Toothbrush For $1000, a Problem with Hospital Overcharges

Mar 2 2010 - 5:03am
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Any time you are a patient in a hospital, make sure you check your bill. Hospital overcharges are a huge problem in the United States, with hospitals overcharging patients billions of dollars a year for items ranging from a toothbrush for $1000 to tissues for $129 or services never received.

Of course, you may find that it is nearly impossible to decipher the charges on that bill, because hospitals typically use code words and medical terminology that can baffle even a sophisticated healthcare consumer. But that does not mean you should allow hospitals to cheat you and the American public, because these overcharges hurt everyone.

The National Health Care Anti-Fraud Association (NHCAA) notes that in 2007, a total of $2.26 trillion was spent on health care in the United States, with more than 4 billion health insurance claims being processed. A conservative estimate from the NHCAA is that 3 percent of all health care spending, or $68 billion, is lost to health care fraud.

Estimates from government and law enforcement agencies, including the Federal Bureau of Investigation, say the loss due to health care fraud is even higher, as much as 10 percent of the US annual health care expenditure, or $226 billion, which is likely a low estimate and will only continue to rise.

Not all of that fraud can be found on your hospital bill, but some of it can. It is estimated that hospital overcharges run about $10 billion per year, which averages out to $1,300 per hospital stay. Some experts say overcharges account for about 5 percent of hospital bills.

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According to one MSN.com article, a woman whose husband underwent hip replacement surgery at a cost of $25,000 found charges for newborn blood tests and a crib mobile on her bill. There have been reports of aspirin costing $10 per pill, of patients being charged for sheets and pillows, and charges for procedures never performed.

Why You Should Check Hospital Bills
Not all hospital overcharges are deliberate, but that does not make them any less wrong. Consumers have a right and an obligation to check their hospital bills to make sure they are correct. But this can be a daunting task. There is no single rate sheet you can consult, and wading through the code words can boggle the mind. Yet experts encourage consumers to review their bills for overcharges.

If you are responsible for some of your hospital stay, overcharges will come out of your pocket. Insurance plans also have a cap, which means that money frizzled away by errors or fraud can take away from your lifetime total on your plan. Overcharges can also contribute to an inability to pay hospital bills, which can ultimately affect your credit rating.

How to Protect against Hospital Overcharges

  • Contact the hospital’s billing department and ask what your room charges cover. If it does not include a box of tissues, for example, bring your own.
  • Ask your doctors for an estimate of your treatment costs.
  • Ask if you can bring your own regular prescriptions from home so you will not have to pay for them again at the hospital. Then make sure your doctor and the hospital staff knows you have your own medication and that it does not appear on your bill.
  • If you are hospitalized for a nonemergency, check your insurance policy to find out what it will and will not cover. Take a careful look at the section called “Exceptions and Exclusions.”
  • Check your insurance policy to find out which medical professionals are covered under your plan, including surgeons, anesthesiologists, pathologists, radiologists, therapists, and others.
  • If possible, write down all the tests, medications, and treatments you receive during your stay. If you cannot do this, ask a family member or friend to do it for you.
  • Do not pay your bill before you leave the hospital.
  • You should receive an explanation of benefits from your insurance carrier or from Medicare (called a summary notice). It should tell you how much the hospital is charging, what your insurance will cover, and what your financial responsibility will be.
  • When you receive your bill, contact the billing department about any item you do not understand. Ambiguous items such as “lab tests” or “miscellaneous fees” tell you nothing. Every state requires hospitals to provide itemized bills. If you cannot clearly identify a charge, the bill has not been itemized.
  • If you are totally frustrated by your hospital bill, you can get help from a medical billing advocate, who knows how to interpret and negotiate hospital bills. You will have to pay for this service, but the cost may be worth it in the end. You can also contact your state’s attorney general office, whose job is to protect consumers from overcharges.

Staying in the hospital is painful enough. Having to deal with hospital overcharges can make the experience seem endless once you have left the facility. Health care consumers need to be vigilant and determined to fight any hospital overcharges both for their own financial well-being and for other consumers.

SOURCES:
Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Expenditure Projections 2007-2017.
Federal Bureau of Investigation, Financial Crimes Report to the Public, Fiscal Year 2007.
MSN.com Money Central
National Health Care Anti-Fraud Association

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