Huge Medical Bills You Shouldn't Pay

CBS Evening News And BusinessWeek Investigate Illegal "Balance Bills"

(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.

[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.

[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.

[besty4261]

This has opened my eyes a bit reminding me how our awesome government really cares about its citizens! When there is somebody putting the screws to us, they don''t get involved, but when we do anything to them we are looking at jail time. Makes you love this country, huh? Seems like everytime we get a president that cares about the less fortunate, they are either assassinated or the press searches intent on finding something to discredit them. I am sooo discouraged. I know that most of us have homes (not huts or caves), but keeping a home is almost impossible these days. People are having to decide on food or medical supplies or electric...will the future ever get better?

[robin_warren55]

I work for a major insurance provider in their appeals and grievance department. I deal on a daily basis with this type of issue. It is stipulated in providers contracts (if they are contracted with insurance co) that they are prohibited from balance billing the patients for any charges above the covered expense. However, it does happen and their are resources for the patient to dispute this issue. Each state has regulations in place and a complaint process that you can follow. A patient can ALWAYS appeal this to the insurance company as well. It is true that when a provider is under contract with the insurance company that alot of times they like to keep the negotiating between the insurance company and the provider, YOU, The patient do not have to sit back and do nothing. I would always suggest either appealing to your insurance company, who must review and resolve the issue for you in most states within 30 days. If this does not work, go to the insurance commissioner for your state. Most of these agencies have a website in which you can file a complaint. As far as the statement that the hospital gave the patient in this story, "said in a statement that her bill was set by her insurance and "is not determined by the hospital." That is untrue, the insurance company does not stipulate nor direct the hospitals how to bill claims, this is determined by the hospitals billing representatives. Sounds like they are into fraudulent billing practices!

[hsinco-2009]

Hear that, I can now give a customer a $400 dollar bill for a $10 item and then say, "I''''m not overcharging, but I will fix any mistakes with extreme hassle to you, and a resolution most likely only achieved in court". How long has this fraud been going on, and how many people can we overfine for their part as an acomplice, so we can start a program that helps people pay their attorney fees and inflated bills?

Posted by lochlan at 10:20 AM : Aug 30, 2008


Kind of sounds like how the sub prime mortgage fraud was perpetuated upon us.

[andor3]

what is really despicable about this is the bill is sent when a patient is just coming home, is perhaps weak or recovering, family is adjusting, dealing with mountains of paperwork and bills from doctors. The hospital will apply pressure and act threatening--it is pure bully tactics, taking advantage of a person when the hospital knows they are not yet at full strength and able to defend themselves.

[cbsfan73]

Many doctors now insist upon a cash payment before service if you don''t have insurance.

This is one of the reasons that we have such a long wait at the emergency room. Hispanics use it as a doctor''s office.

[cbsfan73]

Now, let me tell you the really bad part:

If you don''t pay these fraudulent charges, the hospital will turn it in on your credit report. You can have one hell of a time straitening this out.

[cbsfan73]

True story:

I once had fraudulent medical charges show up on my insurance payment summary.

It was really no immediate skin off my nose. But I wondered: What if this is happening to all patients? That could be billions of dollars.

So I called and reported this information to the insurance company. Guess what? They did not want to hear it! They said that is between them and the hospital and that I should no worry about it. I said: "But I never got this service, don''t you think it is wrong for the insurance to pay for it"? I was brushed off again.

So I reluctantly hung up the phone and then imagined all kinds of cozy, ca hooting, schemes.

[hypnotoad72]

Another whining Liberatarian. I happily accept SSI payments for a handicapped child, food stamps and free medical and there''''s nothing you can do about it. Oh I work full time as well so don''''t say I don''''t "contribute". I have bachelor''''s degree and I legally applied for services. Not everyone is an elitist and perfect like you. Until this government does something to stop the out of control inflation, pork barrel spending, insane government waste, huge tax breaks for greedy corporations and the other million things they do wrong and focus on making a strong economy and not shipping all our jobs overseas will this country be able to be strong. So go stuff a sock in it.

Posted by Mythoughtsr
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RIGHT ON!! :thumbsup:

[indianaman96]

gas tax pays for your roads
property tax pays for schools
corporate tax pays for military
sales tax pays your local fire and police departments
tarifs and trades taxes im not sure of, but where o where are the Casino and Lottery moneys going, wheres social security, where''s the income tax going? Surely the last three are enough to cover welfare and medical care? I dare anyone to find why no Audits have ever been done on Lottery and Casino money, just try.

[cbcrowe3]

You are right, we certainly can''t have social programs to help the poor get health care. I mean, all the welfare today is reserved for corporations, right?

By the way, I include the middle class in with the poor, and if we have 4 more years of the same party that has been in the White House, there won''t be any more middle class to argue about.

[lochlan-2009]

Hear that, I can now give a customer a $400 dollar bill for a $10 item and then say, "I''m not overcharging, but I will fix any mistakes with extreme hassle to you, and a resolution most likely only achieved in court". How long has this fraud been going on, and how many people can we overfine for their part as an acomplice, so we can start a program that helps people pay their attorney fees and inflated bills?