When Steven O'Shea, 42, a Michigan landscaper, fell out of a tree, his chainsaw cut halfway through his forearm. The uninsured father of four received a $39,000 bill from the plastic surgeon who operated on him. Though grateful for the care, O'Shea says, "I couldn't believe it. How was I going to pay a $39,000 bill?"
Christopher McCaughna, 50, of Seminole, Fla., lost his brother, Eric, at age 43 after a five-day hospitalization for a diabetic coma. Also uninsured, Eric left behind a $75,000 hospital bill, which his brother had to settle.
Faced with such daunting charges, O'Shea and McCaughna turned to a private medical billing advocate to guide them through the paperwork thicket. Nora Johnson, with Medical Billing Advocates of America, scrutinized their bills for errors and negotiated reductions.
Johnson is part of an emerging field of medical billing advocates across the country. Armed with knowledge of arcane and complex billing codes, they will help patients organize their debts, hunt for mistakes, and deal with insurers, health care providers, and collection agencies.
Many patients can resolve their own billing problems, but some feel overwhelmed by an onslaught of indecipherable documents, especially after surgery, an accident, or an extended illness. Others are simply too sick to tackle the pile of invoices.
Whether insured or uninsured, those who don't want to deal with the frustration and confusion can hire a private medical billing advocate for about $125 to $150 per hour or a percentage of the savings, typically 15% to 33%.
What types of billing problems can advocates spot? "The most common errors are duplicate charges," Johnson says. For example, patients might bring daily medications, such as blood pressure drugs, from home during a hospital stay but later see charges for these same drugs.
Clerical errors are also common. Johnson once found a $1,004 charge for a toothbrush. "The hospital said it was a mistake, a typo. It's very easy to make those kinds of mistakes," Johnson says.
She discovered duplicate charges in the McCaughna hospital billing and eventually trimmed roughly $39,000 off the $75,000 total.
And after a couple of months on O'Shea's case, Johnson also found errors among them, incorrect billing for surgical tendon repairs that led to an $11,000 overcharge. To O'Shea's amazement, Johnson eventually whittled his tab from $39,000 to $6,000 -- still a significant sum, but one that won't ruin a landscaper of modest means.
Prescription for Medical Savings
When you receive a medical bill, be on the lookout for:
- Duplicate billing: charging twice for the same service, drugs, or supplies
- Typos: entering incorrect billing codes or dollar amounts
- Canceled work: charging for a test your doctor ordered, then canceled
- Upcoding: inflating a charge; for example, your doctor prescribed a generic drug, but the bill lists a costlier, brand-name drug
- Inflated operating room fees: charging for more time than the anesthesiologist's records show you used
Originally published in the March/April 2008 issue of WebMD the Magazine.