In March 2020, at the dawn of the Covid-19 pandemic, Chicagoan Sandra Washington felt ill, and the extreme fatigue she was experiencing continued to worsen.
“I was just literally a body. I didn’t have any feelings. My whole system was drained and depleted,” Washington says.
Her husband took her to the emergency room, where she tested positive for Covid-19 and was admitted for treatment. Two days after her discharge, she received a hospital bill.
“The bill didn’t say, ‘Covid.’ It said, ‘pneumonia,’” Washington says.
This distinction was important. At the end of the month, Cigna Illinois, Washington’s insurance provider, announced it would waive cost-sharing for customers who were treated for Covid-19. So Washington, a community support specialist for Blue Cross Blue Shield, knew she wouldn’t be responsible for the cost of her stay.
But convincing the hospital to correct its error was no easy task. Washington made numerous calls to the hospital and her insurance company, but as time passed with no resolution, she became worried her credit would be harmed by a bill she shouldn’t have to pay.
Medical billing errors
Washington isn’t the only one concerned about medical billing errors. According to Becker’s Hospital Review, approximately 80% of medical bills may contain errors.
Individuals should review their medical bills, because there’s a strong possibility that the bills are incorrect when they arrive, says Avrom Fox, founder of Chicago Patient Advocacy in Skokie.
For instance, after surgery, an individual might receive multiple bills from different providers who were present during the procedure. Fox says it may be necessary to contact each physician’s billing department to understand which provider delivered what service and to negotiate the amount of the patient’s responsibility. “In many cases, the [providers] don’t communicate with each other,” he says.
Providers sometimes bill unnecessary charges, like medical equipment that isn’t correct for a patient’s care, says Teri Dreher, RN, founder of NShore Patient Advocates in Chicago. She recently reviewed a 21-year-old woman’s emergency room bill. She had been admitted for abdominal pain, but the bill had charges for leg wraps to prevent deep vein thrombosis.
“She’s a soccer player. She’s not going to get blood clots from being in bed for 24 hours,” Dreher says.
Reviewing and contesting your bill
Review your medical bills carefully to spot any mistakes. Start with these tips to understand your coverage and resolve medical billing errors.
- Study your policy. Start by reading your policy. “Don’t just shove it in a drawer when you get it but understand what your rights are,” Dreher says. Know the numbers, such as your deductible, co-payment, co-insurance, and out-of-pocket maximum. Check to see whether your healthcare providers are in network. When you understand your coverage, it’s easier to know whether you’ve been charged unfairly.
- Get organized. Organize your medical records and corresponding bills by date and provider, Fox says. Before you contest a bill, calculate the amount you believe you are responsible for and compare it to the statement. Keep a copy of your insurance card handy, or have a photo of it on your phone, because each time you call your insurance company, you’ll need it.
- Learn the chain of command. When you call your insurance company, you’ll usually speak to a customer service representative. But if you feel the representative is not addressing your issue, ask to speak to a supervisor. Many insurance companies have nurse care managers who can help sort out complicated claims with providers. It’s their job to keep as many calls out of the medical director’s hands as possible, so they are often eager to resolve your billing issue, Dreher says.
- Be polite. While you may feel frustrated by the amount of time required to resolve your bill, it’s important to communicate in a respectful manner. “If you start yelling, blaming, and calling names, then they just write you off as an angry person,” Dreher says. Often, calls are recorded, and customer service representatives can place notes in your file alerting other employees that you are difficult, which can work against you. An irate confrontation with the person on the other end of the line is counterproductive. “You have to develop a relationship with the person you’re dealing with, based on trust and transparency,” Fox says.
- Ask for help. Independent patient advocates, like Dreher and Fox, are part of a greater network of professionals who work on behalf of the patient’s interests rather than the institution’s. Greater National Advocates, an organization based in Chicago, maintains an online database of patient advocates. For a fee, independent patient advocates can help with insurance and billing issues, as well as speaking up for patients, coordinating care details, and communicating with medical staff.
Washington had multiple conversations with the hospital’s billing department and her insurance company. After five months of trying to resolve the issue, she threatened to take legal action. Eventually, the hospital corrected the error and voided the charges.
Patience and persistence pay off, Fox says. “If you’re willing to recognize that the process is not something that can be resolved in five minutes but could take five months, the chances are the results are going to be positive.”