Medical Bill Mistakes: How Much It Could Have Cost Me

by Annie on March 19, 2012 · 3 comments

in Healthcare & Health Insurance

While trying to catch up on my reading in my RSS reader, a post from another blogger spark my memory of the medical bill mistake made by the hospital after the birth of my daughter last year. If you remember my discussion about delivery cost, I should only have to pay my co-pays for my office visits and nothing if I deliver in an in-network hospital. Imagine my surprise when I got a medical bill for approximately $900 a month after delivery.

This post is a discussion of my medical bill after labor and delivery and how I was able to reduce the medical bill mistake.

One medical bill for mom and one bill for baby

After delivery, any interaction the baby has with the hospital staff gets bill separately from mom. Normally the parents have 30 days to add the newborn to their health insurance plan. So this separate medical bill for the baby usually gets submitted to the health insurance under the mom’s name.

The pediatrician stopped by twice during my hospital stay — once to make fun of my husband for sleeping on my yoga mat on the floor and then to release us to go home because technically my daughter was born a month before her due date. For these half an hour visits, we were billed almost $300 each.

A medical bill mistake does not resolve itself

While trying to get over the initial shock of receiving a $600 medical bill for my daughter, a few days later I received another medical bill from the hospital for “other services.” Still reeling from exhaustion and overwhelmed from being a new mom, I did what a lot of people would have done. I put the medical bills on top of an existing pile of mail and promptly forgot about it. Deep down, I was hoping it would be a medical billing mistake and that it would straighten itself out.

When I finally call the hospital’s billing department several months later, I was told that my health insurance rejected their claim. To make matters even more complicated, during the initial 30 days after the birth of my baby, our family switched health insurance plan.

Investigating a rejected medical bill claim

My first call was to the hospital billing department to make sure the medical bill was not a mistake. Since they verified my health insurance information, I felt reasonably sure they have the correct information.

My next call was to my former health insurance to ask why my claim was denied. Years ago, I would be able to pull out the EOC (evidence of coverage) to get the details of my health insurance coverage, but these days I only get a summary during the open enrollment period for health insurance. So any questions that arose would have to be address through the health insurance’s customer service line.

According to my HMO, the premiums are split between the medical group and the health insurance. In my situation, the medical group is supposed to pay the hospital bill, not the health insurance. My health insurance recommends that I file an appeal with the medical group. Can you feel the run around starting?

When I call my medical group (not the hospital’s billing department), once again, they said that my health insurance is responsible for the medical bill. They are willing to start the appeal process. But I had to call back a week later to get my assigned case manager.

While amid all these long phone calls, I actually contemplate negotiating a reduction to the medical bill and paying it off. At this point, I think I’ve already spent several hours on the phone over a one week period.

Medical bill errors – a matter of coding

When I called to check on the status of my appeal, I asked the person from the medical group to verify my former health insurance.

“Are you sure we cannot submit the claim under a different code?” I asked.

Good thing I asked the question. Turns out, the hospital has been submitting the baby’s medical bill to the HMO for individuals instead of the HMO for the group plan. Of course the HMO for individuals would reject the medical claim; I was not even a subscriber. This medical bill mistake would have cost me $900 because the baby’s medical bill would still be rejected under the appeal process! One little coding error resulted in several hours of frustrated phone calls.

According to Consumer Reports, medical billing mistakes are more common than you know. 8 out of 10 medical bills from a hospital contain medical bill errors. Like my situation, most of us just pay our co-pays and only notice the hospital bill error when it is beyond the expected $30-$50 range.

So the moral of the story is to always ask to make sure they are coding the medical bill correctly when your medical claim is rejected by your health insurance.

Once the hospital billing department corrected the code for the medical bill, I paid $0. It took my entire maternity leave to resolve this even after they corrected the coding error.

Until next time and thanks for stopping by Small Steps to Health. If you like what you are reading, please share it with your friends.

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{ 3 comments… read them below or add one }

Ryan March 22, 2012 at 11:48 pm

I totally agree. Ever since I also got billed incorrectly last year, I always make sure to it to ask and make them explain cents by cents regarding the bill they are charging me.

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Kris April 22, 2012 at 7:14 am

Actually you were quite lucky that the original amount was a $900 error, on many, many occasions it is much more and can totally wipe out a person financially.

I’m actually attending a medical billing and coding program with the intent of eventually working for the consumer that feel overwhelmed when this occurs to them.

I’m glad that it worked out for you!

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asithi April 22, 2012 at 9:57 am

Kris, it is amazing how something as simple a medical coding error can result in the ruin of lives. And to add insult to injury, there is rarely compensation or even an apology. Thanks for your comment.

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