bills going to insurance companies are "sanitized" of many items routinely billed to cash patients. As they would be denied under billing and coding rules, they never make it onto an insurance claim form but remain open charges on patients' statements.
The codes used are already an indication of whether a charge is payable or not, but you would need to research medical billing guidelines to point them out.
After you boil the bill down to its payable items, checking on "usual and customary" pricing is the next step. Some of the prices are so outrageous as to be laughable. Find out what a reasonable cost might be before engaging in any payment negotiation.
Congratulations on the birth of your son.
If you do not have insurance, a medical claims specialist can help you review your bill for errors. The association Alliance of Claims Assistance Professionals (ACAP)
has a list of advocates listed by state. You do not need an advocate in your state for this type of service. Look for professionals with RN degrees. These advocates would be most likely to provide claims auditing services. An advocate would also be able to help you with payment negotiation.
If you have insurance, your insurance company will review your hospital claims for mistakes and excessive charges for you and take them off our claim. Most insurance companies have a contract rate with most hospitals which will further reduce the cost for you and your insurance company.
Congratulations on your son’s birth!
You have a lot of suggestions here but I wanted to touch base on Medical Bill Advocates who are quick to identify medical billing errors.
I would reach out to a medical bill advocate who can do an audit on the medical bill for you. They will audit the medical records for errors in coding, compliance, pricing and negotiate your out of pocket expenses on your behalf.
You would want to find a medical bill advocate who works on a contingency basis where they charge (25-35%) of what they save you and only if they save you money. This way you know they are working for you as opposed to someone charging a case rate upfront.
I would have a advocate look at the hospital charges, physician charges, anesthesia charges and any other bills you received surrounding the birth of your child.
Medical bill advocates can normally save clients hundreds if not thousands on medical bills. You have nothing to lose by bringing on a medical bill advocate to closely monitor your medical bills on an ongoing basis.
This can save you lots of money in itself!
Hope this helps
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocates
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