Billing for the Hospital’s Mistakes

Another area of duplication on bills occurs when a test is not done correctly, and has to be re-done. If an X-ray is done two days in a row, this generally means the first one was messed up and it had to be done again. Results of tests can be lost, resulting in the tests needing to be ordered again. This is the hospital’s mistake and patients should not have to pay for this.

When there are delays that are the hospital’s fault, a medical advocate will question having to pay for a longer hospital stay. Delays can occur in scheduling necessary tests before surgery, and even scheduling the surgery itself, if the hospital has over-booked its surgical suites. The medical charts will indicate the reasons for any delays, and an advocate will challenge those that are the hospital’s fault. Take note, if in a teaching hospital, for more rare medical conditions, a patient’s release can be delayed just so all of the residents get an opportunity to view this unusual disease or condition.

The most dramatic example of being billed for a hospital’s mistake is when a patent gets a hospital-caused infection. This happens for 5 to 10 percent of all hospital patients. The most common hospital-caused infection is pneumonia. Pneumonia can get into a patient’s lungs when nearby people cough (medical personnel and other patients in intensive care wards), or from respiratory therapy equipment that isn’t properly decontaminated. Other hospital-caused infections are simply a result of medical personnel not frequently washing hands. Whatever the cause, the patient should not have to pay for their hospital stay lasting longer when it was the result of the hospital’s mistakes.

A fairly common billing mistake that can save Emergency Room patients thousands of dollars has to do with the level of room for which they are charged. Both doctors and hospitals charge for ER services by level, from 1 to 5, with Level 1 requiring the least amount of medical equipment and supplies, and Level 5 requiring all sorts of equipment and personnel for the most drastic life-threatening emergencies (usually trauma, heart attack).

The doctor’s coding for what level services he provided and the level room and equipment the hospital says it provided should agree. Doctors must apply certain criteria that establish which of the standardized levels they may bill at (see the discussion of CPT codes above). Hospitals apply their own criteria and are far less standardized. Both the doctor’s and the hospital’s reasoning should be reviewed by requesting a written explanation as to why the level billed was appropriate.

Remember, an inappropriately high ER room level equals unnecessary higher costs to the patient.

Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.

Please call us today at 916.921.6400 or toll-free at 1.800.404.5400, or use our online contact form for a free consultation.

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