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.

[smtalles]

WOW! It''s about time someone does a story on this. I have worked with many individuals through my job with a major insurance company that would normally just pay the bill because the insurance paid their part...right? WRONG! So often I see many individuals being taken advantage of in this manner and the sad part is, more often than not, it was the elderly living on a fixed income. Please continue to follow up on this story and investigate this practice as it doesn''t only happen in California...it''s all over! People wonder why healthcare is so expensive. Well, this isn''t the only reason but it sure contributes to the problem. Good work CBS! Keep it up! Keep this story alive!

[smtalles]

WOW! It''s about time someone does a story on this. I have worked with many individuals through my job with a major insurance company that would normally just pay the bill because the insurance paid their part...right? WRONG! So often I see many individuals being taken advantage of in this manner and the sad part is, more often than not, it was the elderly living on a fixed income. Please continue to follow up on this story and investigate this practice as it doesn''t only happen in California...it''s all over! People wonder why healthcare is so expensive. Well, this isn''t the only reason but it sure contributes to the problem. Good work CBS! Keep it up! Keep this story alive!

[matthewsa1]

This is really a huge deal... its amazing what hospitals / insurance companies try to get away with. I''m glad to see that CBS is taking note of this, hopefully more news organizations will do the same. By the way, if you''d like the help of the medical bill advocates listed in this story (Beth Morgan and Lin Osborn), visited their website at http://www.medicalbilldetectives.com

[insuranceut]

I, too, work for a major insurance carrier. It''s great to see the story, to bring it to peoples attention, however, I feel the whole story has not been told. Is the story about the hsp sending out the HUGE bill after the insurance company has processed according to her benefits OR is the story that she doesn''t have adequate coverage?

I find it VERY hard to believe that her benefits are such that she would be responsible for $60,000 of out of pocket expenses - AFTER the insurance has paid. What is her deductible & coinsurance maximum? Did she utilize a contracted facility? If she used a contracted facility & they are balance billing - they are not holding to their contract with the carrier. There are so many stories in the news these days about healthcare & how bad it is - yet I don''t think the whole story is ever told. The media picks & chooses what they want the public to hear to get people all worked up over things. It would be nice to have the media take an educational approach to things instead.

[sparks224]

This immoral "system" has to come to an end.

What kind of people are we?

[hypnotoad72]

Get off your lazy butts and get a job!!!


(Just joking; I wanted to know how a neanderthal feels when he makes similarly blind and stupid comments...)

[cbsfan73]

All insurance and banking for individual citizens (corporations and businesses excluded) should be run by credit/insurance unions as non-profit organizations.

[cbsfan73]

Insurance and usury applied to individuals is one of the most damming (excuse the circumventing spelling)things mankind has created.

[cbsfan73]

Actually, they are trying to recoup costs from those that can''t afford or refuse to carry insurance. (The latter mainly applies to Hispanics.)

[shippg]

I have a friend who has to have a $9000 IV infusion every month. She pays $100, insurance pays $900. All the rest ($8000) is written off by the hospital every single month. She asked the billing office if this would continue, or would she eventually be cut off? They said that they lose a lot of money on some patients, and make a killing on others, so she should not worry. Ouch!

If med billing is that arbitrary, then they (the providers) are most of the problem. A lot of b.utt-kicking needs to go around before the problem can be fixed. Insurance companies, doctors, hospitals, drug makers, you name it. Everyone s.crews everyone else.

[cbsfan73]

InsuranceUT wrote:
"I find it VERY hard to believe that her benefits are such that she would be responsible for $60,000 of out of pocket expenses - AFTER the insurance has paid."

I too find it hard to believe. Even poor policies almost never have over a $5000 maximum out of pocket.
The whole story is not being told.

P.S. Go get a job where you actually innovate or create something. You are in an unclean business.

[cbsfan73]

carats100 wrote:
"I have a friend who has to have a $9000 IV infusion every month. She pays $100, insurance pays $900. All the rest ($8000) is written off by the hospital every single month."

Hospitals have contracts with most insurance companies. The payments are an meet somewhere in between agreement of how much the service or product is really worth.

[shippg]

cbsfan73, your "really worth" phrase is what I was getting at. The $9000 is arbitrary. If this is so, then uninsured people are hit with the whole tab. The hospital "loses" $8000 on one person, and makes another take out a mortgage.

[cbsfan73]

Hispanics have passed the knowledge between each other that they should not buy health insurance because the hospital treatment is free.

[cbsfan73]

carats100 wrote:
"The $9000 is arbitrary. If this is so, then uninsured people are hit with the whole tab. The hospital "loses" $8000 on one person, and makes another take out a mortgage."

Yes, this accounting scheme also creates an inflated loss to reduce tax liabilities.

[shippg]

Well, we cannot fix the healthcare mess without doing away with this "accounting scheme."

[smurfcrusher]

"...Burdick was overcharged by $40,000, for items like six surgical screws - at $1,750 each. "


Screwed, indeed.

[cbsfan73]

States can revoke your license plate if you don''t carry vehicle insurance.

Maybe people who refuse to carry insurance should have their wages or tax refunds garnished to pay the premium?

Of course this would only be workable with a national health care plan as many people with existing health problems could only afford the premiums at a group rate.

[cbsfan73]

"Burdick was overcharged by $40,000, for items like six surgical screws - at $1,750 each."

Sounds like the screws were purchased by a VA hospital.

[cbsfan73]

"...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."

If the bill was truly set by the insurance company, why would the hospital correct any mistakes?

Sounds like doublespeak to me...

[cbsfan73]

My fellow Americans:

It will be such a sad day on November 4th, 2008 in which the citizens will have to choose whether to eat donkey dung or to eat elephant manure.

What if they gave an election and nobody voted?

I won''t waste my time voting...

[cbcrowe3]

I applaud CBS for running this piece.

Some posters seem to suggest that this lady did not have insurance. She did have insurance.

What we have here is fraud. Outright fraud.

[cbcrowe3]

The hospital "set" this bill, and no one else. What they mean by the "insurance company set" is that the insurance company "set" what it would pay.

The hospital generated this bill. Who else could have? Who else would have had the information to make up the bill. The problem was that the hospital fraudulantly added charges that were not incurred.

[bubbabear200]

After a few phone calls I found out that this hospital purchased these screws from Home Depot.
Each screw cost the hospital 1.98 from Home Depot.
Thanks
Bubbabear

[wardoglrs]

Deregulate the Health Care industry and get the government out of it. Competition is what''s needed.

Just look at the cost of electronics and you see the lite

[spadeisspade]

I don''t get it; hospitals overinflate their bills in order to recoup the cost of *** that use the ER like a GP, so they are now doing it to people whose insurance actually paid these overinflated prices? I mean, with how high they mark up all their tools and services, if an insurance company is even picking up a portion of that tab, it''s still making the hospital profit and the patient shouldn''t owe anything at all!

[ioweign]

Deregulate the Health Care industry and get the government out of it. Competition is what''s needed.

Just look at the cost of electronics and you see the lite

Posted by WarDogLRS at 01:23 AM : Aug 30, 2008

Hospitals are consolidating so there is no competition in smaller cities. The opposite is needed - more government oversight.

We have the FDA and meat inspectors for bad beef - how about something for hospital oversight...

[andor3]

"I find it VERY hard to believe that her benefits are such that she would be responsible for $60,000 of out of pocket expenses - AFTER the insurance has paid."

That is the point. She did not owe it. But the hospital tried to collect money it was no owed. And they do it all the time. I happened to me: A $20k bill and I told them they were not getting a dime. They just said okay oops sorry, computer error.

[andor3]

here is how it works: insurance companies negotiate contract rates for procedures. An insurance company often pays half of what an uninsured person pays for the same thing (a crime and a scam in itself).

Hospitals agree to take the lower amount as full payment, but then try to trick a patient into paying more. When caught, they claim accounting errors. If you pay, they pocket the cash. It is fraud.

The recent run up in health care prices is the knowledge
that Socialize Medicine is around the corner and it is about time. Obama will cap these clowns.

[docpeter-2009]

After a few phone calls I found out that this hospital purchased these screws from Home Depot.
Each screw cost the hospital 1.98 from Home Depot.
Thanks
Bubbabear

Posted by bubbabear200 at 12:49 AM : Aug 30, 2008
_____________
How I wish that were true. Unfortunately, I haven''t seen titanium screws in my local Home Depot, Myabe I''ll check out Lowe''s.
____________________

if an insurance company is even picking up a portion of that tab, it''''s still making the hospital profit and the patient shouldn''''t owe anything at all!

Posted by spadeisspade at 03:25 AM : Aug 30, 2008
____________

Please don''t tell me you think making a profit is a bad thing. Healthcare Is a business. Unfortunately we depend on you becoming sick or injured to make $$. Might I recommend EVERYONE do those healthy things in an attempt to avoid becoming sick or injured.

Also, it cost a lot of $$ to buy and maintain those things all the patients want (x-ray, CAT scans, MRIs, pharamaceuticals, etc.), and have them on-hand and ready to use when you show up at the hospital. It also cost a lot to have that nurse(s) attend to many of the people that, if they had tried to maintioan their health in the first place, show up unannounced at the hospital thinking it is a Doc In The Box.

[jmurrieta1]

But the medical industry DESERVES that money.

Just look at how many bribes they''ve paid to their champions, the Republican party. And no doubt some crooked DINOs were paid off as well, to stand by hands in pocket as the public is plundered by the "healers".

[deepperppl]

What took so long to have a report like this? I''ve known this for years! Will reform happen now?

[tootall10142]

I walked into the CEO office with the bil and said you people are out of your flukkin mind and you already know i am so you arent really expecting payment? If you are I wouldnt be holding my breath.

[mythoughtsr]

No where do you have the right to take my money and give it to someone else. This is what is wrong with this country now, too many Socialist that think the Government should take care of you.

If you liked the service in this other country, then go back there.

Posted by Willyhenail at 08:45 AM

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.

[jeff-fla]

-six surgical screws - at $1,750 each

A few years back a company asked my company to manufacture bone screws. Due to the cleaning process we couldn''t do the job for the price they pay for the screws. A whopping $12.00 per screw. By the time the hospital gets the screws I sure it is around $20.00.
So I guess the mark-up is $1730.00. Where do I sign up.

[ebbtied]

Is billing for a service date of more than 3 years ago legal? In June of 2008 I received notification from a collection agency called Argyle Solutions, Inc of a balance due of $100.00 + $8.85 NYState HCRA tax = $108.85 for a service done in April of 2005. This was the first bill/notice I had ever gotten for this service ever. Back in 2005 I was insured by Oxford Health Plans, but am now on Medicare since 2006.
Thank you. (E-mail: [e-mail].)

[magoo2u1]

"No where do you have the right to take my money and give it to someone else. This is what is wrong with this country now, too many Socialist that think the Government should take care of you.

Every time I think of those wasted social programs I just want to scream. What a list of failed programs:
Highway system, FAA,FDA , Social Security, medicaid,medicare, red lights, stop signs, law enforcement, port authority, funding universities, medical research, FCC, NOAA, the geographic survey,NASA, the treasury, the Army,Navy, airforce,Marines- Man the list just goes on and on. Instances where our money is stolen from us and wasted on useless programs to establish a society where we can live safely and securely in our homes and venture outside and visit a NATIONAL PARK or perhaps FISH.

[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?

[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.

[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.

[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:

[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.

[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]

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.

[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.

[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.

[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!

[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?

[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.