I have invested two years demystifying my hospital invoice. During that period, I found that I was being gouged in an excess of 800% profit. Here’s how I found the system to determine reasonable expenses, as set by the industry’s requirements. My wish is that these details will be necessary to others who are directing the present hospital payments program.
- Requested an itemized bill – I obtained a list of shorthand explanations of services that I couldn’t comprehend.
- Determined Financial Responsibility of Hospital – Red Cross guaranteed me that they already gave out their highest possible compensation amount to the hospital for the services I obtained, and would not be spending any more. They recommended that I get in touch with the hospital to see if they would reduced my expenses, since the hospital decides their own expenses.
3) Found a patient advocate – I went online to discover individuals who have gone through this before and found a number of Patient Advocacy groups. They were very patient and extremely experienced.
4) Reviewed bill for correct coding – I sent my itemized invoice to my patient advocate for review. A billing code is allocated to each product being charged. I found that up to 90% of all hospital expenses are written wrongly. My patient advocate informed me that there is expected to be visibility in the payments program and that there are specified coding recommendations that apply to each hospital. However, this hospital provides its own coding program making it difficult to determine exactly what is being charged. Despite this, my patient advocate was able to determine three wrong requirements in my invoice, leading to over $300 of invalid expenses. They submitted me the appropriate vocabulary from the latest coding guide. I went back to the billing department at the hospital and had them change my invoice.
5) Requested all records particularly the UB-04 form from the hospital – It is the patient’s right, under the HIPAA to get a duplicate of all medical and billing records from the hospital. The UB-04 form is used to determine the price of services. The parts of the HIPAA regulation that the state official referred to were two government 45 CFR codes: The Designated Record set was under rule 164.501 and the Right of Access was 164.524 (a)(1).
6) Was sent to Collections – I kept in close contact with the billing department, who insured me that I was in good standing with them. Each month, when I obtained a new invoice, I called them and assured them that I wanted to settle the balance, and that I was analyzing expenses that were in query. But when I went out of town, and didn’t get my email for a week, I was sent to Collections. This was also during the time that I was being informed that they were “looking into sending out” my UB-04 form.
7) Kept collections department from pursuing further payment – Persistent effort through close communication and rejection to pay any overcharges for my services kept them at bay. I assured them that I would keep them posted to each and every new bit of details that I obtained – and kept them in the cycle every step of the way.
8) Determined the cost of the services – With the requirements on the UB-04 form, my patient advocate trained me how to determine the price of services. To make the long story short, I figured out the correct payment for the services.
9) Calculated fair and reasonable charges: There is a market standard for identifying fair and affordable expenses. It guarantees that the hospital get a profit on their price.
10) Offered a settlement: Between what my insurance organization and I had paid, the hospital had already obtained $905 at this point, already getting a 125% profit as driven by market requirements. I went back to the hospital and was adamant that I settle with them, not the collections organization. They complied. I chose to provide an extra 100% profit, providing them a 225% benefit on price of services, to make sure that the hospital does well. They declined it. Instead, they offered me a program for financial assistance.
The silver lining is that I somehow qualified for an 80% lower price on my invoice. They granted me with a settlement of $348. I took it. This does not get them off the hook for their tremendous over expenses, but it does allow me to settle with them what I regarded to be affordable and fair.