When Ritter Elizabeth Hoy, 33, went to an emergency room in Oxford, Ohio, last summer, she spent approximately six hours undergoing tests until she was sent home with some codeine for her pain and no diagnosis. The following day, very much in pain, Hoy found another hospital, where the physician took an X-ray – something the ER doctor didn’t do the day before – and concluded Hoy had two broken ribs.
"It was my own stupid fault," says Hoy, who had attempted to move a refrigerator on her own in her apartment.
Not long afterward, Hoy, a marketing professional, became sick again – this time, from her hospital bills. The first emergency room visit cost four times more than the second and didn’t even conclude that she had broken ribs.
"It's an absolute scam," says Hoy, who has come to hate hospital bills, never mind that her father worked 25 years as an ER doctor. In fact, two months after her broken ribs, she was spending time with a relative in Florida when she fainted and wound up in another hospital. She didn't stay overnight, but the bill was $10,000.
"I didn't care as much about that," Hoy admits. "By then, my deductible was paid."
Everyone knows hospital billing is out of control, but the bills often produce sticker shock because of hidden costs, charges patients have no idea are coming. Of course, rarely does someone know exactly how much an operation or hospital stay will cost at the outset. But even in the most predictable of situations, hospital costs vary greatly, and mistakes occur often. How often? According to Medical Billing Advocates of America, a national association that reviews medical bills for consumers, 80 percent of hospital bills contain errors.
In 2012, The Cleveland Plain Dealer ran a series of articles examining medical billing and found that at a typical hospital, as many as 289 people put information in your chart that will determine the final price on your bill, assuming you are having surgery and staying in the hospital for four days. That includes intake workers (who take your information), physicians, nurses, billing coders and "many others along the way," as the Plain Dealer noted.
Still, if you're aiming to manage your hospital-related costs before a procedure or you want to undo some of the financial damage after the bill comes, here's what you should look for.
Facility fees. You may pity the administrator who has to explain this fee to a disgruntled patient. Facility fees, sometimes referred to as provider-based billing, can occur after a hospital buys a doctor's practice. If you get a medical test at a doctor's practice owned by a hospital, you may get charged a facility fee that can easily cost hundreds of dollars. And what are you paying for? The hospital's extra overhead. You probably won't be able to negotiate that after a procedure, but you may be able to avoid it if you discover this charge beforehand.
Double billing. Sometimes doctors perform two or more procedures during the same surgery and bill you as if you went into surgery two or more times. There are also news reports of physicians coming into rooms and looking at a chart and then billing the patient for it – even when there's another doctor already overseeing and billing the patient. At some hospitals, you may be checked out by someone lower on the totem pole than the doctor, who is nevertheless around to supervise. So you get a bill from the certified registered nurse and the doctor. In many instances, this isn't supposed to happen, and while your insurer should catch these mistakes, you should also be on the lookout.
Overcharges. This is just what it sounds like – being billed for a service at a price higher than most hospitals charge. Most people don't have a good sense of what one should pay when they're sick, but you can get a better idea about how much medical procedures and physician services in your area cost on Fair Health's website, specifically its Consumer Cost Lookup tool.
Other health care services comparison sites include healthcarebluebook.com and clearhealthcosts.com.
Another possible overcharge is if you were charged for a brand name medicine when a generic was available. You might be able to argue with a hospital administrator that you shouldn't have to pay for a more expensive drug when you could have been prescribed a cheaper equivalent.
Rogue fees. Patients will sometimes discover charges for rogue items like gloves, which should be included in the operating room fee. Or you might get billed for a toothbrush or comb, which should be included in the cost of your hospital room.
Fees involving time. If you're charged for the time you spent in your room on the day you were discharged, most insurance plans won't allow that. You might have some luck arguing that, like a hotel, a hospital shouldn't bill you for the several hours you spent there that morning. (Of course, the hotel analogy, with checkout times normally at 11 a.m. or noon, may not wash if you didn't leave the hospital until 2 p.m.)
And presumably accidentally, sometimes hospitals will bill you for more time than you actually spent in the operating room. So that's something you should keep an eye out for, in case you suspect it added an extra half-hour or so. It can make a real difference. Hospitals charge for operating rooms by the minute, not the hour.
Small wonder that one in four American families struggled to pay medical bills in 2012, and 10 percent of Americans couldn't pay any of their medical bills, according to a survey released earlier this year by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. (The survey used 2012 data, collected from 43,345 families.)
So if you find hidden charges on a hospital bill, especially if it's after a procedure, surgery or hospital stay, can you negotiate the price down? The answer is a definite maybe, according to Robin Gelburd, president of Fair Health.
a living laboratory we're in right now," Gelburd says. "We're in the
process of dramatic changes in the health care industry."
Corrected on April 9, 2014: A previous version of this story misspelled Robin Gelburd's name.