We frequently get questions in the newsroom from people who don’t understand their bills, or who feel they’ve been overcharged. From complaints about your utility bill or cell phone statement to medical bills, we’ve heard just about everything.
That’s why we’re starting a new series at WECT called Understanding Your Bill. We’re going to give answers to some of the most common consumer questions and try to help you make sure you aren’t being ripped off.
We’ll begin with one of the most confusing bills of all: your medical bill.
Between constantly evolving insurance coverage, the complicated nature of medical procedures and coding, and the general stress that goes along with having to see a doctor when you are sick or injured, it can be tough for any of us to figure out what’s what on our medical bill when it arrives in the mail.
Karen Barbalace injured her collarbone in January, and the very next day strained her arm while trying to lift something. She then began experiencing intense swelling in her neck area and went to a local urgent care center for medical advice.
“I was not dying, I just was concerned over this swelling in my neck and didn’t want to have a stroke or something,” Barbalace explained.
A nurse suggested to her they could do an X-ray to assess her collarbone but said if she had soft tissue damage in her neck, she would need a CAT scan to see that. So Barbalace went to the ER at New Hanover Regional Medical Center (NHRMC).
A few hours later, she got her CAT scan results, which showed there was nothing medically dire about her injury.
It wasn’t until March that Barbalace got an Explanation of Benefits from her Blue Cross Blue Shield provider in the mail, showing New Hanover Regional Medical Center had charged $8,430 for her 3-hour hospital visit.
“No money [was] ever discussed,” Barbalace said of her sticker shock over the bill. “If someone had said, ‘This is going to cost you $8,000,’ I would have said, ‘Let’s do the X-ray, as long as it isn’t broken, I’ll take an anti-inflammatory and I’ll probably be okay.’”
Barbalace’s husband Phil was angry. He called NHRMC to protest the charges. After learning the Barbalaces had a high deductible health insurance plan, the hospital agreed to cut the bill in half if the Barbalaces paid cash and withdrew their claim with the insurance company.
NHRMC offered them an additional 25 percent prompt pay discount if they paid within 30 days, bringing the bill down to $3,161, which the Barbalaces agreed to pay.
“We charge everyone the same,” Ed Ollie, Chief Financial Officer for New Hanover Regional Medical Center explained of the hospital’s billing process. “But the insurance companies, Medicaid, Medicare all pay differently.”
Ollie says the hospital provides a Patient Financial Service Department, which receives 400-500 calls a day from patients calling with questions about how much a surgery will cost and what their insurance (if they have it) will cover.
He says many of the billing complaints he hears are from people who did not call in advance to inquire about cost and coverage.
He says obviously, that’s not possible in the event of a medical emergency. But for elective surgeries, try to do your homework on the cost in advance so you can make the best financial decisions.
Ollie said patients are also often upset by the fact they receive bills from multiple health care providers after a hospital stay.
“I think they understand that they are going to get a hospital bill, and many people think that it’s a total, inclusive bill. And includes all the physician’s charges. And it doesn’t. They’ll receive those bills separately. And I think when they are home and when they get the hospital bill, and then they start getting their physician bill, it gets even more confusing to them,” Ollie explained.
The hospital bill only covers the cost for the facility and support staff, not the cost of the actual procedure performed by a physician.
Adding to the confusion, a patient may never see some of the doctors who render care during a hospital stay and then send you a bill. Radiologists who interpret X-rays, pathologists who read labs, and anesthesiologists all bill separately.
Like the Barbalaces, some patients get upset that doctors don’t warn them about the cost of a procedure before ordering it. But Ollie says a physician’s expertise is providing medically appropriate care given your symptoms, not delving into the finances of the cost of a procedure or what a patient’s insurance covers.
“They don’t tell you what the cost is because many times they don’t know the cost,” Ollie explained of the charges for various medical procedures. “And when you have as many thousands of line items as we have, very few people could tell you off the top of their head what the price is.”
The overhead cost of keeping the hospital doors open 24 hours a day, 7 days a week is also built into the cost of medical procedures. And the people who pay their bills absorb the hospital’s cost of providing indigent care to people who receive medical care at a hospital but have no means to pay.
Outside of the hospital, bills from private physicians’ offices are also the source of considerable confusion. WECT recently received a call from a viewer who was upset she was billed for an “emotional assessment” after going to a local urgent care facility for a sinus infection.
After she complained, the medical provider removed the $9 charge for the emotional assessment from her bill. It was unclear whether the patient was billed for that assessment in error, or if the urgent care provider simply removed the charge as a courtesy.
Regardless, it is possible that a doctor may see the need to treat you for a medical issue that is not the primary issue that sent you to the doctor’s office.
If you went to the doctor with a sore throat, but the doctor suspects you have cancer after examining you, they will likely do more than treat your sore throat.
Similarly, if you go in for a sinus infection but exhibit behavior that indicates you are a harm to yourself or others, the doctor will likely try to address your mental health issues.
Once the doctor-patient relationship exists, a doctor must provide the accepted standard of medical care or risk being sued.
Even though the cost of medical care is extremely expensive, there are ways to save. If you don’t have insurance, or if your deductible is so high that for practical purposes you pay everything out-of-pocket, ask your doctor or the hospital about self-pay or cash-pay discounts.
“The goal is to make sure that…somebody without means, or without the ability to have insurance isn’t charged more than someone who has an insurance policy at Blue Cross Blue Shield,” Ollie said of the rationale for offering the discounted rates.
In addition to self-pay and prompt-pay discounts, NHRMC also offers interest-free financing for the first 12 months if you need to set up a payment plan to pay off a medical bill.
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