Copyright Universal Solutions 2008 2009
What you can do
Once you've paid an out-of-pocket medical bill with a loan or credit card, you lose your ability to
negotiate the repayment amount and terms. Here's what you need to know:
• Hospitals are required by federal law to provide care in a medical emergency. Always ask for
an itemized bill and check it for accuracy, because billing errors are common, as high as 90 percent
in some cases.
• If you can pay at the time of service, providers may be willing to cut your bill by more than 50
percent to avoid the expense of billing. When negotiating discounts or any payment terms, ask to
speak to the manager of patient accounts. Get any agreements in writing.
• When you're dealing with a hospital, request a copy of its financial assistance guidelines to see
whether you qualify for free or discounted care. Although non-profit facilities are supposed to
volunteer such help, consumer advocates report they often don't inform patients about these options
unless they're asked.
• Providers generally structure plans to be paid off in no more than 24 months. Negotiate a
longer term if necessary to ensure that you will be able to afford the monthly payment because your
account can be sent to a collection agency if you are paying less than the agreed-upon amount.
Any interest charged is likely to be at a lower rate than a commercial lender's.
• If you are under a financial hardship or on a fixed income, always request a financial hardship
request form. Almost all providers have them but very few will offer them. Once the form is
completed, it goes to administrative review and if approved can reduce your bill up to 70% and allow
for minimal monthly payments. We have worked with some patients we were able to secure as low
as $5.00 a month payments. NOTE: It is vital you fill out this form correctly or you will be denied for
this program. Contact one of our patient advocates to assist you.
• If relying on credit is your only option, shop for the best general-purpose credit card deal rather
than a health-care credit card or loan marketed through your doctor or hospital. Zero-interest offers
through companies such as Care Credit are a good deal only if you're absolutely sure that you will
be able to pay the balance in full during the interest-free period. If you can't be sure you'll be able to
pay on time, Curtis Arnold, founder of CardRatings.com, suggests putting medical charges on one
of your existing credit cards and then transferring that balance. Among the best deals recently
available: Blue or Blue Cash from American Express, which both offer a 4.99 percent rate for the life
of the balance with a 3 percent transfer fee, and Pentagon Federal Credit Union's 2.99 percent rate
for the life of the balance with a 1 percent transfer fee.
Any itemized charge that is not substantiated by documentation in the patient's medical
records is likely to be an error and must be treated as an error unless the doctor or
hospital can demonstrate otherwise. When you receive a medical bill, be on the
lookout for:
• 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. Were you
charged for the discharge day? Most hospitals will charge for admission day, but not for day of
discharge.
• Operating room time: It's not uncommon for hospitals to bill for more OR time than you
actually used. Compare the charge with your anesthesiologist's records.
• Up coding: This common billing mistake occurs when a doctor switches a high cost
medication or expensive service for a cheaper alternative then charging for the more
expensive item or, in some cases, charging for both!
Example: The doctor replaces a top dollar brand name medication for a generic
alternative but stills charges the more expensive brand. This also happens many times
in service based visits where a doctor may have seen you for a total of 10 minutes but
charges the code relative to a 20 minute visit.
• Keystroke error: An everyday mistake in which someone just happens to hit the wrong
keyboard key. An innocent enough mistake but one that can cost you a significant amount of
money.
• 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.
Example: You fracture 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.
• 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).
• 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 the check going to you. You
can find out if the medical provider accepts assignment by asking your insurance company.
When a hospital or doctor accepts assignment, you are assigning the hospital or doctor your
right to the reimbursement check from your insurance company. When accepting assignment,
it is now the hospitals or doctors responsibility to collect from your insurance company and
thus accepts the contracted discounted reimbursement rate. This means if the medical
provider bills your insurance company for $4,132 and you were only entitled to be reimbursed
$1,638, the medical provider must accept this amount and you are not responsible for the
remainder of the bill. This difference is called the contractual adjustment or write off and many
times is mistakenly billed to the patient in error.
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.
• Charges for medications and supplies that a physician did not order or that the patient did not
receive.
• Charges for tests and services that a physician did not order or that were not performed or
provided.
• Charges for certain services that were performed by nurses or technicians, such as equipment
monitoring, that should be included in the room charge.
• Charges for equipment monitoring services on occasions when the equipment in question was not
in use.
• Charges for items dated before the patient was admitted to the hospital or after the patient was
discharged from the hospital.
• Charges for tests and services that had to be performed a second time because they were
performed incorrectly the first time or the results were lost or mislaid because of some other hospital
mistake.
• Charges for improperly identified or unidentified items.
• Charges for personal items, such as a toothbrush, a comb or slippers, that the patient did not use.
• Charges for services that the patient refused.
• Charges for routine supplies used by hospital staff, such as surgical gloves, coats, drapes and
masks.
• Charges for routine equipment such as blood pressure cuffs, heating pads, and thermometers.
• Room charges that were incorrectly calculated, such as if the patient had a semi-private room but
was charged for a private room; the patient requested a semi-private room but was placed in--and
charged for--a private room because no semi-private room was available; the patient was charged for
a greater number of days in a specialized unit like intensive care or cardiac care than he or she
actually spent there; or the patient was charged for a room on the day he or she was discharged from
the hospital.
• Charges that are not allowed by the Health Care Financing Administration or by an appropriate
state agency.
• Charges for services that are completely inappropriate, such as a woman being charged for a
circumcision or a man being charged for a hysterectomy.
FOR MORE INFORMATIVE HELP VISIT OUR WEB SITE AT:
www.usbyscm.com
Or call us toll free at 800-391-2140 Ext: 228
Universal Solutions
Leveling the Healthcare Playing Field for Patients