Hospital Billing Practices
Hospital bills can be very difficult for the average person to understand. According to the Georgia Fair Business Practices Act [O.C.G.A. Section 10-1-393(b)(14)], a hospital or long-term care facility has six business days after you have been released from its care as an inpatient to provide you an itemized statement of all charges for which you are being billed.
Even though you may have had only one hospital visit, you can expect to receive a bill from each provider. In addition to the hospital itself, this might include the emergency department, the radiologist, the admitting physician, the consulting physician and the anesthesiologist. If your primary care physician referred you, you will probably also get a bill from him or her.
If you have insurance, be clear on what it covers. Insurance handbooks have a list of “excluded” procedures that you will have to pay for if they are performed. Be sure to read your benefits manual, call the insurance company, or ask at work about your employer-sponsored plan, so that you know which procedures are covered. You should not rely on the information provided by your doctor. Ultimately, you are financially responsible for all authorized medical procedures and must pay the portion of your bill your insurance company does not cover.
Physician fees are not regulated or capped. Usually, insurance companies set the amount they are willing to pay for a particular treatment; but physicians are allowed to charge as they see fit. Under Georgia law, you have the right to inquire in advance about estimated charges for routine office visits, routine treatments and lab tests (O.C.G.A. Section 43-34A-5).
How to Catch Hospital Billing Errors
If you can, make a note of all tests, treatments, medications and equipment involved in your care. After you get your hospital bill, you have the right to review it and dispute any charges. Taking a few minutes to look it over could save you hundreds of dollars. Ask someone at the doctor’s office or hospital to review any charges you don’t understand.
Even if you have insurance, the cost of billing errors will affect you through the premiums and the charges you pay. Try this strategy to catch common errors:
- Make sure you are charged for the correct length of stay and the right kind of room.
- Be alert for duplicate billings, particularly if you receive several bills. For example, if you have bills for inpatient and outpatient services, make sure the same charge does not appear on both bills. If a test was canceled and rescheduled, check that you were not billed for the canceled test.
- Watch for phantom charges. Many hospitals automatically impose a set of standard fees for procedures they usually perform in connection with certain services, such as the standard battery of tests administered when patients enter the hospital. If you refuse or don’t need some of the tests, make sure you’re not billed for them; the hospital may have neglected to erase these charges from your records.
- Watch for “unbundling,” a creative form of billing in which hospitals make it difficult to determine the total cost of a procedure by listing separate fees for each step. If you add up the unbundled charges, you may discover that the total is more than your insurer considers standard or acceptable for the procedure. Should your insurer refuse to pay the inflated cost, you may be stuck with the overcharges.
- Look for charges for items you didn’t request and for unused items. A hospital may offer a standard kit of supplies when you’re admitted, often with a hefty markup. If you don’t accept some of the supplies, you shouldn’t have to pay for them. Similarly, if you take only a couple of aspirin, you shouldn’t be charged for the entire bottle.
- If you do find errors, contact the hospital’s billing office or patient representative. If they have already filed an insurance claim, call your insurance company.
Usually the mistake is a simple one that can be corrected by contacting the provider’s billing office and, if necessary, your insurance company. However, there are times when mistakes are not accidental.
Filing a Complaint
It is your responsibility to try to resolve billing issues on your own. Be sure to document any phone calls you make as part of this effort.
You should contact the Governor's Office of Consumer Protection only if you were confined to the hospital overnight or longer and did not receive an itemized bill within the required six days following your discharge; or if you believe the hospital made an intentional attempt to defraud you, in violation of the standards of the Fair Business Practices Act.
If your bill is correct but you have a dispute with your insurance company over coverage, you would contact the Office of the Commissioner of Insurance.
Other types of complaints about hospitals, nursing homes and hospices are handled by the Department of Human Services’ Office of Regulatory Services.