Can you audit a hospital bill that I've already paid in full?
Can you audit my hospital bill even if the hospital has already sent it to a collection agency?
If you audit my hospital bill, do I have to pay the hospital in a lump sum, or can I still pay in monthly installments?
Why have I received separate bills with charges that duplicate some of the charges in my hospital bill?
Do you audit bills from physicians and other medical providers?
What do you need before you can start working on my hospital bill?
How long does the hospital bill auditing process take?
Why can't you audit hospital bills for people who have medical insurance?
Why won't you audit a hospital bill that is less than $10,000?
How long can a hospital wait after a hospitalization before it sends me a bill?
Why was I charged so much more than an insurance company would have been charged for the same services?
How can a hospital charge me so much when I was there for such a short amount of time?
What can you do about the outrageously high prices that the hospital charged me?
Why does the charge for a particular item vary so much from hospital to hospital?
How does a hospital justify charging me more for a single dose of a medication than my local pharmacy charges me for a thirty-day supply of the same medication?
Where are the links to this site's content pages?
Up to Top How much do you charge for auditing a hospital bill?
We audit on a contingency fee basis -- our fee is one-third of the amount of money that we save you. The amount that we save you is the difference between how much you owe the hospital before we audit your bill and how much you owe the hospital after we audit your bill. That takes into consideration any discount that the hospital offers you. Up to Top How much do you charge for reviewing my itemized hospital bill to determine whether auditing it would be worthwhile?
There is no charge for reviewing an itemized hospital bill to determine whether auditing it would be worthwhile. Nor is there any charge for providing you with information or for advising you, unless the amount of time required is likely to exceed one hour. For those who do not need to have a hospital bill audited but do need extended hospital bill consulting services, we work on a contractual basis for a fee of $250 for the first two hours plus $30 for each additional quarter hour. Up to Top What is the difference between a hospital bill review and a hospital bill audit?
When we review a hospital bill, we work only with the itemized hospital bill. When we audit a hospital bill, we work with both the itemized hospital bill and the patient's medical records. We determine whether each item for which there is a charge was actually provided to the patient, was ordered by a physician, was an item that can legitimately be billed to the patient and was consistent with the physician's diagnosis and overall treatment program. Each charge is also examined to see whether the amount of the charge is reasonable. We prepare an audit findings report -- a list of charges whose accuracy or validity we dispute and our reasons for disputing the charges -- and send it to the hospital. The hospital is expected to respond to the audit findings report either by producing documentation substantiating the accuracy and validity of the disputed charges or by removing them from the bill. The accuracy and validity of a charge may not always be clear cut, so we generally have to negotiate with the hospital to determine the proper disposition of some of the disputed charges. Up to Top What are the differences between a hospital bill auditor, a hospital bill consultant, a patient advocate and a claims assistance professional?
Hospital bill auditors spend most of their time auditing hospital bills. They are usually also hospital bill consultants, who review hospital bills and provide analysis and advice to their clients. Some of them work solely or primarily for self-funded health plans run by corporations, nonprofit organizations, unions, state and local governments and other organizations. If they work for individual self-pay patients, they are advocates for those patients.
Hospital bill consultants primarily review hospital bills and provide analysis and advice to their clients. Some negotiate or mediate on behalf of individual self-pay patients, which makes them patient advocates. Some of them audit hospital bills.
Patient advocates are primarily negotiators or mediators on behalf of individual self-pay patients. Some of them provide hospital bill consulting services; few of them audit hospital bills.
Claims assistance professionals work with individuals who have medical insurance. They help their clients file insurance claims and manage their medical bills. If they negotiate and mediate on behalf of their clients, they are patient advocates. Claims assistance professionals do not audit hospital bills.
We are hospital bill auditors who work for both self-funded health plans and individual self-pay patients. We offer hospital bill consulting services. We are patient advocates for our clients who are individual self-pay patients. We are not claims assistance professionals. Up to Top How much money can you save me by auditing my hospital bill?
Each hospital bill is unique. We cannot guarantee that auditing your hospital bill will save you any money, but we can generally reduce a hospital bill by at least 10 percent to 15 percent by auditing it; we often do two or three times as well as that. There is no way of knowing in advance how much we can reduce your bill or any other individual bill. We do not make predictions. Our only guarantee is that we will reduce your bill to the greatest extent possible. After all, the more money we save you, the more money we earn. Up to Top Can you audit a bill from a hospital in my state?
We can audit a bill from any hospital located in the United States. We never travel to a hospital to conduct an audit, so it doesn't matter where the hospital is located. No state requires a hospital bill auditor to have a state license or to audit a hospital bill at the hospital that issued the bill. Up to Top How old a hospital bill can you audit?
In theory, we should be able to audit any hospital bill that has an unpaid balance, regardless of the age of the bill or the size of the unpaid balance. In practice, the older the bill, the less likely a hospital is to respond to audit findings on the bill. There are no hard and fast rules, but it is usually very difficult to get a hospital to respond to audit findings on a bill that is more than two years old. Up to Top Can you audit a hospital bill that I've already paid in full?
Once you pay a hospital bill in full, you lose your leverage over the hospital. The hospital may refuse to accept audit findings on the bill. If it does accept audit findings on the bill, it may refuse to agree that any of its charges are incorrect or invalid. The only way to obtain a refund of charges that have already been paid, if the hospital refuses to refund the money voluntarily, is to sue the hospital. Most people aren't willing or able to do that. So the only way that we will audit a hospital bill that has been paid in full is on an either/or basis -- either an hourly fee of $250 for the first two hours and $30 for each additional quarter hour or one-third of the amount of the refund that we obtain, whichever is greater. That way, if the hospital refuses to refund overcharges voluntarily and you decline to take legal action against the hospital, at least we will be paid for the time that we spend working on the case. Up to Top Can you audit my hospital bill even if the hospital has already sent it to a collection agency?
Collection agencies aren't capable of responding to audit findings on a hospital bill, but they are often willing to negotiate a settlement of an overdue hospital bill account and frequently offer a larger discount than the hospital is willing to offer. On those occasions when a collection agency isn't able to negotiate a settlement with us, it will almost always return the account to the hospital. No reputable collection agency will take legal action to collect disputed hospital bill charges, and that is particularly true when a hospital bill auditing company is involved. When the validity of a debt is disputed, a collection agency has to include that fact in any report that it sends to the national credit reporting bureaus, so it rarely bothers sending a report in such cases. Up to Top If you audit my hospital bill, do I have to pay the hospital in a lump sum, or can I still pay in monthly installments?
You can make arrangements with the hospital to pay your bill in monthly installments whether or not you have the bill audited. In either case, however, you do have to work out a payment schedule with the hospital. You cannot simply assume that the hospital will accept a monthly payment without an agreement as to the amount of the payment. Also, you should be aware that it may be to your benefit if you can pay in a lump sum. We have found that many hospitals dislike having to deal with hospital bill auditors and will offer a substantial discount to avoid having to deal with our audit findings if our client can pay the discounted amount in a lump sum. When we are able to negotiate a discount, it is usually greater than the reduction that we could expect to obtain by auditing the bill. Up to Top Why have I received separate bills with charges that duplicate some of the charges in my hospital bill?
The separate bills that you've received are from physicians. Depending on what services you received during your hospital visit, you may receive separate bills from Emergency Room physicians, surgeons, anesthesiologists, radiologists and other medical providers. Very few physicians are hospital employees. Some work for physician groups that staff hospital departments on a contractual basis, some are private practitioners with hospital privileges, and all bill separately for the services that they provide. Certain services have both a technical component (the hospital charge) and a professional component (the physician charge); the charges in the physician bills do not duplicate the charges in the hospital bill. Up to Top Do you audit bills from physicians and other medical providers?
Bills from physicians and other medical providers cannot be audited the way that itemized hospital bills can be audited. We can review bills that you've received from physicians in conjunction with your hospital bill to see whether there are any discrepancies between them and your hospital bill and whether the charges that they contain appear to be correct. In addition, we can probably answer any questions that you have about such bills. There is no charge for this service. If you wish, we can try to get such bills reduced. If we're successful in getting a bill from a physician or other medical provider reduced for you, our fee is the same one-third of the savings that we charge for getting your hospital bill reduced. We review bills from physicians and other medical providers only when they arise from your hospital visit. Up to Top What do you need before you can start working on my hospital bill?
We need a contract signed by a financially responsible person and an authorization form signed by the patient (or the patient's parent or guardian, the executor of the patient's estate, etc.). Unless the hospital offers a substantial discount to avoid having the bill audited, we also need the patient's medical records. As the hospital will charge you for photocopying any medical records that you order, you should not order them until we ask you to order them, unless you want a copy of them for your own use. Up to Top How long does the hospital bill auditing process take?
There are several steps involved in the hospital bill auditing process. The way that the process is supposed to work is as follows:
• You send us your itemized bill. We examine it to make sure that auditing it is likely to be worthwhile.
• We send you a contract and an authorization form; you sign them and return them to us.
• You obtain your medical records from the hospital and then forward them to us. The hospital can take anywhere from a few days to many weeks to photocopy your medical records and send them to you.
• We audit your hospital bill and submit our audit findings report to the hospital. This generally takes no more than a few days.
• The hospital responds to our audit findings report by providing us with documentation substantiating the accuracy and validity of the charges that we disputed or by removing the charges from your bill. The accuracy and validity of a charge are not always clear cut, so we negotiate with the hospital to determine the proper disposition of the charges that fall into a gray area. We sign an agreement with the hospital setting forth the correct balance due on the bill.
If your hospital bill is covered by the federal Fair Credit Billing Act (FCBA), the hospital is required to resolve the dispute over the charges in your bill within 90 days. The hospital loses the right to collect any charges whose status has not been resolved within 90 days, even if it later turns out that the charges were accurate and correct.
If your hospital bill is not covered by the FCBA, the hospital can take anywhere from several weeks to several months to respond to our audit findings report. Negotiations can take anywhere from a few minutes to what seems like forever. It may not be possible for us to reach an agreement with the hospital as to the proper disposition of all of the disputed charges.
Whether or not we reach an agreement with the hospital as to the proper disposition of all of the disputed charges, you are responsible for paying all of the undisputed charges. If you have already paid some or all of your hospital bill, you may have to take legal action against the hospital to obtain a refund of any money that you overpaid. If you pay only the undisputed charges, the hospital may threaten to take legal action against you to collect the disputed charges, but the likelihood that it will follow through is vanishingly small. (We have been in business since September 1998, and only one of our individual self-pay patient clients has ever been sued by a hospital. The hospital was a tiny facility located in an extremely remote rural area. It had apparently never had one of its bills audited before our audit findings report popped out of its fax machine. The hospital not only refused to accept our report, it refused to communicate with us at all. It immediately sued our client for nonpayment. Our client went to the hospital, sat down with the administrator and settled the matter in less than an hour. The hospital even gave him a ten percent discount on his bill.) The usual scenario is for the hospital to issue dire threats and then do nothing. We and our client then wait until the statute of limitations runs, at which time the matter is closed. Up to Top Why can't you audit hospital bills for people who have medical insurance?
A hospital will accept audit findings on a bill from only one party. If you had medical insurance during the entire period of time that you were in the hospital, regardless of how small a portion of the bill your insurance company is responsible for paying, the hospital will accept audit findings on your bill only from the insurance company. If we submitted audit findings on your bill, the hospital would ignore them.
You can ask your insurance company to audit your bill, but it will probably refuse to do so. You can ask your insurance company to hire us to audit the bill, but it will probably refuse to do that as well. If your insurance company did hire us to audit your bill, the hospital would have to deal with us, because we would be representing the insurance company. We would not even have a contract with you. Most of whatever savings we obtained would go to the insurance company. How much you would save would depend on how your insurance coverage is structured.
If you had medical insurance during only part of the time that you were in the hospital -- if, for example, you were in the hospital for the last three days of June and the first two days of July, and your insurance didn't take effect until July 1 -- we could audit the charges incurred on the days when you did not have insurance, which, in our example, would be the last three days of June. You would receive all of the savings that we obtained on the portion of the bill that we audited. But we would agree to audit that portion of the bill only if it contained charges of at least $10,000. Up to Top Why won't you audit a hospital bill that is less than $10,000?
It is almost never cost effective for us to audit a hospital bill that is less than $10,000. Our expenses almost invariably wind up being greater than the fee that we can charge for auditing the bill. We cannot afford to spend ten or fifteen hours or more saving someone $1,000 or $1,500 on a hospital bill. Up to Top How long can a hospital wait after a hospitalization before it sends me a bill?
It is probably legitimate for a hospital to send you a bill at any time before the statute of limitations runs on the financial responsibility form that you signed upon entering the hospital. The length of time involved varies from state to state and depends on whether or not the financial responsibility form is considered a written contract. All of the information that we could find about state statutes of limitations relating to the collection of hospital bill debt is presented here. The information is presented in terms of the collection of hospital bill debt, but it probably applies to the submission of a bill as well. This question is one that should really be addressed to an attorney licensed to practice in the state in which the hospital is located. Up to Top Why was I charged so much more than an insurance company would have been charged for the same services?
A hospital must charge everyone the same amount for the same good or service received on the same day. Insurance companies and other large payers, however, often have contracts with hospitals that call for substantial discounts to be applied to the total charges contained in each bill. If a hospital doesn't offer a large payer discounts on its bills, the large payer can place the hospital "out of network" and send its customers/patients to other hospitals. Hospitals compete with each other for customers/patients, and nearly all hospitals prefer to offer large payers discounts rather than lose their customers/patients to other hospitals. Individual self-pay patients don't have the kind of leverage that large payers have, so they often wind up paying full price for the goods and services that they receive. Some hospitals do discount the bills of individual self-pay patients, but the discounts offered to such patients are rarely anywhere near as large as the discounts offered to large payers. Up to Top How can a hospital charge me so much when I was there for such a short amount of time?
A hospital charges you for the goods and services that you receive. The charges for some services have a time element, but the charges for most services and all goods do not. What matters is what goods and services are provided, not how long it takes the hospital to provide them. Services such as CT scans, MRIs, echocardiograms and ultrasounds carry very high charges but aren't very time-consuming to provide. It's possible to run up a staggeringly high bill in just a few hours. Hospital emergency rooms, in particular, are very expensive places to undergo treatment. Up to Top What can you do about the outrageously high prices that the hospital charged me?
At one time, hospital prices used to be reasonably related to costs. Then managed care came along. Now many large payers -- insurance companies, HMOs, PPOs, etc. -- feel that they have to demonstrate that they're trying to hold costs down. They do so by demanding that hospitals give them large discounts if the hospitals want to remain in the payers' networks. To accommodate the large payers, hospitals raised their prices and then offered the large payers large discounts. Now prices are no longer reasonably related to costs, and small payers -- self-funded health plans, self-pay patients and anyone who doesn't have a contract with the hospital -- face outrageously high prices without the leverage with which to demand large discounts. If the objective is to hold costs down, managed care is worse than a complete failure -- it's counterproductive. We discuss hospital prices and how we deal with them here. Up to Top Why does the charge for a particular item vary so much from hospital to hospital?
Different kinds of hospitals face different kinds of costs. A large, old, teaching hospital located in the heart of a major metropolitan area with many indigent people who use the hospital's Emergency Room as their family doctor has costs that a smaller, newer suburban hospital in an affluent area doesn't have, especially if the former is a Trauma Center and/or has a Burn Unit. In turn, the suburban hospital has costs that a small hospital in a sparsely populated rural area doesn't have. Each hospital has to develop a strategy to meet its costs as best it can given the unique set of resources on which it can draw. In addition, some hospitals are for-profit and some are not-for-profit; some are stand-alone institutions and some are units in a regional or national hospital chain. It's not unusual for two hospitals located within a dozen miles of each other to have hugely different financial profiles, cost structures and price structures. Up to Top How does a hospital justify charging me more for a single dose of a medication than my local pharmacy charges me for a thirty-day supply of the same medication?
A hospital will tell you that its charge for a single dose of a medication includes, at the very least, the costs of purchasing the medication, stocking the medication in its pharmacy and dispensing the medication to the patient. Other overhead costs may also be built into the charge. The typical markup is anywhere from 100 percent to 600 percent. For a very inexpensive medication such as aspirin or acetaminophen, the cost of the medication itself may represent only a very small proportion of the hospital's charge for a dose of it. To save some money when you go to the hospital for inpatient services, if you take certain medications every day, you should bring those medications with you, in the bottles in which your pharmacy dispensed them to you, so that your physician doesn't have to order them from the hospital pharmacy for you. Up to Top |
