Does anyone have experience with hospital billing practices?

[smokey the elder]

It's amazing that people cannot get this information easily. If I didn't get an itemized estimate for a car repair, I'd be p!ssed. I think this may be one of the reasons health care is so egregiously expensive!

[Medusa]

I think this may be one of the reasons health care is so egregiously expensive!

You could be right. I wasn't even able to get an itemized estimate for some work done here in my home! The reason the man gave me: "I'm not the kind of guy who itemizes". I told him "Well, I'm not the kind of woman who pays for something if I don't know what I'll be getting". Of course, I'm still getting estimates from the kind of guys who do itemize. LOL

PG, I wish you luck w/getting an estimate. If you can't, take pomtzu's advice and go over your bill w/a fine tooth comb afterwards. On the bill for the first bone graft I had done on my jaw, they overcharged me by nearly $1300. Since I had to pay cash for that surgery, that money made a big difference to me.

[RICHARD]

Let me explain?

And here is the the secret on how a hospital makes money.


Each procedure/operation is coded by the ICD-10 tables.

Each hospital 'makes up' a list as to what is done - the equipment, materials and staff used.

This is an 'average list'. So....if you go in for a tonsillectomy, they base billing on what an average patient needs to be treated and care for.

They submit that bill to the insurance or government and they pay based on whatever is on that bill. You probably will not get any idea of exactly what it costs because the procedure hasn't been done yet.

You will only see an itemized bill AFTER you get out. They often submit that standard "billing list" and do not go thru it and take off the charges that you do not incur or services you use.

1. you can call the billing/insurance offices. If they do not give you the info..


2. Get your itemized bill and get copies of your medical records. You will find you meds in the medication records. And your materials on the nurse's notes.
Doctor's orders will list what the doc asks for you for your treatment.

You can ask to review your records in person, or you can have copies made.

It's been a while since I worked in a file room, but the hosp may charge you per page copied, so see if you can review, then ask to have only what you need copied.


You state may have different rules (HIPPA) as to accessing your records, so check before you do it!

Hope this helps.

[cassiesmom]

you can call the billing/insurance offices

I do, I do, I do

Definitely call the hospital billing department and ask them outright what their charges are. The first person you speak with may either be stunned that you're asking, not have a clue how to answer, or both. Persist cheerfully.

If you can't get an answer, call other local hospitals, ask them what their charges are, and then call your hospital back and say you have this information from other hospitals and you want it from yours.

Call your insurance company and ask them what their contracted rates are for the service you need. The first person you speak with will probably not be able to give you an answer, but should be able to put you in touch with someone who can. If you are getting nowhere fast with the insurance company, ask your HR department for the name and number of their contact at the company. (It's not the same person you talk to when you call the toll-free number.)

When I did floor nursing, every item in the clean utility room had an orange sticker on it. When we took an item (example: a "comfort kit" consisting of toothbrush, toothpaste and comb) for a patient, we put the orange sticker on a special page in the patient's chart. The nurses had no idea of the amounts that were billed for any of those items or what was not covered by insurance. I worked at the bedside for 8 years and it was only the last six months when I learned that a comfort kit was billed to the patient at about $8 and that insurance did not cover it. When a patient was about at the end of that little tube of toothpaste we would ask their family to bring in another one from home. Or if the patient had no family to bring one in, some of the nurses would do it. We didn't think it was fair to charge a patient eight bucks for a measly little tube of toothpaste that costs not even 1/4 of that at the supermarket. Same thing with topicals like Eucerin cream, Vaseline and non-allergenic lotion that we could obtain for patients from the pharmacy without a physician order. It's a very strange system.

[jennielynn1970]

You can ask for the ICD 10 codes (Used to be ICD9s back when I billed for physicians.

Ask for the codes that will be used for your procedure. Ask the price for that code for your insurance (medicare, blue shield/cross... they should ALL be the same. Billing a procedure different priced to different insurances is FRAUD, even if it's a personal injury or whatever. Same procedure, same price!!!).

Your insurance company has what they call an ALLOWABLE amount for each procedure. Between what they consider allowable and the difference of what they billed you, if they are participating providers with your insurance company (also depending on copays and such) you should only be billed a portion of what that allowable amount was. The doctor is not allowed to receive more than what is the allowed amount by medicare, blue shield and whatever insurance you're using (they all have different allowable amounts).

Anesthesia is measured in increments of 15 minutes. Every fifteen minutes is going to be another so many $$. There is also a base cost for your procedure, again another procedure code from the anesthesia office. Again, you go through what amount the doctor/nurse anesthestist is allowed to collect from that procedure, and that's what they are allowed to collect.

Normally if your doctor is participating, he MUST write off the balance of whatever your insurance didn't consider allowable. This is why you should always go to a doctor that participates with your insurance.

If you have a deductible to meet, that will be taken in to account and will be deducted from what they are paid, because they will be expecting the customer to make up the balance of the "allowable amount" of that procedure code's worth.

Not sure that you can get all that info from them, but you can sure and try to get it all. Say you want ICD 10's or whatever number they are up to at this point (procedure codes for the operations and office visits or whatever you are going in for). You should then be able to call the insurance company, give them the procedure code, and if there are no unforseen issues and problems, they can give you an allowable amount/ratio, and maybe tell you what you're portion will be if you need to pay any of it.

[sparks19]

You go to the hospital in person and visit the billing department. If you can't meet with someone right then you make an appt to speak to someone about billing procedures.

[Marigold2]

You have recieved some excellent advice here. Hopefully everything will go as planned and you will not have any extra charges.
Do make sure that once the bill is recieved you go over it and call if there are any extra charges for things you did not have done. People in the billing department do try their best to help but are often overwelmed by how many claims they have to work on and it can take many months to get it fixed.