Health-care costs will double by 2008 if they keep rising at double-digit rates. People who do not have government insurance: Do what you can to defend yourself.
Are dates accurate? Have they billed you for three days instead of two?
Did a doctor order it? If not, it should not be there.
Were you charged for wait time that was not your fault?
Did you actually receive items and services? Were you billed, for instance, for tests or drugs that were canceled? Some hospitals automatically bill for items that often go with certain procedures: e.g. sedation with childbirth.
Were you charged twice for the same service or item?
Were tests repeated because of hospital error? You should pay only once.
If a doctor, anesthesiologist or radiologist billed separately, make sure their services are not also on the hospital bill.
Hospitals are not allowed to charge for reusable equipment or items.
Is this a routine item that is part of a procedure for which the hospital also bills, like the drape over the patient during an operation? Many auditors question them.
Hospitals mark up items extensively, but generally should not mark up beyond their charge master rates, available at the state Health Care Authority. Warning: Charge masters are very hard to read.
7. Compare your bill to the medical record. The hospital will copy it for you. By state law, they can charge you no more than $10 plus 75 cents a page. You can also compare the two yourself at the hospital.
8. If an item appears on the bill, but is not mentioned in the medical record, you should not be charged for it, no matter how expensive it is. Hospitals may tell you their staff will compare the bill and medical record. Do it yourself, too, or have a knowledgeable person do it.
9. You may ask your doctor to review the bill for accuracy with you.
10. Keep track of your insurance deductible. Your insurance company may bill you after you've fulfilled your deductible.
11. Make a payment plan while you dispute the bill, to eliminate the possibility of credit action. Decide what part of the bill you do not dispute. Try to arrange payments that do not cause you to pay the part you dispute.
You made a list. Now what?
Make an appointment with the hospital. If you do not know Medicare billing rules, you are at a disadvantage.
If an item is clearly double-billed, inaccurate or not in the medical record, the hospital must remove it from the bill. Otherwise:
If you have a large bill, you may want to contract with a hospital bill auditor. An auditor will eyeball your bill — and medical record, if you have it — and decide if it's worth his or her time to audit. Many auditors charge a percentage — a third to half — of what they save you. (This is a better deal for uninsured people. If you are insured, your insurance company collects most of the savings, and you may have to pay the auditor.).
If you have legal questions:
Call the state Attorney General's Consumer Protection division: (800) 368-8808. Attorneys: Check hospitalmonitor.org and "How Consumer Law Can Help" on The National Consumer Law Center site. General advice to consumers:
1. If you dispute a bill in writing, the hospital must investigate your dispute.
2. Hospitals cannot charge you interest on your bill unless you have signed a contract that includes truth-in-lending disclosures.
3. If you are insured, you must be told in advance if your doctor is not a part of your insurance company's network, so you have the chance to refuse his services if they cost more."The omission of any material fact is a violation of the state consumer protection act," said Jill Miles, deputy attorney general. "The consumer has a right to know if the service is covered or not."
4. If the medical provider makes an untrue statement to compel you to pay a disputed amount, they may be violating the West Virginia Consumer Protection Act. Some providers, for instance, tell consumers the state Health Care Authority sets the prices of specific services and materials. This is not true, according to Sonia Chambers, chairwoman of the HCA.
5. Negotiate small payments while the dispute is being settled. This will remove the possibility of credit action. You can sue to recover, if it comes to that.
6. If you dispute a bill without making payments, the hospital may report the bill to a credit bureau, but they must also tell the bureau this is a disputed bill. If your dispute is documented in writing, send it to the credit bureau and tell them why you believe you do not owe the debt. The bureau must then ask the hospital to justify the debt. If the hospital can't, the credit notation is removed.
Health-care costs will double by 2008 if they keep rising at double-digit rates. People who do not have government insurance: Do what you can to defend yourself.
The federal General Accounting Office says medical errors cost patients about $10 billion annually. Credit counseling giant Equifax audited more than 4,000 bills and found errors in over 90 percent of them: double billing, canceled tests, bills for wait time, drugs that weren't given. Consumers can catch — or prevent — such errors.
Before you go to the hospital:
1. Comparison shop, like you would for any product. Find out who charges what.
If you are uninsured, call local hospitals. Tell them you are uninsured. Find out what they charge for the procedure you want. Check the yellow pages for clinics that may charge less for tests like MRIs or blood tests.
If your income is low, ask about hospital free care/discount policies. You may qualify for a discount at one hospital that would not be available at another. Any hospital should have a printed policy.
If you are insured, find out what discounts (if any) your insurance carrier gets from local hospitals, doctors and other medical providers. These discounts vary enormously and can make a big difference in your bill.
If you are looking for an insurance company, check with the state Health Care Authority at (888) 558-7002 to find out what discounts various insurance companies have negotiated with hospitals in your area. Ask each insurance company for a list of doctors who give its customers discounts.
2. The state Health Care Authority plans to have hospital prices, charity care policies and other information on its Web site next year, so you can compare. Meanwhile, read up to equip yourself to spot and ward off hospital billing errors. You may want to start with:
"Sorting Out Medical Bills After a Trip to the Hospital," Maryland Attorney General's Office: oag.state.md.us/consumer/ibt.1-.htm
Consumer Reports January 2003: "Decoding Your Medical Reports"
Hospitalmonitor.org: The Hospital Accountability Project
"The $49,000 hip and other oddities: How is it that American hospitals can charge so much and still cry poor?," Oct. 13, 2003, Money magazine (Type title into search engine).
After you go to the hospital:
Remember: Errors on hospital bills are often accidental. Hospitals may handle thousands of bills per day. A keystroke error can inject a mistake worth hundreds or even thousands of dollars into your bill. People who type in the bills must decipher the doctor's handwriting.
Remember: Compare your itemized bill to your hospital record. Rules of thumb: If it's not in the medical record or a physician didn't order it, it shouldn't be on the bill.
Remember: The state of West Virginia does not set or control the prices of individual items on hospital bills. Hospitals set the prices of individual items. The state Health Care Authority limits only the average of all bills a hospital sends out during a year.
1. In the hospital, keep a running diary, if you can. If you have a friend with you, they can do this. Include dates and times, doctor visits, services, tests, drugs, personal items. Note anything that is canceled: tests, drugs, whatever. Note the time you go into surgery and the time you come out.
2. Do not pay in full when you're discharged, no matter how the hospital encourages you to do so. Some hospital consultants advise hospitals to try to get consumers to do so. Give yourself time to examine the bill.
3. Ask for an itemized bill. The first bill that comes to you may not be itemized. It may say something like "Room & Board — Semi-Prvt $1,149, Hospital Incidentals $18,219.72." You want to know what those incidentals are.
4. If your itemized bill does not include basic information, ask for an expanded bill. You should get:
Understandable explanations of every item.
The dosage and quantity of all drugs and the quantity of other items.
A breakdown on vague items like "miscellaneous."
5. Put all communication in writing. Keep copies of letters, e-mails, phone records, etc. Send notes summarizing conversations. If the hospital threatens to refer the disputed part of the bill to a credit bureau, you can then prove you are disputing it. (See legal advice below.)
6. Review your bill:
Are dates accurate? Have they billed you for three days instead of two?
Did a doctor order it? If not, it should not be there.
Were you charged for wait time that was not your fault?
Did you actually receive items and services? Were you billed, for instance, for tests or drugs that were canceled? Some hospitals automatically bill for items that often go with certain procedures: e.g. sedation with childbirth.
Were you charged twice for the same service or item?
Were tests repeated because of hospital error? You should pay only once.
If a doctor, anesthesiologist or radiologist billed separately, make sure their services are not also on the hospital bill.
Hospitals are not allowed to charge for reusable equipment or items.
Is this a routine item that is part of a procedure for which the hospital also bills, like the drape over the patient during an operation? Many auditors question them.
Hospitals mark up items extensively, but generally should not mark up beyond their charge master rates, available at the state Health Care Authority. Warning: Charge masters are very hard to read.
7. Compare your bill to the medical record. The hospital will copy it for you. By state law, they can charge you no more than $10 plus 75 cents a page. You can also compare the two yourself at the hospital.
8. If an item appears on the bill, but is not mentioned in the medical record, you should not be charged for it, no matter how expensive it is. Hospitals may tell you their staff will compare the bill and medical record. Do it yourself, too, or have a knowledgeable person do it.
9. You may ask your doctor to review the bill for accuracy with you.
10. Keep track of your insurance deductible. Your insurance company may bill you after you've fulfilled your deductible.
11. Make a payment plan while you dispute the bill, to eliminate the possibility of credit action. Decide what part of the bill you do not dispute. Try to arrange payments that do not cause you to pay the part you dispute.
You made a list. Now what?
Make an appointment with the hospital. If you do not know Medicare billing rules, you are at a disadvantage.
If an item is clearly double-billed, inaccurate or not in the medical record, the hospital must remove it from the bill. Otherwise:
If you have a large bill, you may want to contract with a hospital bill auditor. An auditor will eyeball your bill — and medical record, if you have it — and decide if it's worth his or her time to audit. Many auditors charge a percentage — a third to half — of what they save you. (This is a better deal for uninsured people. If you are insured, your insurance company collects most of the savings, and you may have to pay the auditor.).
If you have legal questions:
Call the state Attorney General's Consumer Protection division: (800) 368-8808. Attorneys: Check hospitalmonitor.org and "How Consumer Law Can Help" on The National Consumer Law Center site. General advice to consumers:
1. If you dispute a bill in writing, the hospital must investigate your dispute.
2. Hospitals cannot charge you interest on your bill unless you have signed a contract that includes truth-in-lending disclosures.
3. If you are insured, you must be told in advance if your doctor is not a part of your insurance company's network, so you have the chance to refuse his services if they cost more."The omission of any material fact is a violation of the state consumer protection act," said Jill Miles, deputy attorney general. "The consumer has a right to know if the service is covered or not."
4. If the medical provider makes an untrue statement to compel you to pay a disputed amount, they may be violating the West Virginia Consumer Protection Act. Some providers, for instance, tell consumers the state Health Care Authority sets the prices of specific services and materials. This is not true, according to Sonia Chambers, chairwoman of the HCA.
5. Negotiate small payments while the dispute is being settled. This will remove the possibility of credit action. You can sue to recover, if it comes to that.
6. If you dispute a bill without making payments, the hospital may report the bill to a credit bureau, but they must also tell the bureau this is a disputed bill. If your dispute is documented in writing, send it to the credit bureau and tell them why you believe you do not owe the debt. The bureau must then ask the hospital to justify the debt. If the hospital can't, the credit notation is removed.
"Insurance used to be the thing that stood between people and huge health care bills. Now insurance itself is another huge bill. Or it's just unaffordable. And if you don't have it these days, every day you get up and risk financial disaster." --Sharon Carte, Children's Health Insurance Program (CHIP)director.
One in four working-age West Virginians is without health insurance. More than 60 percent of uninsured West Virginians have jobs.
In the coming months, the Charleston Gazette will explore the reasons why West Virginia's health insurance prices are particularly high. We will introduce you to the people who are uninsured, the people who are teetering on the edge, and the people who are trying to do something about it.
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