It's Christmas Eve, so I thought a story of hope was in order.
If you've ever tried to resolve an error on a medical bill, then you know hope can be hard to come by.
Persuading a hospital or insurance company to admit that it overcharged, billed for a service you never received or billed for the wrong service is as easy as building a snowman in Florida.
Patients get frustrated and disheartened. Eventually, many become so worn down that they're ready to write a check just to put it behind them.
That's how Becky Hatcher of Maitland felt earlier this year.
"I was ready to give up," Hatcher said.
But she didn't. And you shouldn't either.
If you've never dealt with an error on a medical bill, chances are you will someday.
According to the founder of Medical Billing Advocates of America, nine out of 10 hospital bills contain some kind of error. (That this organization, which is devoted to helping people straighten out their medical bills, even exists says it all.)
I first told you about Hatcher in June when I wrote about how difficult it is to price shop for medical procedures.
She went to Orlando Health's Dr. P. Phillips Hospital for a screening colonoscopy in December of last year. She was told the procedure would be free as part of the new Affordable Care Act.
Then, a few weeks later, she received a bill from Orlando Health for $8,799 and was told she owed $1,625 after insurance. So much for "free."
She called to find out why and discovered that, because her doctor observed a minor abnormality (one so insignificant that it didn't require treatment or follow-up), the hospital considered the colonoscopy to be "diagnostic" rather than "preventive." That triggered the big charge.
Hatcher didn't think that was right. She spent six months trying to tell Orlando Health that it billed her incorrectly. The hospital reviewed her account twice and each time rejected her claim that it charged for the wrong procedure.
She was starting to feel as though resolving the bill would take an act of Congress.
As a last-ditch effort, she contacted Sen. Bill Nelson and Sen. Marco Rubio. Both offered to help.
"I chose Nelson's office," Hatcher said. "I'm a conservative. I chose him because he voted for the health-care law, and I figured he needed to know some of the problems."
After correspondence between Nelson's office, her insurance company and Orlando Health, she heard some good news. Orlando Health said it would send her a new bill, this time for a screening colonoscopy instead of a diagnostic one.
"I don't know what caused them to change their minds," she said. "I don't know if it was Sen. Nelson's office. If it was, it's really sad."
Orlando Health's Kena Lewis said the timing of the change was a coincidence and had nothing to do with intervention from the senator's office.
"Persistence can pay off, and procedures can be coded incorrectly," Lewis said.
Medical billing revolves around codes.
Anything and everything you might encounter at a doctor's office or hospital has a code. Doesn't matter if it's a piece of gauze or brain surgery. If you used it, you're going to get charged for it based on the code.
And patients must be their own advocates. Nobody else will look out for you, and mistakes can be costly — even for insured people like Hatcher.
Mistakes are so frequent that a cottage industry, including the billing advocate group I mentioned earlier, has grown up around helping people resolve their bills. Typically, advocates take a cut of the amount they save a patient.
But there are things you can do on your own:
Request an itemized bill if you think you are being charged incorrectly. Hospitals are required to provide one if asked.
Double-check the codes. Your insurance company can help you do this. Or you can look them up online yourself. (I've found that searching "medical code" and the code number you see on the bill usually does the trick.)
If you aren't getting anywhere, ask to speak to the patient advocate at the hospital, insurance company or both. That's something Hatcher said she wished she had known.
As for her case, she received a refund from Orlando Health a few weeks ago.
There is hope. Just in time for Christmas.Copyright © 2015, CT Now