Auditing myself
May 29, 2016 4:30 PM   Subscribe

How do I review, audit, question, and negotiate this stack of medical bills? Employer-based insurance that is a PPO. It's decent. But the hospital's billing department, not so much... Lots and lots of individual bills. Most valid, but some may not be.

TLDR - hospital did not itemize any bills and has billed each service individually. Don't know what's a valid bill. Also, the one itemized bill has some mistakes on it but has already been paid by insurance with our balance currently owed.

Pregnancy and birth, with more visits than a typical pregnancy. We have 80% coinsurance and family and individual deductibles.

The hospital is a mid-sized community hospital with a reputation for being collection-happy. I do like this hospital and my affiliated doctors.

After prenatal visits and services, the hospital would first send “account statements” that only listed the date of service, and the amount they planned to submit for insurance payment. Each statement has my name on it but a different account number and no description of the service provided. We have a LOT of these statements. About a month after each statement arrived, a bill that (supposedly) corresponded to the statement would arrive with the amount we were responsible for after the insurance payment. Again, no description of the service provided.

Our insurance sat on our explanations of benefits (EOBs) until after the delivery. We received an inch-thick stack of EOBs comprising all pregnancy-related payments this year. Trying to reconcile these EOBs with individual hospital statements and bills is like doing taxes blindfolded.

A nurse leader at the hospital conducted an in-person survey before I was discharged. After expressing how delighted we were with the care provided, we mentioned that itemized bills would be helpful. I believe that's why I got an itemized bill for the hospital stay and surgical delivery with our balance due after insurance pay out. The problem: even with my limited experience, I can see some incorrect descriptions and/or services in this first itemized bill. And the total was astonishing. The balance we owe for the hospital stay is a few thousand.

I have no way of getting a complete total of all the other bills because the billing department can only look up individual account numbers; they cannot look me up by name, apparently. I was re-hospitalized for a few days after the delivery and I haven’t even begun to get those statements and bills yet.

What I really need is a way to see a) what they say we owe in total, and b) a way to question certain services and or balances due and c) a way to negotiate the balances for those correctly billed. Again, I really do like my doctors and the hospital, but right now, I could pay a lump $2k and then end up paying individual $250 bills forever and never know when we are close to being paid off.

Should I request an in-person meeting with the billing department? Should I get a lawyer’s help? Suggestions please.
posted by heigh-hothederryo to Work & Money (2 answers total) 3 users marked this as a favorite
Ugh, hospital billing is the worst. Other people will probably chime in with more knowledgeable answers, but what has worked for us in the past (also with post-pregnancy bills from six different sources, some for services that I specifically declined) was:
1. Gather up all our bills; for easy reference, make a spreadsheet with each bill, the source, the account number, and a brief description of what it was for.
2. Call the hospital or show up to the billing department in person. (In my experience, there was no difference in service either way, so I'd do whatever is more convenient.) Explain any issues with the bill; if there really are mistakes, they should be able to remove those items even though insurance has already paid. (However, in my experience, they will not agree that any of these items are mistakes and there is no way for you to prove it.) Confirm that the total amount is what you expect. Also, ask if it's possible for your bill to be reduced. Sometimes they'll give you a discount for paying upfront in a lump sum, as I think you noted in your question.
3. Follow up with a letter documenting whatever you negotiated, and include a statement saying, "As you confirmed on our phone call of 5/29/16, the total amount for our hospital stay on 4/1-4/10 was $5,000, and we will not be receiving any further bills."

I had to go through this process twice because the hospital bills and the individual physician bills could not be negotiated together (apparently some of the doctors are contractors who are not employees of the hospital). I also wrote cover letters with a similar statement to #5 above, saying that this was payment in full of all services received on those dates.

I wouldn't involve a lawyer unless you try going through the above steps yourself and are not satisfied with the results. You'll have to pay the lawyer and if you're talking about a total bill of a few thousand in the first place, it's probably not going to be worth it for you.

Since you mentioned you had a second stay and haven't received your bills for that yet, I would probably call the hospital and ask for an extension on your first set of bills to avoid any collection activity. Then you can deal with everything together.
posted by chickenmagazine at 6:14 PM on May 29, 2016 [1 favorite]

Many insurance carriers have all your EOBs available on your member portal, and I've definitely seen some of mine on my Anthem portal well before they've shown up in the mail. So check there, if you haven't already. For things that aren't there, unfortunately you just have to wait for the bills and EOBs to roll in.

After that, organize your bills and your thoughts (the spreadsheet described above isn't a bad idea, make sure to include notes about the questions you have about each one), have your Summary of Benefits and Coverage handy, and talk to the hospital billing department. It's totally their job to help you understand your bills from them, and to tell you what the next steps are if you have any disputes.

A friend of mine is currently going through this process regarding bills and EOBs related to a surgery, a hospital stay, and prescribed PT. It's taken a few phone calls, and he's had to speak to the hospital's billing department as well as another facility's, but he was successfully able to discover what he'd been billed for and why, and to dispute some of it being considered out-of-network (because you don't exactly get to choose who the hospital assigns to assist your surgery when you're out cold, and it's not unreasonable to expect that they'd assign someone who's in-network just like the hospital is!).

I know this is big PITA and I wish you luck.
posted by rhiannonstone at 9:18 PM on May 29, 2016 [1 favorite]

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