Medicine by the Numbers Part II: The Hospital Bill

Everything unknown is magnified.” -Publius Cornelius Tacitus, senator and a historian of the Roman Empire

Hospital stays can be incredibly stressful. From that open blue gown you and your new roommate must wear to understanding your diagnosis and accompanying treatment, most patients feel overwhelmed and disoriented. When you finally get to go home, weeks may pass, the discharge and rehabilitation process hopefully become manageable, and life returns to normal.  But just as soon as the anxiety from that hospital stay begins to subside, one day there it sits, waiting in your mailbox – an enigma of lines, abbreviations, and numbers that can only mean one thing: your hospital bill.

Perhaps even more than the actual hospital stay, the hospital bill can be difficult to understand. The bill will likely contain an abundance of codes and abbreviations, and it may look more like a cryptographic algorithm than a bill. Depending on the length of a hospital stay, for some the hospital bill can create a psychosomatic reaction strong enough to land you right back in the emergency department—the place where this whole thing probably started.  Before irreversible frustration and despair set in, however, here are some tips to help you understand the sum total of your hospital stay.

Step One – Understand How the Hospital Makes Your Bill

The first step is to understand how the health care industry tallies costs. Every time you visit the hospital, a bill is drawn up to include fees for any procedure, any medication, and just about any service rendered. The bill may include information such as:

·         The date on which any good (i.e., medication) or service (i.e., doctor’s exam) was rendered

·         The department from which it came

·         A brief description, including the quantity, and

·         The amount billed

If nothing else, think of your hospital bill as a very specific and detailed recitation of your hospital stay.

Step Two – Try and Find the Bill’s “Instructions”

If you have health insurance, chances are that someone will eventually send you a document that explains your bill, more commonly referred to as an “Explanation of Benefits” or “EOB”.  Your EOB is a summary of:

·         Costs that the insurance company cover

·         How much the insurance company will pay

·         How much the insurance company will not to pay

·         Why these determinations are made, and

·         How much is your responsibility

You can expect to receive your bill from the hospital before you receive your EOB. Many patients, however, wait to receive their EOB before they pay their bill, mostly because the EOB can be a better indicator of what is actually owed.

Step Three – Understand the Reason for the Hospital Stay

Now that you know how to read your bill and EOB, you may wonder how these costs are determined. Hospitals usually work with outside firms to determine the average price of each good and service offered. They then set their own prices based on these values. To fully understand this process, it is first necessary to understand your condition and subsequent treatment as it is divided throughout several different hospital departments.

In the case of pneumonia, for example, treatment draws from nearly all factions of a hospital, including the pharmacy, laboratory, radiology, and respiratory departments. Also, due to the complexity of treatment required to address the different symptoms, a typical pneumonia stay at any hospital often necessitates help from a variety of doctors, such as an internal medicine doctor, an infectious disease specialist, and even a pulmonologist.  As a result, the combined hospital charges of pneumonia include not just the hospital bill, but also a bill from the laboratory, the radiologist, and the multidisciplinary team who worked so hard to rid your body of its bronchial havoc.

Step Four – Understand Your Treatment

While it is important to understand why you ended up in the hospital, the focus of the bill is really what it took to get you home.  Here’s how a bill might be tallied for pneumonia:

First, to diagnose your condition, your doctor probably requested an X-ray or CT scan to confirm the presence of pneumonia in your lungs. You may have also been asked to take a blood test or sputum culture (a substance that is expelled from the respiratory tract, such as mucus or phlegm, mixed with saliva).

If an X-ray or CT Scan was involved, you probably visited the radiology department, and you should expect to be billed for the services of the radiology technician who takes the films, use of the X-ray or CT scanner, any labs or films, as well as the expertise of the radiologist, a special kind of doctor whose job it is to read these results.

If you had a blood test or sputum culture, you probably met the hospital’s phlebotomist who took your blood. The analysis of any blood sample takes place in a clinical laboratory, complete with a special machine and a special doctor who oversees the lab and reads your results.

If your medical condition necessitated a bona fide hospital stay, at a minimum you can expect a bill for a room.

Inside the hospital, the pharmacy was probably involved in your treatment.  The responsibility for providing the proper medication, as well as monitoring a patient’s progress and ensuring that there are no negative drug interactions, falls on the shoulders of the hospital pharmacist.

Step Five – Read Your Bill 

Understanding the way in which your bill is tallied is still only half the battle. Unfamiliar medications, codes, hospital abbreviations, and procedures can make it nearly impossible to question a given amount or line item. Like any other kind of bill, hospital bills are also subject to computer and human error. A single incorrect procedure code, entered either by the hospital or the insurance company, could mean a difference of hundreds of dollars.  This can be difficult to find, let alone correct.

When in doubt, remember you always have the right to inspect the important hospital documents you need to identify a billing discrepancy.  This can include an itemized, more detailed copy of your bill and a complete copy of your medical chart.  By comparing documents such as these to the bill that arrived in the mail, a sharp eye may discover errors.

Step Six – Remember to Breathe

When you’re sick and in the hospital, you probably want nothing more than to feel better and go home. When you’re home and feeling better, an expensive and confusing hospital bill can really make you feel sick. As confusing as your hospital bill may initially appear, always remember that it is nothing more than an objective accounting of all the events and ingredients that made up your hospital stay.

Craig Boyd Garner Bio

Craig is an attorney and health care consultant, specializing in issues surrounding modern American health care.

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