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Wednesday, June 27, 2012

De-coding the Medical Codes

By Heather Millar

Medical Bill

When I was in active treatment, I kept a running tally of how much my medical care was costing. Then, and now, I daily give thanks for the amazing medical coverage provided by my husband’s employer. Treating my breast cancer cost more than $500,000. Insurance covered all but one $1,200 genetic test and a couple thousand in prescription and medical visit co-pays.

In all the months of going through each item on my hospital bills, I found only one mistake: A series of tests for male hormones such as testosterone. First of all, I’m not male. Second of all, last time I checked testosterone does not have a significant role in breast cancer. Obviously, those tests were done on someone else. But, because my insurance didn’t blink and because the amount of money involved was just a few hundred dollars, I didn’t protest. I should have, I guess, but I was sick and tired at the time.

In that, as in my insurance, I was lucky.

Not everyone is so blessed, as an article published last weekend in The New York Times made clear. The Times article alerted me to a whole profession about which I had never heard: medical billing advocates, people who will review your medical statements, find errors, and help you negotiate with the hospital and doctors. Think of them as credit counselors for the uninsured and the underinsured.

Of course, the story highlights galactic mistakes that make my suspect testosterone test look like an insignificant rounding error: a guy billed $11,000 for an 11-minute hand surgery, a cancer patient billed more than $9,500 for a chemo infusion he never received.

According to Medical Billing Advocates of America (MBAA), they find errors in nearly 8 out of 10 medical bills that they review. These are some of the most common errors: operating room times, duplicate orders, fees that are not “bundled” (for instance, things like gloves, sheets, and IVs should be included in the operating room charge), “upcoding” (inflates the patients diagnosis to something more serious that costs more), and upselling (your doctor prescribes a generic drug but the hospital gives you a more expensive name brand drug).

I guess all this doesn’t surprise me. Medical bills—with their incomprehensible codes, strange divisions of procedures, and unfamiliar language—are about as easy to understand as ancient Sanskrit. No wonder a profession has evolved to help patients de-code the codes.

You can find an overview of the field in the archives of WebMD – The Magazine.

If you’re drowning in medical bills, you can find an advocate through MBAA. These professionals will review your medical invoices, make sure your insurance company is honoring their obligations, and negotiate with both medical providers and insurers. Advocates usually charge a percentage of the monies saved through their efforts.

I’m glad I don’t need the services of an advocate, but it’s sure good to know they’re out there. Have you used a medical billing advocate? If so, did you find it a good experience? Share your thoughts in the comments below.

Photo: iStockphoto

Posted by: Heather Millar at 5:34 am

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