Why YSK: Most hospitals send a summary bill (for example pharmacy: $5,000) hoping you’ll panic and just pay it. These are usually full of errors or huge markups. Before you pay anything, call the billing department and ask for an itemized bill with CPT codes. This will not only force a human to review it, but it also gives you the ability to spot BS. I tried this last year and the bill dropped by about 30% literally just because I asked, so don’t let them rip you off.
As a medical provider at a hospital I can attest that we really have little to no control over any of your medical billing. Not saying that mistakes don’t happen, we are dealing with tens of thousands of people and billing departments usually have a lot of employee turnaround.
That being said, the vast majority of things like duplicate bills, incorrect bills, and redundant documentation is a byproduct of dealing with private insurance companies.
Even if we’ve already done a prior authorization the insurance company can suddenly decide that we didn’t provide the exact right information, or that we didn’t have the right type of referral, or even used the wrong color of ink pen… They can deny a claim, which usually will prompt the billing department to automatically send you guys a bill. At which point you guys call us understandably upset, which prompts us to start the whole authorization process over again.
Dealing with Medicare and especially Medicaid is so easy compared to private insurance, as they have a very clear motive to erect as many reasons to deny or delay coverage as possible. The entire reason the American healthcare system is so archaic and management heavy is because we have to deal with private insurance.
I can guarantee the medical providers hate the situation more than anyone. The day after the United ceo got assassinated was one of the more jolly days I’ve seen at the hospital for years. It was almost unreal to hear my older and very uptight professional colleagues crack jokes about a man being murdered in provider meetings.