Medical Billing Errors Cost Elderly Thousands of Dollars
National reports show that 90% of medical bills have errors, according to Sheri Samotin, President of LifeBridge Solutions, a medical advocacy and elder care coaching organization.
Here are some examples of scenarios that happen all-too-often:
Medical Billing Error #1: Providers that are "out-of-network"
Jerry had a brain tumor surgically removed. He has insurance– a PPO plan. As long as Jerry used providers who are "in network," he would only have to pay his $250 deductible, which he had already met for the year. Jerry researched and found a neurosurgeon and hospital that are "in network," and the surgeon's office contacted the insurance company to pre-certify the inpatient admission. Two months after surgery, Jerry began to receive mail from the insurance company, the surgeon's office, the pathologist, the anesthesiologist, and the hospital. The bills stated that Jerry owed over $4,000 to the anesthesiologist because she was "out of network."
Jerry couldn't understand how the hospital, the surgeon, and the pathologist's charges were all processed as "in network" while the anesthesiologist's bill was not. Jerry couldn't imagine how he was supposed to ask as he was being wheeled into the operating room, "By the way, are you in network?" Rather, he assumed that if the doctor and hospital are both in network, and his surgery was pre-approved, then the charge from putting him under would be too. Jerry made several phone calls to the insurance company, and they told him there was nothing they could do because the doctor was not a participating provider. He called the doctor's billing service and they told him that he was responsible for the balance and they were going to send him to collections since his bill was 90 days past due.
Medical Billing Error # 2: Billing for procedures that weren't performed
An elderly man received a bill for his annual physical. The charges included a line for a pap smear, which even most lay people know is a test that is only performed on women. Had he reviewed the bill right there at the check‐out window, that charge would have been removed before the claim was ever sent in to the insurance. Now, he has made numerous calls to his insurance company – to no avail so far.
Medical Billing Error #3: Duplicate charges
Hospital bill that itemized 77 of the same item at $198 each. That's more than $15,000 of charges. This item is something that no one could have done to them 77 times in the space of a three-day hospital admission. Can you guess? We're talking about a urinalysis. Not only was the charge itself very high, but the number of tests just didn't make any sense. If this patient had requested and reviewed the bill, I'm pretty sure she would have picked this up.