Healthy Savings On Hospital Bills

(CBS)  Last May, Detroit landscaper Steven O'Shea was cutting a tree when he slipped. As he fell, right on his chainsaw, it sliced into his arm, CBS News correspondent Wyatt Andrews reports.

"Right up to the bone. It went through all the muscle, the tendon," O'Shea says.

O'Shea, who is uninsured, praises the surgeons who saved his arm. But the bill they sent would have cost an arm and a leg. The total: $39,000 for a three-hour operation.

"I was outraged when I looked at that bill. I opened up the envelope and thought 'where in the world do they come to this figure,'" O'Shea says.

Like millions of Americans, O'Shea also found his bill confusing — a baffling list of codes. So after an Internet search, he found Nora Johnson, who calls herself a billing advocate.

She's a kind of medical detective, an advocate trained to sniff out mistakes on hospital bills. She found a big one on O'Shea's.

The hospital repaired six tendons, but he was sent a bill for nine. "The took $11,000 off of his bill," says Johnson, of Medical Billing Advocates of America.

Johnson says almost every hospital bill she has ever reviewed has an overcharge.

"I see it every day on every bill," Johnson says.

Consider Joe Manchin's bill. After his knee replacement last year, Manchin says most of his $34,000 bill was a list of charges simply labeled "hospital extras." Whatever happened, he thought, to plain English?

By the way, Manchin is governor of West Virginia. He says nobody can understand what each hospital extra is. "The best accountant in the world can not understand this," he says.

That bill led Manchin to propose radical surgery — for hospital bills.

Manchin believes the broken billing system can be fixed by patients. His unique idea is to have the state's Medicaid patients become watchdogs over their medical bills and pocket 10 percent of any error they discover. The change, he says, will instantly improve billing and save money.

"With technology today, they can't tell me that can't be done. I know it can," Manchin says.

Nora Johnson believes every patient can be a watchdog. First, she says, don't settle for a summary bill: Get an itemized bill. Look for charges on procedures doctors did not perform, and then check for duplicate charges. If you want a billing advocate like Johnson, start with the Web site Bill Advocates. Then scroll down and click on "find an advocate."

After Steve O'Shea found an advocate, negotiations began with the Henry Ford Health System, where officials tell CBS News "the services we billed for were rendered." However, last week they drastically reduced his bill — to around $6,500, about where Johnson said it should have been all along.

"It's a profitable error, and errors always seem to have a way of working out to be profitable," O'Shea says.

O'Shea thinks the lesson is that his bill, and the bills of most Americans. have mistakes that need correcting.

[marx96]

I have been in the healthcare field for 24 years. Why isn't there anything about insurance companies' practices? Dr.'s are becoming scarce due to HMO's driving them out of business. Hospital's and Dr's get a small fraction from insurance companies compared to what is billed. As far as uninsured patients. I have a HMO, and I have to pay for any copays and deductibles upfront also. Uninsured can negotiate with hospitals for discounts on their own. I know that our facility works with anyone who is willing to pay. When pt's come in, we are the best and they are so thankful for our services. After they leave, more often than not, all we hear are complaints. As far as fraud, how many people come in to the hospitals and give incorrect phone #'s, addresses, etc. They can never be tracked down. It's very irritating when there only one side to a story. The overhead to operating a hospital is astronomical. I only wish I had the talent and knowledge that Dr's must have to save lives everyday. It truly is a miracle, if one would sit and think about how complex the human body is.

[sclaires]

Ever since last week I have had a severe tooth ache which was only eased by narcotics. On Monday I saw my regular dentist who said that due to a. calification around the roots, b. no channels to do a root canal, c. it already has a crown, d. abscess, he could not remove it so he sent me to a dental surgeon. I saw the dental surgeon today, Tuesday, and was charged $95 just for the consultation and panarex x-ray. Then I was told that it could not be scheduled until I had paid the $95 and then I would have to pay $450 just for the surgery before surgery. Just that total amount came to the amount that I receive each month on disability. So, as soon as I got home, I called my MC people and explained the situation before I asked for an increase in the amount I can charge. They were willing to give me more then I wanted but I declined that amount and said that I wanted only an increase of $600 which was granted right then and there. Now, to top it all off, they were UNWILLING to accept payments each month which is what I am doing with my regular dentist. Dental bills are as bad as medical bills and when a provider is unwilling to work with someone who has a limited income that just shows how greedy some of them are. There definitely needs to be an investigation into the charges made by the providers, be them medical or dental. When all is over with this abscessed tooth, it will have cost me a small fortune and I consider that it will be a "gold plated tooth".

[dan9111]

mollydtt, that is an excellent point. If only the ridiculous hospitals would realize the savings by not mutilating male babies. Not to mention the extensive cost of reconstruction when the man grows up. The whole bait-and-switch operation is pretty depressing, considering they advertise themselves as healers.

[mollydtt]

Most of the time the charges are mere codes. A wrong code can trigger problems. My bill from the hospital when my daughter was born had a code that I couldn't identify. When I inquired what the number signified, they told me it was for a circumcision. They took the charge off immediately.

I'm referring to comment by M032793 on 3/26/07.

I think s/he is missing the major point in the article. Health care costs begin with medical providers. If they are not billing accurately then it would be difficult for patients or health plans to pay what's a "fair" amount for medical care received. Why are medical costs in the US so high compared to other industrialized nations, but quality of care is comprable?

[snoke21]

I work for a firm that does nothing else but investigate and correct these types of bills as well as providers that submit the abusive and sometimes fraudulent bills. We save millions for Insurance Companies,it's amazing and people wonder why healthcare costs are so high. In fact in 10 years experts say 20 cents of every dollar we spend will go towards our healthcare costs. www.sentinelgrouponline.com [e-mail]

[m032793]

I do not agree that "most bills need corrected". I have been in the medical billing field for over 20 years, yes errors do happen even in this day and age!

Most doctors and hospitals want repeat customers, I don't believe the majority of them are billing for services not rendered.

It seems to me that the media likes to make the doctors and hospitals out to be the "bad guys". I would like to see the media address the issue of insurance companies not paying the doctor for the services that are provided to their members (the patient).

Doctors wait months and months for payments from insurance companies. When they do pay, they often deny charges stating it is not "their policy" to pay for a particular charge and tell the patient not to pay the doctor either, even though the service was provided. They make up their own rules, not using standard medical billing policies, just their own in house policy. Which however, is a big savings for them.

Insurance companies take appropriate discounts using "Wrap Networks" or "Silent PPO's" to pay claims at a lesser amount, therefore saving them more money, and cheating the doctor or hospital. Again telling the patient they should not pay the doctor for the discounted amount, when in fact, no discount should have been taken at all.

So again, the doctor is expected to write off more of charge, getting barely enough to cover the cost of the service that was provided.

So tell me, who is the "Bad Guy"?

[sheiladeuel]

Katie,
Lately I have seen stories about providers of services including such things as medical bill accuracy reviews, medication utilization and efficacy review, assessment of need for supportive services and acting as a clients healthcare agent.

I am a provider of this same range of services aimed at assisting clients in organizing, coordinating and managing their healthcare. I have defined my services as Personal Healthcare Management.

These services are the very actions that are defined by payors as risk reduction and counseling services and that providers do not have sufficient time achieve. I believe that these needs should be met by a nurse. I deliver advanced nursing care and practice patient advocacy at its best.

I would be interested in sharing more of my experience with you if you would like to learn more.

Thank you for your attention and bringing me stories that make me think.

smd

[hcmadmin]

This great!
I had a bill and had it negotiated by a medical bill negotiating company and it worked. I saved 30% of my medical bill. You can too. It is just paying for what you are getting, and nothing more, nothing less.

Just wanted to share my experience.
i used
www.hcmediation.com
but there are many more out there to pick from

sincerely
JT

[arcvn]

What hospitals are doing seems prevalent, if we believe the news reports. It certainly sounds like fraud - and not human "error." Why aren't the insurance companies suing the hospitals? Why aren't the patients suing for what they must endure along with their health problems? Where are the law enforcement agencies? How can this be treated by the news media as "normal" behavior by hospital billing offices -- and the public must pay the price.....