This article was published in the Oregonian 05/24/09

For lots of us contesting a bill takes guts.  Challenging caregiver bills after they’ve just saved your life is downright ulcer-inducing.  But you should if you think something’s wrong or the bill is high.  To help, medical billing advocates in Oregon offered tips on keeping medical cost down and identifying billing errors.

The strategies:

Ask for a detailed statement:   Federal law requires that medical providers give you this but they often don’t, especially if you are covered by insurance.   Without it, you wont’ know what to contest.

Make sure your insurer covers procedure beforehand:   Some won’t or they’ll require pre-authorization.  This is especially true for nonemergency measure such as laser eye surgery.

Ask for codes, especially for non emergency procedures and before you’re treated.  Ask your caregiver or hospital for the billing and diagnostic codes for the services they provide.  Find out how much you will be charged for each.  Then call your insurer and see how much it usually pays for the service represented by the code.  Also simply ask, “Would you mind giving me the CPT code and the ICD-9 and I’ll call my insurance company?”  (See a fuller description off the codes later in the article)  That will help you determine how much you could be paying out of pocket – particularly in the case of elective procedures.   You may be able to negotiate the difference.  Just remember caregivers might not know all the codes they will end up using, especially if complications arrive.

Wait to pay any questionable bill:   If you haven’t paid, it’s a lot easier than trying to get a refund because you can negotiate.

Shop around:   Compare prices for surgeries or procedures at other hospitals or practices beforehand.  Such information also comes in handy when challenging your bill.

Plead your situation:  Explain any financial difficulties you are under from a job loss or unforeseen medical shock.  Sometimes that helps.

Watch for excess charges for supplies:   If you get charged time in an operating room, you should not also be charges for supplies such as lap sponges. Those should be covered in the operating room charge.

Talk to the right person:  At a practice, ask for the billing department.  At a hospital, ask for accounting or the business office.  Pay a visit to them before you are discharged.  If you are not getting anywhere and you still believe you’re right, ask for a supervisor.  Appeal to bigwigs by a certified letter.  Remain firm but calm:  Don’t get belligerent.  Treating other as you would treat yourself often goes further.   Still be firm and be persistent.  One phone call or visit probably won’t resolve your problem.

The Codes:

Getting familiar with coding acronyms can help you determine what you’ll pay for a medical procedure beforehand and whether you’ve been billed correctly afterward.

CPT is billing or procedure code (short for Common Procedural Terminology) used by both private practices and hospitals.  They are often five or six digits long.

ICD-9 is diagnostic code short for International Classification of Diseases 9th Revision.  Three to five digits long.  Preventive measures, which many insurance plans cover often start with a V.

HCPCS is an additional set of CPT or billing codes used by hospitals (short for Healthcare Common Procedural Coding Systems) usually five characters long with letters sometimes attached; they are used for supplies, products, medial equipment and prosthetics.