Understanding Medical Bills (Not As Easy As It Sounds)

When somebody gets a medical bill, it can be extremely confusing. Hospital bills are the worst because they often have a lot of line items. On top of that, medical bills tend to have a lot of codes and unfamiliar terms. Both doctors and patients have a responsibility to reduce confusion surrounding medical billing and also keep healthcare costs down by making sure bills are accurate and reflect only the care needed and received.

For the patient, it is important to check the initial itemized bill for errors. Mistakes happen – people have even been sent somebody else’s bill. If the hospital doesn’t send you an itemized bill, ask for one. Then check the bill for services you ended up not using, duplicate charges, and cases where the charges and total don’t match. If you are confused, call the hospital and get it all explained to you. Accidental overcharges happen, and they can be substantial (In some cases, intentional overcharges happen).

If your bill still seems very high, don’t be afraid to negotiate – if in doubt, call a patient advocate. Always check the initial bill, not the partial bill after health insurance has paid some of the costs. If you have insurance, your insurer will do their best to negotiate the bill down for you. They don’t want to be overcharged either. The itemized bill might not resemble what you end up paying, but it should still be checked.

Of course, avoiding the high bills in the first place helps. Nobody wants a surprise medical bill. First of all, always ask the doctor or hospital for a cost projection, especially for major costs like surgery or childbirth. This can then be compared to the final bill, but will also give you some chance to prepare. Also, make sure the doctor is in your insurer’s network. One thing which can happen is that a hospital is in-network…but one of the doctors you see isn’t. Specialists such as anesthesiologists and radiologists may be out of network and, oddly, neonatal units are sometimes not in the same network as the hospitals. You should request an in-network provider or work out some kind of deal in advance. Also, if your insurer pays all costs of preventive care, then make sure you know what’s considered preventive.

From the doctor’s or hospital’s perspective – it’s important not to be that guy. Use a good medical billing system that flags duplicate charges so they don’t go to the patient. Today’s social media environment means that incorrect bills can “go viral” and be seen by a lot of people – including current and future patients. Partnering with a medical billing company can help a lot, reducing your costs and helping avoid mistakes. Those reduced costs can then be passed on to your patients.

As for reducing costs – it’s a doctor’s responsibility to help keep soaring healthcare costs down. Obviously, you need to receive the money you need to keep your practice in business, but you can also help. Encourage your patients to get the preventive care they need, which is cheaper in the long run. Work on standardizing best practices within your office and with the specialists you refer to. And, of course, reduce medical billing costs and inaccuracies. Make sure, for example, that preventive care is coded appropriately so insurers don’t mistake it for treatment or monitoring of an existing condition.

Doctors can and should do something to keep costs down for their patients – both to remain competitive and because it is the right thing to do.