Insurance Dispute Services – Provided by HealthCareAdvocates.com. If you’ve ever been denied medical coverage or a medical payment, access to a specialist or you’ve been turned down for a medical procedure by your health insurance, you need Healthcare Advocates Insurance Disputes Services. Our team of professionals will work on your behalf to help you get the care you require. And if you’re covered by a PPO, traditional indemnity plan, Medicare or MediGap, we’ll also be there for you to handle problems of non-payment, being dropped from your health plan, outstanding charges, bills that were incorrectly sent to you, and charges that should never have been made. As Seen On: Peter Jennings, CNN, Wall Street Journal, NY Times, Forbes.
If your insurance company is refusing medical treatment that you believe is necessary to save your life or can evoke emotion interest, try calling TV news and radio stations in your area. Many TV stations have programs that help people with problems which they portray on the news. The insurance may not want to be featured as denying you needed treatment.
Health Plan Navigators – CMS.gov
Companies that review medical bills and hospital bills for overcharging errors usually work on a contingency basis, meaning they get paid a percentage of the amount they save you. That percentage can be as high as 50%, so make sure you understand their charges before you have them review your medical bills or hospital bills. Also, read our tips below.
Alliance of Claims Assistance Professionals – a national, not-for-profit organization providing assistance with health insurance claims issues to patients and caregivers throughout the U.S.
Medical Billing Advocates of America – Today’s complex medical billing and hospital billing system allows fraud and abuse to go undetected. Studies have shown that as many as 9 out of 10 medical bills and hospital bills contain errors (of course, always overcharging you). Hospital bill errors and doctor bill errors are compounded by the fact that insurance companies are not reimbursing correctly–they just pay the incorrect medical bills unquestioningly, but deny legitimate charges. MBAA can help consumers do something about it. As Seen On: CNN
National Health Care Anti-Fraud Association – Founded in 1985 by several private health insurers and federal/state law enforcement officials, the National Health Care Anti-Fraud Association (NHCAA) is a unique, issue-based organization comprising private and public-sector organizations and individuals responsible for the detection, investigation, prosecution and prevention of health care fraud.
Checking Your Hospital Bills – An article at ConsumerReports.org
Medical Billing Analysts performs medical bill review and audit services to determine total amounts billed, total amounts paid, and reasonable value of care by looking at the Usual, Customary, and Reasonable (UCR) rates for all medical expenses charged by the hospital or medical provider. For proving damages in personal injury cases, Medical Billing Analysts will provide a comprehensive report and is available for trial testimony to justify all medical services billed. Services are billed at $200 per hour for evaluations. Time involved can range from 2 hours to review a hospital bill and more depending upon complexity and number of bills.
How to Read Your Medical Bill – Understanding CPT codes can help you avoid inaccurate charges AARP
Coding – Everything about physician billing and coding.
What should your medical treatment cost? Healthcare Blue Book is a free consumer guide to help you determine fair prices in your area for healthcare services including surgery, hospital stays, doctor visits, medical tests and much more.
Request both the hospital and your insurance company to audit the hospital and doctor bills.
Demand an itemized bill (you must be given an itemized bill if you request one) and review for the following:
Duplicate billing: Make sure you haven’t been charged twice for the same service, supplies or medications.
Number of days in hospital: Check the dates of your admission and discharge. Most hospitals will charge for your admission day, but not for your day of discharge. If you were charged for the day of discharge, ask the hospital to waive the charge for that day. If the hospital charges you for your room/bed on the day of your discharge and charges someone else for the same room/bed on the day of their admission, the hospital will be paid twice for the same day.
Incorrect room charges: If you were in a semi-private room, make sure you’re not being charged for a private room.
Operating Room: It’s not uncommon for hospitals to bill for more operating room time than you actually used. Compare the charge with your anesthesiologist’s records.
Unbundled Charges: This is when a group of tests are billed individually, when they should have been billed together. Surgical procedures and tests frequently consist of several parts. For instance, you could have received a cervical MRI and a lumbar MRI. A hospital or MRI facility can bill $1,200 for each MRI if they were done at different times, however, if they were performed on the same day the total amount that the facility will be paid by an insurance company may be only $1,400 or $1,800 instead of $2,400. Many times, MRI’s will be scheduled on different days, frequently one day after the other, in order to bill at the higher rate. Do not allow a hospital or MRI facility to charge you the full price if they did this. An example of a procedure could be where you fractured two fingers and you were charged the full price to set each finger individually, instead of the full price to set one finger and a discounted price for the second finger.
Up Selling: This occurs when a doctor orders a generic drug which is readily available, but the hospital provides you with a more costly brand name drug without your knowledge or consent and bills you for the more costly medication. Since you are not an expert at determining whether or not a drug use generic and you may not have even been in a mental condition to make that determination; your doctor ordered the generic drug; and it was readily available in the hospital drug store, you are not responsible for the increased charge.
Fraudulent Coding often called Up Coding: Hospitals may change the charge for a lower cost service or medication to one that’s more costly. For instance, a doctor may order a generic drug, but the hospital “accidentally” bills the patient for a much more expensive brand name drug when the generic is actually provided. If done intentionally, this is fraud. Where this occurs several times on one bill or occurs with multiple patients, this could constitute intent.
Fraudulent Coding/Weird Charges/Fake Language: Hospitals may invent confusing language to cheat patients. They use medical sounding names for everyday items and charge you an astronomical price. For example, an “oral administration fee” is really a charge for the nurse handing you pills. You do not have to pay for that because it is part of the room and board. Other items that have appeared on hospital bills are: “disposable mucous recovery systems” (a box of Kleenex tissues); “Thermal therapy” (a plastic bag filled with ice); “Gauze collection bag” (a trash bag); and finally, one patient who was given a teddy bear by the hospital and charged for a “cough support device.” Not only is this fraud, but the teddy bear was a gift.
Keystroke error: A computer operator accidentally hits the wrong key on a keyboard which can result in an incorrect charge or a charge for a service you didn’t get.
Canceled work: You may have been charged for expensive services or tests which your physician ordered and then canceled or for some reason was never rendered.
Assignment: Check to see if the hospital or doctor accepts assignment of your insurance payment. This means that the hospital or doctor is allowed to bill your medical insurance and to receive payment directly by your insurance company, without a check going to you. This is a good thing. You can find out if the medical provider accepts assignment by asking your insurance company. When a hospital or doctor accepts an assignment, you are assigning to the hospital or doctor, your right to the reimbursement check from your insurance company. By accepting assignment, the medical provider is now in your position and has whatever legal rights you had to collect the payment, and no more. When accepting assignment, a hospital or doctor may not legally seek any payment from you. This means that if the medical provider bills your insurance company for $3,682 and you were only entitled to be reimbursed $1,136, the medical provider must accept this amount and you are not responsible for the remainder of the bill.
Why do hospitals and doctors accept assignment? Because when the check goes to the patient, many patients keep the money which requires the hospital or doctor to sue the patient. Accepting assignment allows the medical provider to know that they will be paid and to avoid the costs of litigation if the medical provider must sue the patient to recover payment for services rendered.