After a stay in the hospital or having a medical procedure, the last thing you want to do is review your bills. In the long run, though, it could save you money and give you peace of mind.
Documents you may receive:
A hospital bill.
This comes from the hospital and it lists the major charges from your visit, such as the services you received, medicines and supplies. It may not be the most up-to-date document, depending on when certain claims were submitted to your insurance company.
An Explanation of Benefits (EOB).
Your insurance company will send one of these. It is not a bill. (Really!) An EOB explains the services you received, what is covered, the payment(s) that your insurance made, and deductibles or co-insurance and co-pay. Your PHS/EOB and hospital bill may not match. Sometimes there is a delay between when the hospital bill is printed and the claim is received and processed by your insurance.
It can be a surprise to get other bills after your medical treatment. For example, you may get separate bills for:
- Lab – facility charge
- Lab – professional charge for reading
- Room and equipment used for procedure – facility charge
- Surgeon – performed the service, professional charge
- Anesthesia bills – professional charges from assistants and anesthesiologist
- Pre-op and post-op charges are often not included, but this depends on various other guidelines
If you do not understand a charge on your bill or you think it’s wrong, contact the hospital’s billing department to ask them to explain. Keep a record of the date and time you called, the name of the person you spoke to and what you were told.
What are these codes?
Any of these codes could also show up on your PHS or EOB.
- HCPCS Level I, or CPT Codes, identify procedures or tests. They are five-digit codes listed as service codes. They are universal, meaning all providers in the United States use them.
- HCPCS Level II Codes identify supplies or products. They start with a letter and are also referred to as service codes.
- ICD-10 Codes are part of a system to identify every possible diagnosis. ICD is short for the International Classification of Diseases. In the United States, every service that is billed with a CPT code must also be linked to an ICD code to assure the treatment fits the diagnosis. If you only have one condition being treated at the visit, all of the diagnosis codes should be the same, or start the same.
- Revenue Codes identify the amount associated with the procedure and are specific to each facility. Revenue codes are not universal.
Put it all together
Once you have your PHS or EOB, closely examine your bill to make sure it’s correct. Be sure to verify:
- Detail, not summary. The first statement you’ll receive may be a summary bill. You can ask for a detailed bill, often called an itemized bill, that shows each charge separately with codes.
- Dates and number of days. The dates on the bill should match when you were in the hospital. If you were admitted after midnight, make sure the charges start on that day. If you are discharged in the morning, check that you are not charged for the full daily room rate.
- Surgery charges. Surgery should be a timed operating room charge, in minutes. Make sure that the time lines up with how long the doctor told you your surgery took. If your bill also lists anesthesia sleep and wake times, they should approximately reflect the amount of time spent in the operating room.
- You received all the services you’re being billed for. For example, sometimes doctors order medication in a hospital setting, but the patient doesn’t take it — yet gets billed for the drug anyway.
- Number errors. Check that there are no extra zeros added after a number (for example, 1500 instead of 150).
- Double charges. Ask about duplicates for services, medicines or supplies.
- Medicine charges. If you brought medicines from home, make sure you don’t receive a bill in error for those while in the hospital. And if you receive a generic drug in the hospital, make sure you don’t receive a bill for the brand-name version.
- Charges for routine supplies. Question charges for things such as gloves, gowns or sheets. They should be part of the hospital’s general costs.
- Costs of reading tests or scans. You should be charged only once unless you got a second opinion.
- Canceled work or medicines. When the doctor cancels a tests, procedures or medicines, check that these items are not on your bill.
- The individual charges add up to the total at the bottom and match the summary bill’s total.
You’ve reviewed your bills and know where to go for clarification. You may even have saved some money. Now you can get back to living a healthy life.