HOW TO CHECK-UP ON YOUR HOSPITAL BILLS

Don't assume that your hospital bill is correct. Duplicate billing, code errors and charges for unrequested items are mistakes that occur far too often. Why pay hundreds or even thousands of dollars more than you have to?

Probably the last thing you want to do after a hospital-stay is fine-tooth-comb the confusing computer codes and odd abbreviations on your bill. But it's worth the time and effort to review hospital bills carefully--you may be shocked at the number of costly errors you'll find. And if you think you don't have to worry about hospital charges because you're insured, take a close look at your policy. Most insurance companies require that patients make a co-payment (usually 20 percent of the total bill). Even if your policy says it covers 100 percent, that usually means it will pay for what the company considers to be "reasonable and customary." Anything above that amount comes out of your pocket. There are two other good reasons to be vigilant about bills. First, the more insurance companies have to shell out for hospital costs, the higher the premiums they will charge their customers. Second, some companies offer a reward of 25 percent of the savings to employees who find errors.

Hospital-Speak: What if I Can't Understand It?

Is There Anything I Should Be Looking Out for?

• Are the dates of your stay accurate? You don't want to pay for a three-day hospital stay if you were only there for two days.

• Did you receive all the services and products you are being charged for? This includes the type of room you had (private, semiprivate), TV and telephone rental, personal items (tissues, slippers), and medications and tests. Sometimes a whole series of items and tests are billed to you even though they were canceled by your doctor.

  Note: Frequently, consumers complain that they were charged for an entire surgical or emergency kit even though only a few items from it were actually used. But according to the Attorney General's Office, this is a legitimate expense because these kits are sterile and have to be kept sealed until needed. Once they are opened, the rest of the kit is unusable.

• What exactly is grouped under the category labeled "miscellaneous"? Always ask for a detailed itemization.

• Have you been charged twice for the same service? Such double-billing is a common error.

• Did the hospital staff lose or misplace a patient's records, x-rays or tests results? If this happened to you and your tests were repeated, be sure you aren't charged for the replacements.

• Are the doctors who attended you, including anesthesiologists and radiologists, billing separately from the hospital? If that's the case, make sure there aren't any charges for their personal services on your hospital bill.

• Are there numbers that seem out of line? Clerical errors in punching in codes or figures may lead to overcharges.

• Finally, are there bill entries that you still don't understand or can't account for in your own records? Frankly, there are certain kinds of errors that even the most sophisticated consumer might not find. Charges for inappropriate treatments or unnecessary supplies and lab work can be hard to spot. If this is the case, ask a hospital representative and/or your doctor to review the bill with you.

What if I Find an Error?

If You Need Help

In the event you have trouble dealing with your paperwork or getting payment from your insurance carrier, there are professionals you can turn to for help. For a referral to a claims assistance professional in your area, contact the Alliance of Claims Assistance Professionals (ACAP) at 877-275-8765 or visit their web site at www.claims.org. Click on the Professional Referral section.

For more information go to their web-site at www.thehealthpages.com/articles/ar-$hosp.html

Understanding Your Medical Bills

After your doctor's appointment, your doctor's office submits a bill (also called a claim) to your insurance company. A claim lists the services your doctor provided to you. The insurance company uses the information in the claim to pay the doctor for those services.

When the insurance company pays your doctor, it might send you a report called an Explanation of Benefits, or EOB, that shows you what it did. You need to be able to read and understand the EOB to know what your insurance company is paying for, what it's not paying for, and why. An EOB is not a bill.

Your doctor's office might send you a statement. A statement shows how much your doctor's office billed your insurance company for the services you received. If you receive a statement before your insurance company pays your doctor, you do not need to pay the amounts listed at that time. After your insurance company pays your doctor, you may need to pay the doctor any balance due.

Keep in mind that not all insurance companies send EOBs, and not all doctors' offices send statements. You may receive one or the other or both.

The next page shows an EOB and a billing statement with instructions to help you understand them. You should use what you learn to review your EOBs and billing statements carefully. Here are some things to look for:

• If the dates of service and description of services on your EOB and billing statement aren't the same, or if they don't match other records you may have of the visit, contact your doctor's office first.
• If you have questions about why your insurance company did not cover something or about the amount you have to pay, contact your insurance company.
• If more than 60 days have passed and your insurance company still hasn't paid your doctor, contact your insurance company.

Finally, you should keep your EOBs and statements organized (e.g., filed by date) so that you can access them easily should questions arise.

For more information go to : www.aafp.org/fpm/20040300/monitor_boxc.html

Understanding your bill

Review your medical bills carefully to check for any mistakes.  Even if you are covered by insurance, the cost of billing errors may come out of your pocket in the form of higher co-payments and drug costs.

Here are some resources to help you make sense of your medical bills.

• Medical Billings: Information from the Bureau of Consumer Protection in the Wisconsin Department of Agriculture, Trade and Consumer Protection.
• Understanding your Medical Bills:  Information from the American Academy of Family Physicians to help you understand billing statements from your doctor and explanation of benefits (EOB) reports sent by your health insurance company.
• How to Check Up on Your Hospital Bills, from Health Pages, provides tips on what to look for as you review your hospital bill.

Disputing your bill

If you find an error in a medical bill, Health Pages recommends the following:

• Contact the hospital or doctor's business office or patient accounts supervisor immediately.
• Let your insurance company know about the errors.
• Put everything in writing and keep copies.

If you are unable to resolve a billing dispute with a hospital, clinic, or doctor's office, contact the Wisconsin Department of Agriculture, Trade and Consumer Protection at (608) 224-4960 or 1-800-422-7128 (in Wisconsin only).

Paying off your debt and protecting your credit

Unless you have successfully challenged your bill, you are responsible for paying all of your medical bills.  If you cannot pay, here are some things to consider.

1. Try to negotiate a payment plan. Your hospital or provider may be willing to accept smaller monthly payments. Keep in mind that your payments generally need to be reasonable and you must keep up with your payments. In its advice to parents of chronically ill children, the American Academy of Family Physicians recommends the following: 
   • Notify the appropriate offices quickly.
   • Keep in touch with your creditors.
   • Record the names and phone numbers of the people you are dealing with.
   • Document the date, time, and results of your phone calls.
   • Pay something - even a small amount - on each bill each month as a gesture of good faith.
2. Get information on charity care in Wisconsin hospitals.
3. Apply for Medicaid. If you are eligible, Medicaid may pay for some of your existing medical bills. Wisconsin Medicaid coverage can begin as early as the first day of the month, three months before the month you apply, if you would have been eligible in those months, so apply as soon as possible.
4. Go for credit counseling. Be aware, though, that some services charge high fees and do nothing to really help reduce your debt. Make sure you are working with a credit counseling service (also known as an adjustment service agency) that is licensed by the Wisconsin Department of Financial Institutions.
   
   • A list of licensed credit counselors can be found at the Department of Financial Institution's website. If you have questions or complaints about a particular agency, call their Licensed Financial Services Section at (608)-261-7578.
     
   • Information on how to choose a credit counselor is available from the Federal Trade Commission.
     
   • The National Foundation for Credit Counseling (NFCC) accredits credit counseling agencies that provide free or low-cost services. You can search for an NFCC member credit counseling agency from the NFCC website or by calling 1-800-388-2227.
     
5. Be creative about finding help from outside sources.  Charitable foundations, civic organizations and churches and community groups might be able to help. The Patient Pal (PDF, 197 KB) from the Patient Advocate Foundation includes some fundraising ideas for those with high medical bills.
6. Don't ignore bills. Though tempting, this is not a good strategy. Hospitals and providers are more likely to negotiate with you if you contact them immediately.
   
7. Don't transfer debt to a credit card. Most experts warn that this is a poor choice for paying off medical debt for two reasons:
   

   • The interest rates on your credit card will add significantly to your total payment. 

   • Transferring medical debt to a credit card may affect your eligibility for Medicaid. Some medical costs can be deducted from gross income to determine your Medicaid eligibility. Medical debt on a credit card may no longer qualify as medical debt.

Dealing with collection agencies

If your hospital or other health care provider has turned your bill over to a collection agency, you are protected against harassment by the Fair Debt Collection Practices Act (FDCPA).  

• Debt Collection: Your Rights and Responsibilities, from the Wisconsin Department of Financial Institutions, provides information on how to deal with collection agencies.
• Debt Collection, also from the Wisconsin Department of Financial Institutions, provides information on your rights.

If you have questions about your rights or the conduct of a collection agency, contact the Department of Financial Institutions at (608) 264-7969, or  1-800-452-3328 (in Wisconsin only).

Bankruptcy

The decision to file for bankruptcy should be last resort. More information on bankruptcy, including how to file, the pros and cons of filing for bankruptcy, working through bankruptcy court, and re-establishing credit, is available from Consumer Action, a non-profit consumer rights organization.

Legal help

If you find that you need legal help to deal with your medical debt, the Wisconsin State Bar Association's Legal Explorer Web site provides general information on finding a lawyer and information on finding a lawyer if you have a low income. 

The Legal Service Corporation Services, a private, non-profit corporation established by Congress, allows you to search for a local legal aid program from its Web site.

For more info. visit their web-site at www.dhfs.wi.us/guide/spec/probdebt.htm

KATIE BECKETT PROGRAM

WISCONSIN MEDICAID ELIGIBILITY AND BENEFITS

The Katie Beckett Program is a special eligibility process that allows certain children with long term disability or complex medical needs, living at home with their families, to obtain a Wisconsin Medicare Card.

To find out more about the Katie Beckett Program go to http://dhfs.wisconsin.gov/bdds/kbp/