What is 99213? It’s not a zip code; it’s a billing code that means “doctor’s office visit.”
Medical bills from doctors, hospitals and labs can be so littered with abbreviations and digits that you will wish you had a decoder ring.
“Even an itemized bill can be very hard to decipher. There are a lot of acronyms,” said Joshua Greenberg, president of HealthCPA, one of a growing number of medical billing advocacy firms. “Your first step is to make sure the bill makes sense to you.”
Although consumers would not dream of paying a grocery bill or restaurant bill without an itemized list, they routinely write a check to a hospital without seeing one. That’s a costly mistake warns Pat Palmer, founder of Medical Billing Advocates of America.
“Nine out of 10 times, that bill is going to have errors and overcharges,” she said. “You should never pay a bill without getting a detailed, itemized statement.”
Hospitals are required by law to provide an itemized bill, but only when specifically asked for one. Even the itemized list can read like a code.
“They have descriptions that are very clever, like tissues are “mucous recovery systems,’ ” Palmer said.
If you see a mysterious charge on your bill, Palmer recommends skipping the billing office and calling the department where the charge originated.
“Call the nurses station in that department and ask exactly what it is. They’ll know,” she advised.
What’s the most common error?
“Charging for things that are routine supplies, that are already factored into another charge,” Palmer said. “Watch for things like gloves, gowns, sheets.”
In addition to spotting errors and duplicate billings, medical advocates help consumers negotiate lower bills, resolve disputes and review insurance claims.
Greenberg said one in seven insurance claims are initially denied.
“People feel victimized. It’s aggravating to pay a monthly premium for insurance, then when you need the money, it’s not there, or you have to jump through hoops.”
Advocates charge by the hour or a percentage of the amount saved, or through a subscription. For example, HealthCPA charges a a subscription of $19.95 a month, plus $5 a month for each additional family member.
“We tracked it internally, how much we save people, and found for every $1 we were paid in fees, we saved them $2,” Greenberg said. “But time and stress are almost a larger motivator to subscribers than the money. It’s like getting someone to do their taxes.”
Greenberg said his customers include people who are older or starting to see doctors regularly, people expecting a baby and people who are “just busy and overwhelmed and realizing they are losing money.”
Even if you don’t hire a professional advocate, Greenberg said you can be your own advocate.
“Use polite persistence. Remember, everyone in the health care giving system — they all care. They are just operating in an incredibly complex billing environment, with many opportunities for misinterpretation.”
If you find you have a talent for being your own advocate, you could turn pro. Palmer, who has trained 80 people who have opened medical advocacy firms across the country, says it is a field ripe with employment possibilities.
“Fifteen years ago when I started, I had to stomp my feet to get someone to pay attention, but with the down economy and health reform, more and more payers are coming forward, looking to cut their health care costs,” she said.
Palmer’s customers include consumers, businesses who self-insure, insurance companies and attorneys with cases involving health care billing.