Itemization

January 6, 2006 10:49 AM

Am I entitled to an itemized bill? Do I have any recourse if someone billing me won't provide it?

These are medical bills, naturally. Itemization is important to me because I have to compare it with my explanation of benefits from my insurance to see how much I owe. I'm not going to take the health care provider's word for it, because frequently they try to overbill. But I notice increasingly I don't get itemized bills from hospitals/drs, etc. I can't see how they arrive at the amount I'm billed, and it's nearly impossible for me to reconcile it with my explanation of benefits.

I spoke with one hospital and they sent me a printout from whatever accounting system they used, and it was completely unintelligible, and nothing close to a bill. I've recently received one for physical therapy that covers weeks at a time, and simply says "pay this amount," no mention of what the insurance paid, etc.

Basically I need to know what the original charge was, what my insurance co. paid, what was excluded (because some always is, and often they try to hit you up for it). Do I have any legal right to this info from the hospital?

posted by FortyT-wo to work & money (9 comments total)

Any question about your "legal rights" must necessarily say at least what country you live in, and if in the U.S. you'll want to also mention your state and possibly even city, if you live in a city that might be prone to legislate about such things. (NYC and SF come to mind.)
posted by mikewas at 11:14 AM on January 6, 2006

So sorry, US. St. Louis MO. Obviously I'll never actually be suing anyone, but when I pursue the itemized bill, I would like to know whether it's something they have to provide if i ask for it. Sort of a "know your rights" thing.
posted by FortyT-wo at 11:18 AM on January 6, 2006

You haven't provided your jurisdiction, but the answer is "probably". New York's Patients' Bill of Rights says:

"(16) Receive an itemized bill and explanation of all charges."

Google for your jurisdiction and patients bill of rights. I believe many hospitals may have a sort of patient ombudsman whose job is to explain such things to patients, ask if there is one in this case.

Remember the standard rule: You can always not pay.
posted by jellicle at 11:21 AM on January 6, 2006

Basically some types of industies are required by law to provide itemized charges, at least on request. Regulated industries such as banking, utilities, and landlords come to mind. I don't know about medical expenses - as mikewas says - it may depend on our state or local laws. But - essentially common law principles would give you the right to know exactly what you are being charged for and how much, even if there is not a specific law covering it.
That's from a *legal* standpoint. From a more practical standpoint in your situation, the hospital bills are probably full of codes that only make sense to the insurance companies. Hospitals and doctors are notorious for just sending the bills to the patient - I suppose in hopes some patients may just pay it, since it takes them longer to get money from the insurance companies and usually the insurers will also put up more of a fight. And of course the insurance company wouldn't mind you paying more than your share, either. My advice is to pay absolutely nothing to them - wait until your insurance company sends you a clear-cut bill. Don't be surprised if this takes a year or even a year and a half - seriously.
posted by sixdifferentways at 11:28 AM on January 6, 2006

Don't pay it until it is itemized the way you want. If they turn you over to a collection agency or your insurance start harrasing you, the bill will HAVE to be itemized to be worth anything in court.
posted by nickerbocker at 12:20 PM on January 6, 2006

You could also contact your insurance company and ask for a copy of what they were billed. They many have received more details than you get.
posted by blue_beetle at 12:22 PM on January 6, 2006

Perhaps:

State Survey Agency
Missouri Patient Care Review Foundation
3425 Constitution Court, Suite E
Jefferson City, MO 65109
573-893-7900
posted by WCityMike at 12:24 PM on January 6, 2006

In many places as mentioned above, hospitals are required to provide an itemized bill on request, especially if the patient is disputing the bill. That said, if you do not know some medical jargon you may not recognize some of the charges; for example in some hospitals a $30 "mucus recovery system" is that box of tissues the nurse so helpfully offered you for your sniffles. And the bill generally does not include payment information from the insurance company so you have to pursue that information carefully.

Having said that, it can be worthwhile to look closely at your bill. The system that generates the bills in US hospitals is incredibly complex and error-prone; two articles about it are here and here.
posted by TedW at 12:33 PM on January 6, 2006

(1) You might look at SimoHealth - it's free, downloadable software that helps track medical bills.

(2) According this site (by a company that does medical bill auditing), and has a lot of info (more relevant to self-payers, though):

Hospital billing disputes involving individuals are covered by the dispute settlement procedures provided under the federal Fair Credit Billing Act (FCBA), which is enforced by the Federal Trade Commission (FTC).

(3) I would NOT do what sixdifferentways said (My advice is to pay absolutely nothing to them - wait until your insurance company sends you a clear-cut bill.) First, of course, the billings are from the medical providers, and the insurance company has no interest whatsoever in collecting money for those providers, from you. Second, failure to pay bills can ruin your credit, not to mention getting collection agencies to pursue you.

I do think you should ask your insurance company to help, and if they aren't responsive, complain to the source of your insurance (your employer?).
posted by WestCoaster at 2:56 PM on January 6, 2006