I guess it's been more than 4 years since I've written an article more for the rights of patients than talking to those who are already in health care, although when I talked about hospital charges I'm betting that most people working at hospitals don't know much of this stuff either.

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Hospital billing and its relationship with the public is much different than any other business in this country. Whereas there's all this noise about how unfair it all is, I don't necessarily take that view all the time. Sure, there are some charges that might seem to be kind of expensive, but there are lots of expenses people don't understand that hospitals have and things they have to do because of regulation, which explains why you sometimes read that hospitals aren't doing so well financially. More of them need to call me but... oh well... 🙂

Anyway, this one's for you, the patient, because I know what you're going through. I myself am sometimes a patient, being diabetic and having a back issue, and here and there I have to call for one reason or another. Probably not for most of the reasons I'm going to cover in my 5 rights below but, since it's part of what I do for a living, I can offer you some ideas you might try.

1. Ask for an itemized bill. A complaint I hear all the time is that patients get a summary of charges from both the insurance company and the hospital but don't remember everything they had done. By law, hospitals aren't required to send an itemized bill out without a request because of HIPAA privacy laws (I'd tell you what HIPAA means but it wouldn't mean anything to most of you). In this regard they're not sure who'll see the bill & open it first, and sometimes patients come to a hospital for something they don't want anyone else to know about and by law are protected.

2. Ask for an explanation of what some things are on the bill. Great, you've received your bill and it all looks like hieroglyphics. I don't know of a single hospital that uses the full description that's in the procedure book, let alone the full description of what the diagnosis code means. Truthfully, the people who you'll talk to when you call them on the phone might not know either. But you have a right to know so you can call and ask for it, whether you can talk to someone who can tell you everything or whether they'll have to research it and send you something.

3. Dispute charges, though not all of them. Sometimes a script will have come in from your doctor for services to be provided and the hospital might not have provided them all after seeing the results of your first test. Also, sometimes hospitals might charge you for something that wasn't on the script, which is actually fraud (though most of the time accidental) whether they did it or not. You might have to confer with your physician to verify whether it was all requested or not, because sometimes a physician adds things to a script without telling you, but once you've confirmed it and it's wrong, call the hospital.

4. Ask about reduced balances or charity care options. If you don't have the money to pay the entire bill up front and may not have it, you might want to ask about these things. Almost every hospital now offers discounts to self pay patients instead of making them pay the entire thing (most of the time there are signs all over the hospital about it but most people don't think about it until they get their bill). With charity care, they'll test your income against the poverty line options and could potentially reduce your bill, even possibly qualifying you for a 100% write off. However, to get that you might live in a state where they'll help you apply for Medicaid first, and only if you get rejected by them for making too much would you get it.

5. Payment plan options. If you know you're not going to qualify for anything like #4, you can ask for payment plan options. This gives you the opportunity to pay your balance down over time. On this one every hospital will have a different plan. Some are pretty aggressive, being told they can only accept payment plans that pay the entire bill within 6 months. Other hospitals might have plans where they'll work with you to accept a certain amount of money monthly, even if it takes many years to pay off. Some hospitals will have a deal with an outside lender, who will in essence buy your balance and set you up on a payment plan at some type of interest rate. Still, that's better than worrying about trying to pay off the entire thing at once.

I hope that helps some. If you have any questions on this please ask.