Medical Billing Confusion: Do You Know What You're Paying For? -

Medical Billing Confusion: Do You Know What You're Paying For?

By Tracey Early

The rising cost of health care and what you are paying for it can be astounding. It starts with the bill. Many of us get it in the mail, pay the portion owed and toss it aside. But do you really know what you're paying for? Many people don't.

Tony Walker says his wife Lacy is the love of his life. But a car accident in the 1990s had him fearing for her life.

Lacy survived but suffered brain damage which led to countless trips to doctor's offices and testing at Greenville Hospital System’sRogerC.PeaceRehabilitationHospital.

“They gave us a lot of information,” said Tony. “They gave us a lot of hope.”

That hope turned to confusion when they got the itemized bill, charging for a visit Tony says they never had.

“When I looked at it and it said two hours service at $375 an hour, I knew it was wrong because we were not there on 9/27,” said Tony.

He then called Greenville Hospital System and his wife's insurance company for answers.

Pat Palmer, Founder of Medical Billing Advocates of America says cost confusion among consumers is a crisis.

"It's like you're paying blindsided,” said Palmer.

She trains health advocates across the country to help patients sort through their billing, because that confusion could be because of a mistake.

“We've estimated that at least 8 out of 10 bills that come through our office contain errors,” said Palmer. “And I'm being conservative.”

One of the advocates Palmer works with agreed to help with theWalker's case.   

Her advice: Ask for a copy of the medical records for each visit and the billing codes used.

So we went searching for answers.

“The day you contacted Greenville Hospital System, I received approximately a half a dozen calls from them,” said Tony. “Finally someone tells me, yes, we were not there.”

It turns out that two hour visit on 9/27 wasn't an error. It also wasn't for testing as seen on the bill.   

It was for paperwork, six pages.

“There was not differentiation in fees charged for office visit, testing or anything. It's all a flat $375 fee,” said Tony.

GHS says it’s required to use the codes, which are set by the American Medical Association.

Lynn J. Waters, Director of GHS revenue cycle responded with a statement that reads in part:

"We aim to be transparent and provide our patients the information that they need to make informed decisions about their personal care and costs they are incurring. At the same time, as health care has advanced technologically, methods of documentation and billing have also become more complex. We recognize this and strive to continually improve our patient education process.

GHS has made significant changes to its billing process over the past several years to help make the billing process more transparent and patient-friendly. Improvements include reformatting the bills to make them easier to read and a tool that allows patients to better estimate their portion of a bill before services are performed.

We cannot discuss specifics of individual patient care with you because of healthcare confidentiality issues. The Current Procedural Terminology (CPT) codes you’ve asked about are set by the American Medical Association. The CPT code set describes medical, surgical and diagnostic services and includes some codes that allow time for test interpretation and report preparation.

The CPT code set is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations and payers. GHS and other healthcare providers are required to use the codes.

GHS values its patients and understands that questions about billing may arise. Patients who have questions about any bill are urged to contact GHS’ 24-hour customer service accounts line at 864/454-8611 or 800/998-8995. Patients may also meet in person with a patient account representative or a financial counselor at 255 Enterprise Boulevard. Patients are urged to reach out as soon as questions arise so that issues can be quickly resolved."

As a courtesy, GHS did agree to write-off the Walker's portion of their cost. Tony is grateful for the gesture but says their otherwise positive experience will forever be tarnished by a bill.

“I hate that I had to call 7 On Your Side, but now I am tickled to death that I did,” said Tony.

GHS couldn't speak directly about theWalker's case because of privacy issues, but encourages any patient who has a question about a bill to call as soon as they notice the issue. The GHS 24-hour customer service line is (864) 454-8611 or (800) 998-8995.

The medical billing advocate that helped us with the Walker's case is Beth Morgan of Medical Bill Detectives. She can be reached at (203) 834-5028.

If you have a question about a medical bill at any facility, request an itemized bill so you can see exactly what you’re paying for. If you have a question, start by calling the facility. You can also request your insurance provider look into any questionable charges.

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