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Inflated Charges and Medical Billing

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Inflated Charges and Medical Billing

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The issue of exorbitant markups on everyday items in hospital bills has been a long-standing concern that continues to plague patients. While numerous instances of outrageous charges have made headlines, such as $7.00 for two Tylenol or $30 for a simple bag of ice billed as a “thermal therapy kit,” hospitals have yet to be deterred from this practice. These exorbitant markups persist and warrant scrutiny, as they contribute significantly to the overall cost of healthcare for patients.

One of the less apparent tactics employed by hospitals to inflate charges is the practice known as “unbundling.” Federal laws, including those governing Medicare, require hospitals to consolidate all related expenses associated with a medical procedure or operation into a single bundled charge. This encompasses not only the direct costs of the surgery or procedure but also ancillary items and services, such as blankets, nursing staff, and the use of the operating room. Patients must diligently scrutinize their bills to ensure that services bundled with a surgical procedure are not separately billed, doubling the cost.

A different form of unbundling emerges when a hospital bill includes a generic “room and board” or “room kit” charge, only to reveal specific itemized charges for seemingly basic amenities like toilet paper, facial tissue, soap, shampoo, or toothbrushes. This practice further exacerbates the financial burden on patients by charging separately for items that would typically be expected to be included in the room and board fees.

Moreover, the potential for inflated charges also exists due to coding errors made by hospital or physician staff. These errors can arise when a procedure or service that is similar but more expensive is mistakenly billed. Incorrectly assigned Diagnostic Related Groupings (DRGs) can lead to higher bills for patients. To navigate these pitfalls, it is crucial to cross-reference the services documented in the doctor’s records with the corresponding charges on the hospital bill to ensure accuracy and fairness.

How Our Law Firm Can Help

Our legal team specializes in assisting individuals in finding insurance coverage to address these excessive bills or negotiating reductions in cases where insurance coverage proves insufficient. We recognize that navigating the complexities of healthcare billing and insurance claims can be overwhelming, and our expertise is dedicated to helping patients obtain the best possible outcomes in their healthcare billing disputes.

When patients face inflated hospital bills, it can be a disheartening and frustrating experience. Many have read about these extreme markups, which often involve common items such as overpriced pain relievers or everyday necessities like facial tissues. However, it’s disheartening to note that hospitals have not ceased this practice despite the public outrage generated by such stories. The result is that patients continue to bear the brunt of exorbitant charges for items that should reasonably be priced.

The Practice of Unbundling

One aspect of this issue that is not often discussed but is equally concerning is the practice of “unbundling.” Federal laws, such as those governing Medicare, mandate that hospitals consolidate all the costs associated with a medical procedure or surgery into a single bundled charge. This comprehensive charge is supposed to include not only the direct expenses related to the procedure itself but also all the ancillary goods and services essential to patient care, such as the use of the operating room, the medical equipment used, and the services provided by nurses and other healthcare staff.

However, some hospitals engage in a practice known as “unbundling,” where they itemize these costs separately on the patient’s bill. This means that patients may face charges for seemingly essential items like blankets or nursing services that should be covered within the overall cost of the procedure. It’s crucial for patients to carefully review their bills and ensure that these bundled services are not also separately billed, as it can significantly inflate the total cost of healthcare.

Furthermore, another troubling aspect is the presence of generic charges labeled as “room and board” or similar descriptions on hospital bills. These charges often give the impression that they encompass all the essentials of a patient’s stay, including providing basic amenities like toilet paper, facial tissue, soap, shampoo, or toothbrushes. However, upon closer examination of the bill, patients may discover that these items are charged separately, compounding their financial burden.

Coding Errors

Additionally, coding errors made by hospital or physician staff can lead to inflated charges. These errors occur when a procedure or service that is similar but more expensive is mistakenly billed. It’s crucial to understand that the doctor’s records are more likely to reflect the actual services performed, and patients should review both hospital bills and doctor’s records to identify and rectify any discrepancies.

The issue of inflated charges in hospital bills is a multifaceted problem affecting countless patients nationwide. While the stories of extreme markups on everyday items have garnered attention, other practices like “unbundling,” itemized charges for basic amenities, and coding errors also contribute to the financial strain on patients. Seeking legal assistance to navigate these complex billing issues and negotiating reductions or insurance coverage can help ensure that patients are not unjustly burdened by exorbitant healthcare costs.

Editor’s Note: updated 10.25.23 Photo by Nappy on Unsplash