Huge Medical Bills You Shouldn't Pay

(CBS)  For families squeezed by falling incomes and rising prices, the last straw can be an unexpected medical bill. Even those with health insurance can see huge bills for the uncovered portion of their care. But a CBS News/Business Week investigation found that many of these so-called "balance bills" are seriously out of balance - and shouldn't be paid.

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Several months after back surgery, Linda Burdick sat holding a hospital bill for almost $60,000.

And this was after her insurance had paid its share of the bill. She had no idea she'd be billed for anything close to that amount.

"And just said to my husband, 'Oh my God, we're going to owe $60,000 to the hospital. How are we ever going to pay that?'"

The bill Burdick received is called a "balance bill." When the insurance company doesn't pay the total charge, doctors and hospitals often bill patients for the balance. The problem is, millions of balance bills these days are either illegal - or they are highly inflated.

Last year in California alone, the insurance industry reported that 1.7 million patients had been "balance billed" $528 million above what the patients owed.

Burdick hired two billing investigators. After demanding an itemized accounting, health care navigators Lin Osborn and Beth Morgan believe Burdick was overcharged by $40,000, for items like six surgical screws - at $1,750 each. They say overbilling is now the norm.

"Outright wrong is 100 percent," Osborn said. "I've never seen a hospital bill that I thought followed all the regulations correctly. Not once."

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Read BusinessWeek's investigation.

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Burdick's hospital, the Beth Israel Deaconess Medical Center in Boston, declined an on-camera interview, but said in a statement that her bill was set by her insurance and "is not determined by the hospital." Hospital officials said they have "no evidence of overcharges in her bill, but would be willing to correct any mistakes."

Burdick also asked her state attorney general, Richard Blumenthal, for help. Blumenthal's office has handled thousands of balance bill complaints.

"There's no explanation for some of them except purposeful balance billing or overcharging," Blumenthal said.

"If you don't fight, you are going to lose," Burdick said.

Burdick's fight applies to anyone with a suspect medical bill. All patients have the right to an itemized bill. Any charge can be disputed directly with the hospital.

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If you think you're a victim of medical-bill fraud, or "balance billing," and are seeking help, check out our list of resources.

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Patients can complain to their state attorney general and, as Linda did, contact a medical billing advocate. Burdick says she's still working with Beth Israel Hospital hoping to bring that $60,000 bill into better balance.

[vtwin4Christ]

I made a vid regarding balance billing and how the scam works. It can be found on youtube by going to youtube and entering the following in the search bar:
vtwin4Christ balance billing

https://www.youtube.com/watch?v=f0cCLDC7yug

[Gdad34]

Can you Confirm if members of Congress have their own Medical Program, separate from the public. If they pass some form of "Socialized Medicine" will they be exempt from a mandatory program for us citizens. They allready have their own non-contributory pension plan.

[oldpilot954]

gctomajtom -- If that country you were in is the one I am aware of, everything you said is true. Of course at 65 or 70 years old they cut you out of any major medical care and treat your cancer with only pain killers.

[rdanner3-2009]

What if your insurer (as Medicare did me) sends you a hate-letter accusing you of "ordering a procedure you knew we did not cover"? I''ve had that happen (1998, was in hospital for extreme dehydration; doctors ordered a CT scan to check something for infection. I had nothing to do with the ordering of said CT scan, yet Medicare made it plain they believed I had literally ordered the doctors to do one. It has soured me on Medicare ever since (not to mention the huge money I''m paying to them). I wouldn''t trust government-run health care to be any better than a Yugo that had been flattened by a semi.

Fraud is a problem, not just in the medical industry, but in many areas. Perhaps an investigation into other industries (software industry comes to mind) would not be amiss.

[rdanner3-2009]

What if your insurer (as Medicare did me) sends you a hate-letter accusing you of "ordering a procedure you knew we did not cover"? I''ve had that happen (1998, was in hospital for extreme dehydration; doctors ordered a CT scan to check something for infection. I had nothing to do with the ordering of said CT scan, yet Medicare made it plain they believed I had literally ordered the doctors to do one. It has soured me on Medicare ever since (not to mention the huge money I''m paying to them). I wouldn''t trust government-run health care to be any better than a Yugo that had been flattened by a semi.

Fraud is a problem, not just in the medical industry, but in many areas. Perhaps an investigation into other industries (software industry comes to mind) would not be amiss.

[magoo2u1]

Why is it the medical community charges my wife 1800 dollars for a procedure, accepts 400 dollars from the insurance company and 100 dollars from us and calls it "done" ? Why not charge 500 bucks to start with, why the overcharge on paper?

So they can screew the tax payer for 1800 when somebody doesn''t pay, that ''s why. They should be called "thieves" not doctors. "Sorry I''m late for work but I had to take my son to the thief this morning, he had a sore throat".

[oneworldusa]

If a Dr. or facility accepts an insurance plan, then they are contracted by that company to charge no more than the plan agreement with them allows.

You may have your copays, coinsurance or deductibles, but regardless, the Dr. or facility CANNOT charge you more than the agreed price legally.

If you have met your insurance obligations in the form of copays, coinsurance or deductibles for a service or facility stay, you don''t have to pay the Doctor or facility ANTHING. Tell them you know that and tell them to send you a cancelled bill as a receipt that your obligations have been satisfied.

[kj_jranch]

I have had a son injured in an accident this year and the hospital he was transported to is a member of my insurance company's network. We were assured that the co-pay and deductible would be all that would be required of us due to registering the admission but the hospital charged a trauma team activation fee. The insurance company says this is an unnecessary charge and no direct services are provided by the fee. I have paid all co-pays and deductibles but they still insist on charging the fee which is a severe financial hardship on us. They want me to fight the insurance company through the state insurance commission but in actuality I agree with them that an activation fee is not an actual service and they have a contract with the insurance company to accept what they believe to be acceptable charges. They are not backing down and I do not know what resources I have to resolve this. We believed that when we were told our deductible amount would be how much we would need to come up with by the hospital after admission, after certifying it with the insurance company, that would be a reasonable thing to believe. Now we are told that we are responsible for these additional charges and cannot get either party to negotiate them. What should I do?

[ausus-2009]

gctomajtom,

I am surprised you don''t mention the name of the country that gave you this wonderful medical service. I wonder if it really exists.

I do have knowledge of medicine in several countries and the nirvana sometimes described by others doesn''t meet reality.

In England where they have socialized medicine, they lost a huge number of their most talented doctors when medicine was nationalized. They went to places such as Canada, Australia, New Zealand, South Africa and even the US. My own experience with English medicine was eye-opening. My wife was very ill and was given the choice of spending 8-12 hours in an ER or seeing a private doctor. The private doctor cost us more than $300.

I endorse the statement by another correspondent about Canadian medicine. Many Canadians do cross the border for proper treatment. I have been told this by a member of my family living in Canada who has hospital experience both as an employee and as a patient.

[ausus-2009]

gctomajtom,

I am surprised you don''t mention the name of the country that gave you this wonderful medical service. I wonder if it really exists.

I do have knowledge of medicine in several countries and the nirvana sometimes described by others doesn''t meet reality.

In England where they have socialized medicine, they lost a huge number of their most talented doctors when medicine was nationalized. They went to places such as Canada, Australia, New Zealand, South Africa and even the US. My own experience with English medicine was eye-opening. My wife was very ill and was given the choice of spending 8-12 hours in an ER or seeing a private doctor. The private doctor cost us more than $300.

I endorse the statement by another correspondent about Canadian medicine. Many Canadians do cross the border for proper treatment. I have been told this by a member of my family living in Canada who has hospital experience both as an employee and as a patient.

[cscasi]

I had a relative a male that when he looked closely at his hospital bill he had been charged for a pap test.

I have no bills as I am now also acitizen and resident in the UK where is is free. I pay for nothing. You could have had that but when Hilary tried they made a mockery of it loosers!


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Posted by jerryomara at 07:59 AM : Aug 30, 2008

That''s why it is so hard to get elective/necessary surgeries and other things done in countries with socilaized medicine, like the United Kingdom and Canada. Research with Canadians who come south to the United States for treatment because they either cannot get it or have to wait too long to get it under their socialized medicine system. See if the majority truly think their health care system is better than that of the United States.

[Belisarius6]

We have a free society in Canada - people are free to go elsewhere (i.e. the States) for their medical needs if they don't want to wait. But polling those same Canadians for their opinions on Canadian healthcare is more than a little biased don't you think? Canadians live longer and are healthier than Americans and are overwhelmingly in favor of keeping our universal healthcare plans over switching to the American for-profit system. There's a reason why every modern, industrialized country in the world except the U.S. has socialized medicine - it works and its cost effective.