Confusing Hospital Bill Codes Are One Reason They Are Ridiculously Expensive
If you’ve ever been to the emergency room or even seen your doctor, often times you’ll receive a statement from them or your insurance carrier with confusing alpha-numeric codes or abbreviations that are strange to understand. The only thing that DOES make sense is the dollar amount they place right next to them, which is often fairly expensive. After reading your medical bill, really all you’re left with understanding is how much money you owe them and that’s it.
There’s actually a reason why normal-everyday people aren’t able to understand these bills and it all has to do with why they are always (always) so ridiculously expensive.
A piece written by the New York Times’ Elizabeth Rosenthal investigates the growing shadow industry of hospital billing and coding and how this “endless war” of consultants and billing coders between hospitals and insurance companies are leaving Americans in the crossfire with hospital bills so outrageous, they are leaving thousands bankrupt.
According to the article, over the years, hospital coding has become increasingly more complex with as “coding systems begot new coding systems” while “strategic coding meant increased payment” which led to the need for “coding specialists…coding courses and coding degrees”
Rosenthal states that in regard to a billing coder’s job to make “seemingly subtle choices (as to) which code to use (that can) have large financial consequences.”
When it comes to actually drumming-up a patient’s bill, “Each billing decision…can be seen as a battle of coder versus coder. The coders who work for hospitals and doctors strive to bring in as much revenue as possible from each service, while coders employed by insurers try to deny claims as overreaching.”
To help increase their bottom line, hospital coders will “teach doctors (as) doctors pay to take courses – to learn how they can “upcode” their charts to a more lucrative level.”
With patients who have health insurance, most of this will go unnoticed, however for those who are uninsured who DON’T have the support of opposing billing coders, they are left at the mercy of the hospital and a system that is designed to beat down patients who can never afford their prices.
Are High Hospital Bills Against The Law?
On its face, there have been no challenges to the legality of these astronomically high bills, however, the way that hospitals are collecting on these hospital bills using hospital liens has left them open to lawsuits about not only the legality of the hospital lien but about how ridiculously high their hospital bills can be.
To explain, hospital liens are legal documents filed at your local county that allows the hospital to collect your hospital bill debt by staking an automatic claim to any settlement you may receive from a car accident injury claim in an effort to pay off your bill. There are a few requirements for the hospital lien to be legal:
1) The patient is admitted into the hospital within 72 hours of the accident.
2) The charges associated with the hospital lien DO NOT exceed the reasonable and regular rate.
The illegal part happens when hospitals violate the “admitted into the hospital” part of the law when they file hospital liens on patients who have ONLY been seen and treated in the emergency room AND when the hospital KNOWINGLY charges what is clearly beyond the “reasonable and regular rate.”