A Bill Not Named William
Modern medicine has afforded the world’s population endless benefits. Thanks to scientific advances in medicine, the world’s life expectancy has improved dramatically from the 19th Century to the present. Life expectancy in the United States in 1860 hovered around 40 years of age (give or take). As of 2020, just 160 years later, life expectancy has nearly doubled to around 77 years of age now according to the CDC. This is in large part due to research and advances related to vaccines that target illnesses such as: tuberculosis, polio, diphtheria, measles, influenza, chickenpox, multiple types of hepatitis, and many more… We are certainly blessed with the quality of medical care we are receiving. It’s a shame we are usually not treated with that same level of care when it comes to receiving the medical bill from your healthcare provider of choice (or more likely the one your health insurance company decides you can have). Many of us have experienced going to a clinic for a blood or urine sample only to be told that the clinic is out-of-network for your health insurance plan (not in cahoots apparently).
The cost of healthcare services in the US rose 3.0% from June 2022 to June 2023. Outpatient care prices increased even more, 5.7% from 2022. This doesn’t bode well for people in need of healthcare. Many Americans have HDHPs (high-deductible health insurance plans) and those won’t pay a dime for their care until that deductible is met. You could be looking at $10,000 or more out of pocket before your health insurer lifts a finger. As of 2021 55.7 percent of Americans are enrolled in a HDHP, the highest on-record. Additionally, Americans have seen record-high rates of inflation for consumer goods, property values have skyrocketed leading to increased property taxes, and an overinflated real-estate market has made it difficult for first time buyers to purchase a house and buy into the American dream. With inflation at the forefront of all this, why are consumers treated so poorly when it comes to medical billing? at time, you are even lucky to even receive the bill, as it often has the wrong address or just seemingly never existed.
Lien On Me? Strength Optional
Indulge me with a little personal story. In the woes of my freshman football season, I was both a hero and a punching bag. I was a member of my high school football team, and can recall having great success on Thursday nights. Monday, Tuesday, Wednesday, and Friday I was a minion, often playing practice squad and ragdoll for the varsity football team. But Thursdays, I was a wrecking ball. On Thursday nights the junior varsity team was allowed to play games. In those games, I wreaked havoc. As a defensive tackle, I would break-up double teams, sack the quarterback multiple times, and force multiple fumbles. It was truly a blast for that one day of the weak. But, on the other days ending in “y” it was quite a different experience. One particular encounter saw my helmet go flying and my chin open up. As scout-team fullback, I was leveled by the best player on our team. The wound on my chin, while small, would require a couple of stitches.
I was brought to a doctor’s office and stitched up accordingly. All was well for a few weeks. I stayed out of practice for a few days for the wound to heal, and the following week I was able to practice without an incident. Friday was the day for our varsity team to shine. On occasion, the junior varsity players would see the field if the game’s score was out of hand. Our Varsity football team jumped out to a thirty-five to zero lead (that is 5 touchdowns and 5 extra points) which is pretty substantial in the game of football. This meant I got to play almost three-fourths of the game. There was a problem however, I had opened up the wound on my chin yet again. This led to a trip to the only place open at 11 o’clock that night, the ER. The ER basically just glued the wound shut and sent me on my merry way. I wish this story had a happy ending.
The ER unfortunately never sent the bill to my family’s house. This was a time where things like digital billing and EMR (electronic medical records) weren’t as common. Due to the bill not being paid, that hospital thought it was a swell idea to place a lien on my family’s home. A bill that was never delivered, yet the hospital wanted to be rewarded for their bill not being delivered. Needless to say, the bill was paid, but why did this incident occur? Turns out incidents like these would resurface when I was an adult. Medical bills would often have the wrong address, as reported by the collection agency, or we simply didn’t receive a paper bill. It’s almost as if these healthcare providers don’t want to be paid. The service is exorbitantly expensive, and then when they need to be paid it is nigh impossible to track down a method to pay the bill for the service. And sometimes, a lien will be placed on your property. Only then will know that you actually have a medical bill that needs paying.
Cracking the Code
Unfortunately, patients aren’t armed with certain information, such as what medical care will cost prior to the procedure. The cost of supplies and services rendered can be estimated by their physician, but the patient is unaware what is billed, how many bills to expect, and from whom to expect a bill. Often the patient’s information is transferred from multiple parties, which starts with the information from the patient. Then the patient’s information, including the aforementioned billing address, is provided to the healthcare provider. The information is then provided to the Payer, or in most cases the Health Insurance Company. If you’ve ever played the password game growing up, where you whisper in someone’s ear a password and they in-turn whisper that password down through a line of people, you’ll remember that the information often barely resembles the originator’s password. If one of those parties incorrectly fat-fingers a typo on your street address number or ZIP code, you could be rewarded with a shiny new lien on your property the next time you try to refinance or sell your home. Typos are unfortunately not the only obstacle healthcare consumers are wrestling with however.
Othercommon medical billing errors include:
- Coding Errors
- Charges for Canceled or Refused Services
- Date and Length of Stay Errors
- Code Unbundling
- Duplicate Charges
Medical Coding is a unique skill, utilized to communicate services provided to patients. Unfortunately, mistakes in coding a service can lead to costly overcharging. For example, let’s say you had a 30-minute well-visit that was coded as a 45-minute visit, that would be an example of “upcoding”. Upcoding is the practice of unknowingly or maliciously overcharging a patient’s care by using the medical code for a more expensive service. Medical Codes are used for the types of service provided, as well as the length of the service. Let’s say you are a patient in the Emergency Room and released the same day, but the medical code used to bill you reflects you were admitted to the hospital for two-days, this would be an example of a Length of Stay error. Unfortunately the health insurance provider isn’t privy to the care you received, as they weren’t present for your procedures. This means that if certain care was coded incorrectly and you haven’t met your deductible, you are the only one able to protect yourself from coding mistakes.
One way to protect yourself against these coding errors and potential “upcoding” issues, is to ask for an itemized billing statement from your provider, rather than a summarized statement. This will list the services and resources used for your treatment, along with the revenue codes tied to the facility. There are over 150,000+ medical billing codes, something Raymond Babbitt (Rain Man) would have a tough time memorizing. Luckily, the Centers for Medicare and Medicaid services does have a Physician Fee Schedule tool you can utilize to research the fees on your itemized bill. To protect yourself from data entry issues, such as an incorrect address, it is a good idea to contact your health insurance provider and the healthcare provider performing the service to validate that your personal information is correct. But honestly, that’s a lot to put on a patient, who often may not even know all the parties involved in their care.
Advances in medical science have doubled our life expectancy in the United States since the 19th century. Don’t let upcoded medical bills, or incorrectly recorded personal information lead you to calling for Elizabeth (Sanford and Son). What you can do: Ask your doctor about the potential cost for the services provided, verify your personal information with the facility and your insurer, and retrieve an itemized bill rather than a summarized one to double-check that the medical coding used on your bill matches the service you received. Check the length of stay and the date(s) you received care. Otherwise, you may find a nasty lien on your property for services unpaid. Medical Billing will hopefully improve accuracy in the future, but until then know how to protect yourself. Most of all, please stay healthy!