I spent two years demystifying my emergency room bill only to uncover that I was being gouged for 800% profit by the hospital. During that time, I learned how to calculate fair and reasonable prices, as determined by the industry standards.
Here’s what I learned: the two most blatant culprits of the overcharges were due to Secret Prices and Coding Errors/use of an Internal Coding System…I’m sure that’s no surprise for OutOfPocket Blog readers.
A little background
It was suggested that I go to the Emergency Room by my doctor who had prescribed a course of oral antibiotics for an infection. I then came down with a stomach virus and was unable to keep down the medication. My infection progressed, so my doctor instructed me to go to the ER for IV antibiotics. I went, received excellent care, stabilized within six hours, went home and had a full recovery.
Then I received my first billing statement. Those antibiotics and basic blood tests cost $7,051. Then my PPO policy negotiated it down to $3,525, with no explanation. These prices seemed so arbitrary to me, I just wanted to know they were fair and reasonable, as determined by industry standards.
By working with a patient advocate at Southwest Bill Review, I learned that up to 90% of all hospital bills are coded incorrectly. My patient advocate told me that there is supposed to be transparency in the billing system – and that there are definitive coding guidelines that apply to each hospital. However, this hospital administers their own coding system – making it impossible to determine exactly what is being charged. I learned that this is very common.
I then developed a 10-step-process to hospital negotiation. My hope is that this information will help people navigate through the current medical billing system.
The 10-step-process can be found at my blog, Hospital Overcharges 101. Also be sure to check out the Youtube video of my experience.
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I can be followed on Twitter at: MedOvercharg101 and the Facebook Fan Page, Medical Overcharges 101 – when the 140 characters on Twitter just isn’t enough.
--By Lynn Jordan
Lynn Jordan is an award winning freelance producer and writer having worked in the television and live event production industries. This is her first time with the hospital billing system and her hope is that what she has learned will help other people confront their medical bills.