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Health 411: Steps to resolving a medical bill dispute

If you can't resolve it with a hospital's billing department, chief executive or chief financial officer, turn to government agencies and consumer advocacy groups for help.

August 08, 2011|By Lisa Zamosky, Special to the Los Angeles Times
  • For an accurate diagnosis, find a doctor who will stick with a patient as the case is explored.
For an accurate diagnosis, find a doctor who will stick with a patient as… (Ric Feld, Associated Press )

Several months ago I went to the emergency room for a respiratory problem. I was treated and released the same night. I was a self-pay patient. I requested the detailed billing to compare with my medical record and found several errors, including duplicated charges and overcharged items. When I discussed this with the billing department they refused to admit it. What is my next step in this situation?

It's critical that you put your dispute with the hospital in writing, clarifying that your itemized bill contains items or services that have been billed in error, says Pat Palmer, founder of Medical Billing Advocates of America, a consumer advocacy group in Roanoke, Va. List each item you're disputing and request that the inaccurate charges be removed or that a written response with documentation to support the charges be sent to you.

If you've hit a brick wall with the billing department, escalate your complaint, says Martin Rosen, an executive vice president of Health Advocate, a patient advocacy organization based in Plymouth Meeting, Pa. Address your letter to either the chief financial officer or chief executive officer of the hospital, or both, and indicate that you've tried and failed to settle the matter with the billing department. "A reputable hospital, if it made an error, would make good on the fact that you were overcharged," Rosen says.

Be sure to send the letter via certified mail and keep copies of all correspondence, including bills and canceled checks. Also keep a record of the name and number of anyone you speak with. That case file will be useful if you have to take your complaint to an outside organization, Rosen says.

If you're being stonewalled by the hospital, file a complaint with the department of public health or insurance in your state. In California, state law requires hospitals to reimburse patients who have been overcharged. Complaints of noncompliance can be filed with the California Department of Public Health on its website. Go to http://www.cdph.ca.gov, click on the "Health Information" tab and then "Health Facilities Consumer Information System." A link for "Consumer Complaints" is on the left side of the page.

If your bill is large, it might be worth seeking outside help. For a fee, organizations like Medical Billing Advocates of America (billadvocates.com) and Health Advocate's consumer arm, Health Proponent (www.healthproponent.com), can help you fight incorrect charges or lower your bill. "Our track record is a 50% discount on average," Rosen says.

And given that you are a self-pay patient, you should be aware that a handful of states, including California, have laws limiting how much hospitals can charge patients who pay for care on their own. According to Anthony Wright, executive director of California advocacy group Health Access, patients without insurance are typically charged three to four times more than those with coverage.

My elderly mother has a urinary tract infection that won't clear up. She is allergic to most antibiotics so the doctors don't prescribe them, and they don't seem to know of anything else that she could tolerate. We are at a loss as to who to see next or where to go to get her treatment. Any guidance would be appreciated.

Being misdiagnosed or improperly treated for an illness is quite common, says Rochelle Porper, vice president of strategy for Best Doctors, a Boston-based medical consultancy that helps patients get the right diagnosis and treatment.

There's a good chance something has been overlooked or missed with your mom's case. Some possible alternatives to consider: "It's not uncommon to have a positive urine culture but not have a urinary tract infection," says Dr. Christopher Wolter, assistant professor with the Mayo Clinic who specializes in female and reconstructive urology. Often, misreading lab results leads to inappropriate treatment, Wolter says.

An overactive bladder, which is more common among the elderly, or other conditions that can cause reoccurring urinary tract infections may have been missed. Interstitial cystitis, a difficult-to-diagnose condition that may mimic a urinary tract infection, or even a prolapsed pelvic floor may be inhibiting your mother's ability to fully empty her bladder, according to Wolter.

"Medicine is a deductive science, rather than something we can see and know for sure," says Dr. Lisa Sanders, a primary care physician at the Yale University School of Medicine and author of "Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis."

The key is to find a doctor who will stick with your mom as her case is fully explored. For an elderly woman, a doctor who specializes in geriatric medicine is a good place to start. Wolter and Sanders also suggest finding someone who specializes in female urology or voiding dysfunction, a sub-specialty niche within the field of urology. A gynecologist, if your mom hasn't already seen one, is another specialist who may be helpful.

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