Big Hospital Bill? Negotiate!

Brett Goldstein is used to dealing with big numbers. After all, he runs a pension service company. But nothing quite prepared him for the shock of the medical bills he received after his daughter broke her leg and spent less than 24 hours in the ER. The total tab? Around $30,000.

Although Goldstein had health insurance, his daughter had broken her leg in a fall on someone else’s property, and their insurance would pay the bills. All he had to do was forward them to the property owner’s insurance company. That twist, though, led Goldstein deep into the complicated world of medical billing. If he hadn’t forwarded them, “the bills would have gone straight to my health insurance company,” says Goldstein and he probably wouldn’t have discovered that the hospital had made billing errors. Even though the charges would be covered by insurance and thus wouldn’t come out of his pocket, he dug in, questioning every item.

“I was double billed. I was billed for things (my daughter) didn’t receive,” he says. “Some of these charges were ridiculous.” Twenty minutes in the operating room, for example, resulted in a $7,400 charge. “I have an $800 anesthesia bill from the hospital but they don’t provide anesthesia,” he says, noting that he also received a separate $1,800 bill from the third-party anesthesiologist who did provide that service.

Goldstein, who has also written a book about retirement, developed a list of steps patients can use to challenge and negotiate medical bills.

Among the most important: Request your medical records. (You may have to pay a small fee for copies.) The medical records include information like doctor and nurse’s notes, the medications you were given, and notes about your care. Then request forms UB-04 (typically used for hospital, rehab or surgery center or clinic bills) and/or CMS 1500 (typically used for doctor’s bills).

Goldstein explains that the UB-04 is what the hospital uses to bill the insurance company. It lists what department generated revenue from the patient. He warns that it may not be easy to get these forms. “The hospital doesn’t necessarily want you to see this because if you matched up the codes with the medical records, you’ll be able to find mistakes,” he says. He provides a sample letter to send to the hospital demanding the forms.

In the report he offers consumers on his website, MedicalDebtReview.com, he explains:

On the CMS-1500 there are two sets of codes you’ll be looking at. The first code is the CPT code which is used by insurance companies to determine the amount of money they will pay a doctor or hospital. The other code is an ICD-9 code, which tells you what type of injury or illness you had.

“If the codes don’t match with your medical records, you have found a mistake,” he further explains. His daughter’s bill listed code 72170-26—the CPT code for an X-Ray of the pelvis. But her records listed ICD-9 code 821.01, indicating that they fixed a fracture of the femur.

With medical records and billing codes in hand, you can challenge mistakes. A simple web search can help you find out what various codes mean.

After you’ve disputed errors on the bill, the next step is to find out what the services you did receive actually cost. Goldstein says the UB-04 will list a code that states what Medicare would pay for that service. You can use that information to negotiate more reasonable charges for the services you received.

Goldstein recognizes that not everyone has insurance that will cover large doctor or hospital bills. He encourages them to make sure their bills are accurate before they start negotiating payments or discounts. “Everyone says to negotiate medical bills,” say Goldstein. “But I’d rather get the bill down in the first place (by challenging mistakes) and then negotiate.”

Image: Tony Crider, via Flickr.com