Common Hospital Billing Errors

“Unbundling” is another common cause for overcharges. When a hospital unbundles, it splits the price of a single medical procedure into several costs, then bills you for each one. Instead of charging you P 2,500 for an emergency hysterectomy, for instance, it would charge you P 2,000 each for removal of your fallopian tubes, ovaries, and uterus, at a total cost of P 6,000. While unbundling is not technically illegal, it is considered by PMA standards. Confront the hospital’s billing department and withhold payment until the charges are properly explained if you suspect such practices.

Being charged more than once for the same procedure is another source of billing errors. Sometimes this is due to an administrative mistake. At other times it results from a technician’s insistence on repeating a test. Refuse repeated tests unless they are medically necessary, then study your bill for duplicate charges; if a test is repeated because of a technician’s error, you should not have to pay for it.

Your bill will also be fatter than it should be if it contains “exploding tests,” a process by which separate tests from several samples are conducted, when a combined test from a single sample could produce the same results. If you are charged for a number of tests and only recall having one or two, you may be a victim of “exploding tests.”

If you are suspicious or do not understand any part of your bill, make sure a hospital representative explains it to you. If your insurance company refuses to pay a part of your bill that you thought you were covered for, check for inappropriate or unethical billing practices on your bill before you question your insurance company.

Ask your doctor or your hospital’s billing office for the name, fee, and billing codes of the procedures you will undergo during your hospital stay. When you receive your bill: 1) Check that your insurance company’s name and your group number is correct 2) Look for the name of a hospital contact in case you have questions. 3) Make sure the “Service Date” column lists the correct dates you received each procedure. 4) Check that the billing codes refer to specific procedures you received. 5) Check that the “Summary of Charges” itemizes each of the procedures you received. 6) Scrutinize each corresponding charge. 7) Make sure the amount that your insurance company will pay reflects a reasonable and accurate percentage. 8) Check that the amount you must pay is correct.