Check out our recent mention in US News and World Report How to Read Your Hospital Bill.
Here are 4 things you can do to help you understand your hospital bill:
Step 1: Review your personal Information
Before you start, make sure you have the following information available to review your hospital bill:
• If you have insurance, get your latest explanation of benefits statement from your insurance company which you will need when you review your balance due
• Review the personal identification information that generally appears at the top of the bill and ensure it is correct
This includes the patient name, billing address, what (if any) insurance was applied, and admitted and discharged dates
Step 2: Get oriented to your bill
Oftentimes bills will include several categories of information such as
• Number of units provided
• Internal hospital billing code
• Standardized medical billing code (such as CPT, HCPCS, or ICD code)
• Description of each service*
• Charge for the services rendered
• Patient balance due
*A service may include, for example, a medical procedure, supply, drug, or test administered.
Step 3: Review details
Date: Generally this is the date of service, but it could instead be the date the charge is posted to your bill. Each hospital decides what date they want to use. If the date of service is used on the bill, you should ensure the dates of service fall within your admitted and discharge dates.
Number of units provided: This is the number of units of a medical procedure, supply, drug or test that has been administered to the patient while in the hospital. You should review these units to see if they seem accurate, and notice any ones that seem particularly high. These numbers can be checked by getting a copy of your medical records from the hospital and making sure the numbers match with your records.
Internal hospital billing code: These hospital billing codes are used for various internal, administrative needs in a hospital, and therefore are not helpful to you when reviewing your bill.
Standardized medical billing code: These standardized billing codes are shared by all medical facilities nationwide and are set by medical associations or government agencies (such as Medicare). While it is usually easier to review the description of the service to verify that you received this service, some bills include a code without its associated description. If this is the case and you have a question about a code, you can contact the hospital or insurance provider for a description of the charge. For additional references, see medicare.gov for ICD and HCPCS codes and ama-assn.org for CPT codes.
Description of each service: This is the description of the medical procedure, supply, drug or test administered that is associated with the internal hospital billing code and the standardized medical billing code. It may include things like dosage information, amount of resources required, or the amount of time the service was administered.
Many medical terms and definitions can be found on the Medterms website.
Charge for the services rendered: These are the charges generated by the hospital billing office based on the services rendered. You should review these numbers to see if any ones that seem particularly high. You can contact the hospital billing office to better understand how the charge was derived.
Patient balance due: This is the amount you owe to the hospital after any discounts or insurance has been applied. You should make sure that any payments or adjustments made by your insurance company (which appears on your explanation of benefits from your insurance) was applied to your bill. If anything does not seem correct in this balance due, call your insurance company or the hospital billing office.
Step 4: Get help from a medical bill advocate
If you still need help with understanding or resolving any of your medical bills, contact a medical billing advocate. They are trained to review your bill for errors, fair and reasonable pricing, and resolve issues with the hospital billing office on your behalf.