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Medical billing errors spawn an industry to help consumers

TAMPA — The way Ana Inglett sees it, people pay more attention to their car repair bills than their doctor bills.

That's a big mistake, she says.

Inglett runs a Tampa company that checks medical bills for errors, and she says they occur more often than people think. She estimated that as many as 80 percent of bills contain errors, but Malcolm Sparrow, a Harvard researcher and expert in health care fraud, once put that number closer to 90 percent, a figure insurance companies dispute.

Whatever the magnitude, errors can add up quickly, especially with health care costs skyrocketing and patients paying a larger share of those costs.

"At the end of the day, health care is a business, and consumers have been left out in the cold," said Inglett, whose company, Medical Billing Advocates of Florida, is among a growing number of private firms across the country that consumers hire to help sort through the medical jargon and complicated coding in their doctor bills and insurance forms.

The national firm that Inglett's company is affiliated with, Medical Billing Advocates of America, says that consumers often lack the knowledge and time to question their bills.

"They're dealing with a sick family member; their main focus is on their recovery," CEO Candice Butcher said.

Most people, she said, don't know that they can request an itemized statement from a medical provider, so they often don't know what precisely they're being charged for.

But if they did, they might find items such as these, which companies like hers have found in patient bills:

• A box of tissues, billed as a "mucus recovery system," for $12.

• A piece of gauze used to wipe down surgical equipment, billed as a "fog elimination device," for $57.

• A teddy bear, billed as a "cough support device," for $57.

Butcher said the summary bills that patients receive usually have items such as these lumped into a broad category of "medical supplies."

"Consumers should know that they have rights," Butcher said. "They have a right not to be afraid to call and question something that doesn't make sense in a bill."

• • •

Since launching Medical Billing Advocates of Florida in June, Inglett said her employees have helped dozens of consumers.

Among them was Amy Peterson, who said that a billing advocate determined that the cost of a colonoscopy was incorrectly applied to her insurance deductible when it should have been covered as preventive care.

Inglett said the most common billing errors involve things such as:

• Billing for duplicate tests and procedures.

• Unbundling of charges, which is when a number of things that should be billed as one item are billed separately.

• Human error, such as an incorrect keystroke.

• Fraud.

Butcher said consumers should call their medical provider or insurance company whenever they suspect there is an error.

But if they find they need more help, Medical Billing Advocates of America (www.billadvocates.com) provides a list of more than 70 firms that it has trained.

Inglett said consumers who contact her company are given a free consultation. The company charges a percentage of what it saves the consumer. If the medical charges are correct, and the insurance has paid properly, the service is free, Inglett said.

• • •

Mark Smithson knows how complex the system is. He's a service vice president for Humana, a health insurance company that receives about 6 million claims a month.

As one example, he noted the tens of thousands of codes that doctors use to describe diagnoses and treatments. Things will get even more complicated in 2013, when the United States adopts a new coding system that will increase the number of possible codes from about 17,000 to 155,000. This effort to provide more precise data is aimed at improving patient care.

Smithson disagrees that errors occur as often as the billing advocate companies and the Harvard professor say.

"I can tell you that 90 percent of bills don't have errors," he said.

He said that even before Humana receives a claim, there's a system that makes sure the claims are complete and have the required forms. The company also routinely looks for things such as coding errors from medical providers.

The company's audit results show that claims are paid with 99 percent accuracy, he said.

To help make benefit statements easier to understand, Smithson said Humana's Medicare plan members receive a "Smart Summary," which describes — in plainer terms — services received each month.

Smithson said the benefit statements also include a phone number to call with questions, or to report a suspected error. "We are very serious about quality," he said. "We want to make sure we're paying correctly."

• • •

Though billing advocate companies look first for billing errors and overcharges, they also can negotiate lower fees from health providers or appeal denials of insurance coverage.

Joyce Baiss, 47, of Tampa said Inglett's company helped her 81-year-old mother, Loretta Baiss, after she received a $1,700 bill from a pharmacy for an antibiotic therapy for gangrene on her toe.

Baiss said the family thought the procedure would be covered under her mother's Medicare or TriCare insurance, and spent three to four months unsuccessfully arguing their case.

Baiss said a billing advocate renegotiated the bill with the provider. "It went down to $500," Joyce Baiss said.

Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330

FAST FACTS

What you can do

Billing advocates suggest the following steps to protect yourself from medical bill surprises.

. Request an itemized statement from your health provider. Pay attention to every charge. If something seems wrong, ask questions.

. Compare your explanation of benefits from your insurance company to your bill.

. Know your options. Question high charges for things that cost a lot less outside the hospital, such as facial tissues or bandages.

. Be organized. Keep careful records of your conditions, including when they were first diagnosed or treated.

. Know your policy. Read it to find out what your insurance will and won't cover.

Medical billing errors spawn an industry to help consumers 11/26/09 [Last modified: Friday, November 27, 2009 9:27am]

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