The Bitter Pill of Health Costs/What you can do

This past week, there has been a lot of discussion about  the Time magazine article by Stephen Brill Bitter Pill: Why Medical Bills are Killing Us,”  and the video about why he wrote the article

Brill’s conclusion is that hospitals and other providers can simply charge what they want because consumers – patients and their families – are simply participants in a “fixed poker game that [they are] forced to play in the worst of times with the worst of cards.” I have heard from colleagues who say that hospital costs are what they are because of all the people that have to be paid, and it’s the fault of the pharmaceutical companies. Others blame insurers and still others blame lawyers and lawsuits. Bottom line is that everybody has a finger pointed at somebody. It’s time we point it as ourselves and realize that as a health consumer there are things we can do:

• Use an advocate who knows your wishes and can help you understand what is being said about your situation and who can help you make the choices you want. They can also verify what did or did not happen during a medical appointment, trip to the ER or during a hospitalization. Have them take notes. 

• Keep a personal health notebook and take it with you to appointments and to the hospital. It can help in avoiding duplication of tests, prescribing drugs you’ve had reactions to and provide information that may be relevant to your medical situation, but not readily available in your chart. 

• Make sure that the treating hospital, medical provider, pharmacy and lab facility are covered by your insurance.

• Before tests, treatments, procedures, hospitalizations or medications are ordered, ask about anticipated outcomes, and less expensive options. Don’t be afraid to decline something that you don’t want or feel is necessary. If the course of treatment will be the same whether you have a test or not, maybe you’d like to opt out of the test. Be sure and let the provider know up front if you have limited or no insurance coverage.

• Since 8 out of 10 bills for health services contain errors, go through your medical bills with a fine tooth comb. It can literally save you thousands of dollars. That means asking for an itemized bill. According to Alice Park, author of Tips for Lowering Your Medical Bills,  do the following

- Ask for an explanation, in writing, from the hospital’s billing department for any disputed charges.

- If you go to the hospital at night and end up being admitted after midnight, make sure your charges for the room start on the day you start occupying the room.

- Check the level of room for which you were charged. Hospitals charge for ER services by level, depending on the amount of equipment and supplies needed, with Level 1 requiring the fewest (e.g., a nosebleed) and Level 5 representing an emergency (trauma, heart attack). Question the level indicated on your bill and ask for a written explanation of why that level was billed. Hospitals have their own criteria for determining levels and should make this available upon request. “They don’t freely hand this information out, but they will send it to you if you ask for a written response,” says Pat Palmer, founder of Medical Billing Advocates of America.

- Doctors also charge for ER services by level, also ranging from 1 to 5. Their levels are standardized, and physicians are required to meet three criteria to justify billing at each level. Question the level listed on your bill and ask for a written explanation of why that level was billed by your physician.

- The hospital level should be equal to or lower than that of the doctor-billed level; if it’s higher, that’s a red flag that there may be a billing error.

- Question charges for what seem like routine items, such as warm blankets, gloves and lights. These should be included as part of the facility fee.

- Question any additional readings of tests or scans. You should be charged only once for one doctor’s reading of a scan, unless it is a second opinion or consultation.

- If you received anesthesia, check that you were charged for only one anesthesiologist. Some hospitals use certified registered nurse anesthetists (CRNAs) but require that an anesthesiologist supervise the procedure, so some bills will contain charges from both, which amounts to double billing.

- If your anesthesiologist is out of your insurer’s network, ask him or her to accept in-network reimbursement.

- You can also ask your insurance company to send reimbursement for anesthesia services directly to you, and then you can resolve the bill directly with the anesthesiologist. In most cases, the anesthesiologist will accept the in-network rate rather than engage in a protracted negotiation with you about payment.

For more on this topic check out Controlling Out of Pocket Medical Expenses