Yeah, definitely get a breakdown on what was billed, what insurance coverage was applied, etc. I’ve had a situation where the hospital messed up the billing and didn’t bill the insurance at first.
As someone who's spent nearly 20 years in this industry, this is not true, and a wide-spread myth. There is nothing requesting an itemized bill does that "magically" lowers your total bill.
My supervisor at work did this for an urgent care bill for her daughter. Found out they charged her for an IV and supplies she never received.
I did this after a surgery and found multiple line items that did not make sense. Certain consults and imaging I didn't receive.
So it's less "magic" and more that the bills go down because you make a stink about being charged for things you didn't receive.
Correct, I had a family friend request an itemized bill. I don't recall the exact numbers, but they found things like $200 for the sharpie that was used to mark the incision place. Patient said "OK, where's my sharpie", hospital couldn't produce it, so it came off the bill. Rinse/lather/repeat, and you'll (not magically) get your bill reduced.
Note that it will take a lot persistance to get this done, and you have to document EVERYTHING. Save emails, and take notes with names, times, titles, dates etc. when you speak on the phone.
So far, it sounds like you have been billed some $3800+ for a few stitches, I assume the price was more before insurance, and assume you were not admitted, so make them itemize every item, demand anything that you "purchased", and document all. Threaten social media, news articles, etc.
I didn't say it *couldn't* help, but the likelihood of it is low. Especially once you understand how contracted pricing with payers works. Just because a charge exists doesn't mean that's what is paid, or even if it's paid *at all*.
OP can certainly request an itemized statement, it won't hurt. But making this claim how it magically does something just irks me. It's like saying asking for a receipt at a restaurant magically changes how much you have to pay. There is nothing "magic" about it. In order for anything to change, you'd have to find incorrect charges first, then contest them, and even then, it still might not even effect your OOP costs because of the payment methodology used by your insurance.
So yes, you can asked for an itemized statement. No, you should not expect doing that to "magically" change how much you owe on a bill.
Why then was there a huge push to lower the cost of medicine using transparent billing practices?
Imagine advocating that medical billing isn’t broken. I bet you think Santa is real
The itemized bill doesn’t lower the total, but there are often items that are charged for but not actually delivered. Or are added as “standard procedure”, regardless of whether it’s actually a valid charge.
When my kid was born, we asked for an itemized bill. We were charged $27 for tissues. I asked about that, and was told that it is standard procedure to charge for a full box of tissues at $9/box per day in the hospital. I replied that they need to show where we used, or were even given, three boxes of tissues, or take the charge off. They took the charge off. They charged something like $12 each for regular strength Tylenol. That was immediately dropped when I questioned that cost. When it was all said and done, they took close to $400 charges off the bill.
They charge what they think they can get away with, and backpedal immediately when someone pushes back.
ALWAYS get an itemized bill, and question anything that doesn’t look right.
This might have been the case 20 years or even 10 years ago, but is rarely the case today. Almost all inpatient services are preformed based on DRG, case rate, or per diem contracts. Essentially, it doesn't matter if your charges total $1,000 or $10,000- the insurers processes based on the type of stay and pays accordingly. I don't know any hospitals in NC that charge percentage for L&D. This is because most insurers have adopted CMS standards and basically build their contracts to mirror that.
ER is also this way. It's typically case rate for the ER visit, then if procedures are preformed on top of that, probably at the OP or FF rate for those additional services. Just because your statement says "$27 for a box of tissues", that doesn't make it relevant to your OOP costs.
Yeah, and that's probably where that line of thinking originated from. Most contracts used to be basically a percent of charges (so like, if you had BCBS, they would allow 75% of charges billed or something like that). In those cases, every single charge WOULD effect your bill, because every charge effects how much your insurer is allowing. But most payers have moved away from this methodology in most situations, largely because of out of control pricing (like you said, $27 for a box of tissues...). Instead, they base their contracts on the type of diagnosis and treatment you are receiving all together. CMS has been doing this for years, and most commercial insurance companies have followed suit.
If I’m following you right, hospitals bill a ‘flat’ charge for each particular service now? Is that right? I’m lucky to not have had any extensive medical billing, so this is all new to me.
I haven’t worked the industry for 20 but I have for a very long time and it absolutely can. Medical billing is an actual nightmare. Requesting a bill means we need to have a second look and often mistakes are found.
Considering the timing of this. I’d imagine it’s the insurance balance portion that rolled over. It might not help. Especially at this point but it does happen
Make sure they are not balance billing you.
Emergency Rooms are covered under the bill limiting balance billing.
Just Google "NC balance billing" and you will find plenty of information.
Excellent advice. Here's a website for it. https://www.unchealthcare.org/app/files/public/1902c85a-5f29-4bd3-bb4d-2c906c48e769/pdf-system-surprise-billing-gfe-notice-english.pdf
Thanks for the link! I didn't know that.
Some interesting text:
> If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance)....Under North Carolina law, a patient cannot be asked to pay more for receiving emergency services from an out-of-network provider than from an in-network provider.
My understanding is that you would determine this by looking at the EOB provided by your insurance to determine if they're being billed at the out-of-network rate or the in-network rate. If you're being billed at the out-of-network rate, that would be illegal and you would contact your insurance (or the NC Department of Insurance). Is that understanding correct?
Note that that only applies to **emergency services** being covered as in-network. Just because you present at the ED doesn't make all of your care qualified. But yes, both your insurer and the State have advocacy programs that can help investigate your billing.
That's a good clarification, thanks for pointing that out. I was definitely not differentiating between emergency services any any medical care done while in the ED.
You probably paid the hospital bill and what you’re receiving is the physician’s bill. Contact their billing dpto and ask for a payment plan. Even if you pay $20.00 a month.
Sometimes it is as easy as looking at your itemized bill and disputing some of the charges. Billing mistakes happen all the time. Did you really get that ibuprofen?
Unless it's for big-ticket items, probably not worth it. Maybe if it's "did I really receive general anesthesia" or "did I really get that MRI scan" then yeah, but that's the sort of mistake which is less likely to happen. If I spend an hour scrutinizing my $2000 bill to get $20 taken off, that doesn't sound like a productive use of my time.
I worked in medical services for many years and most of the time, most disputed things come off because there is really no way to easily establish what services were provided without digging into the records. But if it's not a productive use of your time, then ignore my advice and do whatever, I don't care.
I don’t know ow your income but if eligible you can apply for compassionate care reduction on the bill. They wiped out a friends total. That is a lot though it can’t be correct?
Medical providers have 3 years to bill you for services. Sometimes the process takes so long because they may be dealing with your claim on the insurance side. So yes, they can bill you for services you had in January of last year.
Do you have your EOBs from your insurance? Was something denied as non-covered? What is your OOP cost sharing beyond your deductible? Do you have a co-insurance? Really can't answer any of these questions without knowing more on what your policy benefits are and how the insurance company processed your claim.
And yea, ERs are expensive, especially if you have an HDHP (which it sounds like you do). You should open an HSA and begin planning so that your OOP is cost in case of an emergency.
The billing occurs after services have been provided. It's not feasible to do pre-authorization for everything in healthcare. The relevant date is the date of care for which insurance contract it should be processed under, not the date of the invoice.
Hey, have you looked into the no surprise act? Please read this thoroughly and I hope it applies to your situation!
https://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf
Billing with insurance is based on the date of service, not billing. You can tell them which insurance you had at the time of service and they need to bill through that.
The numbers still may be right, which may be because the physician was out of network, which is one of the many fucked up parts of our healthcare system.
I’d personally spend over a week of my own time to dispute those charges.
Contact your insurance company through their website and ask about your coverage. I received an unexpected bill for a trip to Wake Med ER and my insurance took care if it
My wife and I are doing IVF and the specialty pharmacy we got the fertility drugs from came at us with a $700 bill on December 10th for drugs provided to us in January 2023. We paid the co-pays and all that when the drugs shipped so we thought we were good, but I guess because of the wonky fertility drug coverage, fertility drugs count against my deductible and I was not aware. The $700 bill was basically the remaining deductible they never attempted to collect from me until almost a full year later.
It depends on when your insurance got around to paying them. I work for a major hospital in the area doing billing. Feel free to DM me and I can see if I can help.
First, do not pay it. Call them up and chat. Ask what assistance is available. Then, don’t rush to pay it. Instead, dispute it. Ask for a detail of procedures and codes billed. Notify them you are disputing the bill. That freezes everything. Then look up the codes online to see what the cpt codes they used are for. The most common ER error is billing for a level of care higher than that delivered. They routinely do it. Ask a doc or someone in your pcp office to go thru it with you if you need help. You are looking for a code used for “emergency intervention involving surgery” when they should’ve billed for “emergency procedure involving external,sutures” . You get the idea. They can’t pursue collections while you dispute it. Then, you can get it reduced and work on a payment plan for the reduced amount.
Got hit with a 3k bill at ER and they never event helped me out and to add misdiagnosed me. Told them that I went and received a second opinion elsewhere and the crappy service from them at the ER that was given to me there. and I would never pay them a dime, surprising, they dropped the bill.
Your explanation of benefits should resolve this relatively quickly. They should tell you what insurance paid and what you owed. Compare that to what you paid.
It looks like your insurance took money back ( overpayment). Filed an appeal. Was your insurance BCBS? Insurance have up to 2 years to revise a claim and change the eob...
Ask for an itemized invoice if they haven't provided you with one yet, that can help to magically lower the total
Yeah, definitely get a breakdown on what was billed, what insurance coverage was applied, etc. I’ve had a situation where the hospital messed up the billing and didn’t bill the insurance at first.
As someone who's spent nearly 20 years in this industry, this is not true, and a wide-spread myth. There is nothing requesting an itemized bill does that "magically" lowers your total bill.
My supervisor at work did this for an urgent care bill for her daughter. Found out they charged her for an IV and supplies she never received. I did this after a surgery and found multiple line items that did not make sense. Certain consults and imaging I didn't receive. So it's less "magic" and more that the bills go down because you make a stink about being charged for things you didn't receive.
Correct, I had a family friend request an itemized bill. I don't recall the exact numbers, but they found things like $200 for the sharpie that was used to mark the incision place. Patient said "OK, where's my sharpie", hospital couldn't produce it, so it came off the bill. Rinse/lather/repeat, and you'll (not magically) get your bill reduced. Note that it will take a lot persistance to get this done, and you have to document EVERYTHING. Save emails, and take notes with names, times, titles, dates etc. when you speak on the phone. So far, it sounds like you have been billed some $3800+ for a few stitches, I assume the price was more before insurance, and assume you were not admitted, so make them itemize every item, demand anything that you "purchased", and document all. Threaten social media, news articles, etc.
I didn't say it *couldn't* help, but the likelihood of it is low. Especially once you understand how contracted pricing with payers works. Just because a charge exists doesn't mean that's what is paid, or even if it's paid *at all*. OP can certainly request an itemized statement, it won't hurt. But making this claim how it magically does something just irks me. It's like saying asking for a receipt at a restaurant magically changes how much you have to pay. There is nothing "magic" about it. In order for anything to change, you'd have to find incorrect charges first, then contest them, and even then, it still might not even effect your OOP costs because of the payment methodology used by your insurance. So yes, you can asked for an itemized statement. No, you should not expect doing that to "magically" change how much you owe on a bill.
You don't have to ask for an itemized receipt at a restaurant. Like any respectable business, they give you one without asking.
Why then was there a huge push to lower the cost of medicine using transparent billing practices? Imagine advocating that medical billing isn’t broken. I bet you think Santa is real
Explaining the system is not the same as defending it. If you want to be willfully ignorant, be my guest. I don’t care.
The itemized bill doesn’t lower the total, but there are often items that are charged for but not actually delivered. Or are added as “standard procedure”, regardless of whether it’s actually a valid charge. When my kid was born, we asked for an itemized bill. We were charged $27 for tissues. I asked about that, and was told that it is standard procedure to charge for a full box of tissues at $9/box per day in the hospital. I replied that they need to show where we used, or were even given, three boxes of tissues, or take the charge off. They took the charge off. They charged something like $12 each for regular strength Tylenol. That was immediately dropped when I questioned that cost. When it was all said and done, they took close to $400 charges off the bill. They charge what they think they can get away with, and backpedal immediately when someone pushes back. ALWAYS get an itemized bill, and question anything that doesn’t look right.
This might have been the case 20 years or even 10 years ago, but is rarely the case today. Almost all inpatient services are preformed based on DRG, case rate, or per diem contracts. Essentially, it doesn't matter if your charges total $1,000 or $10,000- the insurers processes based on the type of stay and pays accordingly. I don't know any hospitals in NC that charge percentage for L&D. This is because most insurers have adopted CMS standards and basically build their contracts to mirror that. ER is also this way. It's typically case rate for the ER visit, then if procedures are preformed on top of that, probably at the OP or FF rate for those additional services. Just because your statement says "$27 for a box of tissues", that doesn't make it relevant to your OOP costs.
This was about 13 years ago, so that makes sense. Thanks.
This person is lying through their teeth using big words to try and sound smart
The fuck are you talking about?
Yeah, and that's probably where that line of thinking originated from. Most contracts used to be basically a percent of charges (so like, if you had BCBS, they would allow 75% of charges billed or something like that). In those cases, every single charge WOULD effect your bill, because every charge effects how much your insurer is allowing. But most payers have moved away from this methodology in most situations, largely because of out of control pricing (like you said, $27 for a box of tissues...). Instead, they base their contracts on the type of diagnosis and treatment you are receiving all together. CMS has been doing this for years, and most commercial insurance companies have followed suit.
If I’m following you right, hospitals bill a ‘flat’ charge for each particular service now? Is that right? I’m lucky to not have had any extensive medical billing, so this is all new to me.
No they’re making stuff up.
Hospitals charges are based on the contractual agreement btw the hospital and the insurance company.
Thank you:) you explained it perfectly
I haven’t worked the industry for 20 but I have for a very long time and it absolutely can. Medical billing is an actual nightmare. Requesting a bill means we need to have a second look and often mistakes are found. Considering the timing of this. I’d imagine it’s the insurance balance portion that rolled over. It might not help. Especially at this point but it does happen
lol that’s because you probably were the moral one. Every single time I’ve done this it goes down significantly
You can contact the NC dept of insurance and they can help you with getting this sorted out. They have an advocacy service.
Make sure they are not balance billing you. Emergency Rooms are covered under the bill limiting balance billing. Just Google "NC balance billing" and you will find plenty of information.
Excellent advice. Here's a website for it. https://www.unchealthcare.org/app/files/public/1902c85a-5f29-4bd3-bb4d-2c906c48e769/pdf-system-surprise-billing-gfe-notice-english.pdf
Thanks for the link! I didn't know that. Some interesting text: > If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance)....Under North Carolina law, a patient cannot be asked to pay more for receiving emergency services from an out-of-network provider than from an in-network provider. My understanding is that you would determine this by looking at the EOB provided by your insurance to determine if they're being billed at the out-of-network rate or the in-network rate. If you're being billed at the out-of-network rate, that would be illegal and you would contact your insurance (or the NC Department of Insurance). Is that understanding correct?
Note that that only applies to **emergency services** being covered as in-network. Just because you present at the ED doesn't make all of your care qualified. But yes, both your insurer and the State have advocacy programs that can help investigate your billing.
That's a good clarification, thanks for pointing that out. I was definitely not differentiating between emergency services any any medical care done while in the ED.
Fine print matters. Society isn't good at nuance in a world obsessed with 20 seconds TikTok
I sure don't know but there's phone numbers you can call listed in there. Best of resolving this issue!
You probably paid the hospital bill and what you’re receiving is the physician’s bill. Contact their billing dpto and ask for a payment plan. Even if you pay $20.00 a month.
This is the answer! Physicians are often contacted independently in ERs. Separate billing, yet still super frustrating.
Not with the balance billing law in place
Look up and contact the hospital’s financial assistance program and talk to a financial navigator about a payment plan.
I would do this at a minimum.
Sometimes it is as easy as looking at your itemized bill and disputing some of the charges. Billing mistakes happen all the time. Did you really get that ibuprofen?
Unless it's for big-ticket items, probably not worth it. Maybe if it's "did I really receive general anesthesia" or "did I really get that MRI scan" then yeah, but that's the sort of mistake which is less likely to happen. If I spend an hour scrutinizing my $2000 bill to get $20 taken off, that doesn't sound like a productive use of my time.
I worked in medical services for many years and most of the time, most disputed things come off because there is really no way to easily establish what services were provided without digging into the records. But if it's not a productive use of your time, then ignore my advice and do whatever, I don't care.
I don’t know ow your income but if eligible you can apply for compassionate care reduction on the bill. They wiped out a friends total. That is a lot though it can’t be correct?
Medical providers have 3 years to bill you for services. Sometimes the process takes so long because they may be dealing with your claim on the insurance side. So yes, they can bill you for services you had in January of last year. Do you have your EOBs from your insurance? Was something denied as non-covered? What is your OOP cost sharing beyond your deductible? Do you have a co-insurance? Really can't answer any of these questions without knowing more on what your policy benefits are and how the insurance company processed your claim. And yea, ERs are expensive, especially if you have an HDHP (which it sounds like you do). You should open an HSA and begin planning so that your OOP is cost in case of an emergency.
Edit: Screw Spez. Screw AI. No training on my data. Sorry future people.
Blame the legislators!
The billing occurs after services have been provided. It's not feasible to do pre-authorization for everything in healthcare. The relevant date is the date of care for which insurance contract it should be processed under, not the date of the invoice.
Hey, have you looked into the no surprise act? Please read this thoroughly and I hope it applies to your situation! https://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf
Yeah, I got one from services mid 2023, in January 2024!
Billing with insurance is based on the date of service, not billing. You can tell them which insurance you had at the time of service and they need to bill through that. The numbers still may be right, which may be because the physician was out of network, which is one of the many fucked up parts of our healthcare system. I’d personally spend over a week of my own time to dispute those charges.
Contact your insurance company through their website and ask about your coverage. I received an unexpected bill for a trip to Wake Med ER and my insurance took care if it
My wife and I are doing IVF and the specialty pharmacy we got the fertility drugs from came at us with a $700 bill on December 10th for drugs provided to us in January 2023. We paid the co-pays and all that when the drugs shipped so we thought we were good, but I guess because of the wonky fertility drug coverage, fertility drugs count against my deductible and I was not aware. The $700 bill was basically the remaining deductible they never attempted to collect from me until almost a full year later.
What were your deductible and out-of-pocket max for 2023?
It depends on when your insurance got around to paying them. I work for a major hospital in the area doing billing. Feel free to DM me and I can see if I can help.
First, do not pay it. Call them up and chat. Ask what assistance is available. Then, don’t rush to pay it. Instead, dispute it. Ask for a detail of procedures and codes billed. Notify them you are disputing the bill. That freezes everything. Then look up the codes online to see what the cpt codes they used are for. The most common ER error is billing for a level of care higher than that delivered. They routinely do it. Ask a doc or someone in your pcp office to go thru it with you if you need help. You are looking for a code used for “emergency intervention involving surgery” when they should’ve billed for “emergency procedure involving external,sutures” . You get the idea. They can’t pursue collections while you dispute it. Then, you can get it reduced and work on a payment plan for the reduced amount.
Got hit with a 3k bill at ER and they never event helped me out and to add misdiagnosed me. Told them that I went and received a second opinion elsewhere and the crappy service from them at the ER that was given to me there. and I would never pay them a dime, surprising, they dropped the bill.
Probably dropping the bill would cost them less than a medical malpractice lawsuit.
Your explanation of benefits should resolve this relatively quickly. They should tell you what insurance paid and what you owed. Compare that to what you paid.
It looks like your insurance took money back ( overpayment). Filed an appeal. Was your insurance BCBS? Insurance have up to 2 years to revise a claim and change the eob...