If you require a trip to the hospital, your health should be your primary concern. However, all too often, a recovering patient later receives an excessive or surprise bill for the visit, which causes additional stress and worry.
Excessive or surprise hospital bills can arise whether you are self-pay or have insurance. In many instances, this can be the result of clerical errors, fraudulent practices, or procedures that were either not authorized or performed by providers who were not within your insurance company’s network. If such a scenario arises for you, it is important that you know how to protect yourself and your finances.
Review Your Hospital Bill
Whether you have insurance or pay out of pocket, the first thing you should do when you receive your hospital bill is review it thoroughly. This means that you should go through each line item to ensure you had the services for which you are being billed. Sometimes, a simple error in coding can result in your being billed for the wrong procedure.
Every item for which you are billed must correspond with the procedures that are documented in your medical records. If you are questioning any items that appear in your bill, you should request a copy of your hospital records to ensure that you are being billed appropriately.
Emergency Room Bills
Even if you visit a hospital within the network approved by your insurance policy, it is important to understand that not every doctor, nurse practitioner, physician’s assistant, or specialist who you see at the hospital is within that network. As most emergency rooms are staffed by outside sources, you may end up receiving separate bills from various providers, in addition to a bill from the hospital.
Emergency room bills can add up to thousands of dollars, simply because you did not have a choice in which doctors, NPs, and PAs treated you. If you have received an excessive emergency room bill because you were treated by providers outside of your network whom you would not have otherwise authorized, it is crucial to investigate your options to reduce those bills. Many states have enacted Surprise Medical Bill laws that protect you from these exact situations. Be sure to see if your state provides such protection and if not, be sure to try to negotiate a reduction in the fees.
Prepare in Advance
Often, a hospital or emergency room visit stems from a critical health condition, and you may not be able to plan in advance. However, if you have control over the situation, it is important to ask questions prior to the visit to protect yourself from unexpected bills.
If possible, inquire in advance who will be treating you at the hospital, and only authorize treatment by the providers who are contracted with your insurer. It is also important to be aware that if your insurance company works with other networks, the doctors in those networks may have negotiated higher reimbursement than what the doctor directly contracted with your insurer would have received. This can be especially problematic for patients with higher deductibles.
Although you may not always be able to prepare for an emergency room visit, a good example of a situation in which you can plan in advance is for a baby delivery. Even if the hospital where you plan to deliver is within your insurance company’s network, the anesthesiologists and pediatricians who provide services may not be. When you register for delivery with the hospital, make sure to only authorize medical care by doctors who are contracted with your insurer.
In addition, if your medical condition is not a life-threatening emergency, you may consider first visiting an urgent care facility within your network, rather than heading directly to the emergency room. If the doctor there determines that your condition requires a trip to the emergency room and cannot be treated at the urgent care facility, this may be helpful to later negotiate reductions in bills incurred due to the emergency room visit.
How an Experienced Medical Bill Advocate Can Help
If you have received an unfair, excessive, or surprise bill for a hospital stay, or emergency room visit, an experienced medical bill advocate can help negotiate a reduction and save you thousands of dollars. Systemedic is a nationally-recognized medical billing advocacy company with decades of experience in helping victims of fraudulent and unethical medical billing practices. If you are experiencing a medical bill dispute, contact Systemedic today at (845) 639-0007.