What’s more, in spite of the introduction of the Affordable Care Act meant to reduce billings and make health care more affordable, some hospitals have been seen to ignore those provisions. This is especially true for patients who are un-insured, as the hospital deals with the patient directly. The patient, in this instance, has no one to negotiate, or intercede on their behalf --and that's when legal experts say the patient should not try to hash out the hospital bill on their own with the billing department, but rather, enlist the help of an attorney.
It should be noted that with regard to hospital charges for service or emergency room cost, provisions in the Affordable Care Act require that hospitals do not bill patients without insurance at a higher rate than those patients who are insured. It should be a level playing field. However, pundits conversant with how many hospitals operate suggest this little-known aspect of the Act is largely being ignored by many hospitals.
As overbilling has become such a common occurrence, ‘Dispute Medical Bill’ is an equally common process on the part of insurers who expect hospital bills to be far higher than they should be.
A revealing window to high emergency room fees and other examples of overcharging opened up last year with the release of a study by Ge Bai of Washington and Lee University and Gerard F. Anderson of the Johns Hopkins Bloomberg School of Public Health, and published in Health Affairs in 2015. The study authors determined that, on average as an industry, hospitals charged patients or their insurers 3.4 times the baseline rate for services as observed by the US government.
It gets worse. A total of 50 hospitals were identified as having the highest markup rate that ran, on average, 10 times what it cost to provide treatment or services for the year studied, in 2012.
Seventy-five percent of the hospitals showing the highest rates of hospital overcharging were in the south – with 40 percent in the state of Florida alone.
The worst offender for 2012, according to the study, was North Okaloosa Medical Center in Crestview, Florida. That facility showed a 1,260 percent markup for treatment and services over and above what the hospital spends to provide those services and treatment, according to the study.
It is for this reason that insurance companies will routinely question everything itemized on a hospital bill, and negotiate to get those costs down. Having to undertake dispute medical bill forensics routinely, insurance companies have become skilled at the art of accepting nothing at face value.
Patients who do not carry insurance – and therefore pay for services ‘retail’ – do not have access to such skilled negotiation. Thus, there is a greater tendency for hospitals to try to go after full payment from uninsured patients who fail to question the hospital fees.
Further, there remains the possibility that a hospital will attempt to bill an uninsured patient at a higher rate than that of an insured patient. Advocates stress the importance of communicating assertively with the hospital, asking straight away if the billing rates are equal. If not, the patient has the right to ask the hospital to immediately re-calculate the bill at the lower rate.
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But doing so will not necessarily remedy the situation--there may still be a high hospital bill to pay, and one that is still inflated. Legal advocates advise patients in this position to not attempt to resolve the issue on their own. Rather, before even trying to pay the bill, the patient should seek legal help because, at that point, the patient will not only be dealing with bill collector calls, but an overstated hospital bill as well.
Given that outstanding medical bills can have such a detrimental effect on an individual’s credit score – and one’s ability to acquire a mortgage, or financing – qualified advice and intervention from a skilled legal professional could be a wise hedge to an individual’s financial future.