10 Medical Billing Overcharges to Blow the Whistle On

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10 Medical Billing Overcharges

10 Common Medical Billing Overcharges You Can Prevent

From surgery costs, to administrative fees, to equipment charges, hospitals and clinics routinely overcharge their patients for services both big and small. The medical principle of “first, do no harm” sometimes seems to have gone out the window completely.

Unfortunately, there are no laws to keep hospitals and clinics from doing this. It is our responsibility to step up and blow the whistle on these—let’s face it—criminal practices.

When you’re done, please share your thoughts with us below!

You can also download the PDF here: 10 Billing Overcharges Report

 

 

 

 

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1. Billed for Time Not Spent in the Room:

time not spent in roomYou arrive at the emergency room on Tuesday at 10:00 p.m. The doctor writes an order to admit you as inpatient to the ICU (Intensive Care Unit) at 11:35 p.m. You do not enter the room until 2:00 a.m. on Wednesday. The hospital charges you $3,000 for the ICU on Tuesday. Their reason for the full-day charge on Tuesday: “The doctor wrote the order before midnight.”

Blow the Whistle! A patient must physically occupy a room/unit to incur a daily room charge. A written order to admit as inpatient does not meet the definition of room occupancy.

 

2. X-ray Déjà Vu:

You arrive at the emergency room on Sunday with a possible broken arm. The ER physician looks at the X-ray, confirms that it’s broken, puts a cast on you, and sends you home. On Monday, the radiologist looks at the same X-ray and confirms that the ER physician was right. Because of this, you are charged twice for the reading of the X-ray.

Blow the Whistle! The physician’s reading of the X-ray is included in his or her visit charge and cannot be billed as a separate service.

 

3. Double-Charged for Anesthesiology:

medical overchargeDuring a surgery/procedure, a CRNA (certified registered nurse anesthetist) administers anesthesia medication, supervised by an anesthesiologist. Both the CRNA and the anesthesiologist bill you full price, as if they had performed the services separately.

Blow the Whistle! A patient should never pay more than what the anesthesiologist would have received if he or she had performed the service independently. Therefore, the CRNA and the anesthesiologist each should not be paid more than 50% of the total charge.

 

4. Charged for a Medical Error:

During outpatient gall bladder surgery, the surgeon accidentally nips your small bowel. Outpatient status changes unexpectedly to a 4-day inpatient stay in the ICU, resulting in a $40,000 hospital bill.

Blow the Whistle! This type of medical error is considered a “never event,” meaning that the patient should never be charged or any services directly related to the mishap. Dispute all charges relating to the error and any follow-up appointments as well.

 

5. Billed for “Medical Supplies”:

medical billing advocateYou are admitted to the ICU for an illness or injury. During your stay, you receive services such as oxygen, a ventilator, cardiac monitoring, etc. After discharge, you receive a summary bill that includes $15,000 for “medical supplies.”

Blow the Whistle! Patients should not be charged for services, supplies, or equipment that is routinely available in the ICU. These charges are considered routine as well as part of the cost of doing business, and should be included in the room charge.

 

6. Ignored Warranty:

You return to the hospital for surgery to replace failed leads to a faulty pacemaker. A new pacemaker and leads are surgically implanted. The bill you receive contains a $35,000 charge for the pacemaker and leads.

Blow the Whistle! The pacemaker had a warranty, meaning that the facility never paid any cost for the replacement. Patients should not be charged any fee for new pacemakers and leads.

 

7. Charged for Technical Problems:

insurance claimYou arrive at the hospital with an injury and the physician orders X-rays. The X-ray
department performs more than one X-Ray due to an error with the initial X-ray (i.e., wrong body part, clarity of film, misreading of the X-ray, etc.). Later, multiple X-rays show up on your bill.

Blow the Whistle! Patients should not be charged for a mistake made by the physician or radiology technician.

 

8. Room Overcharge:

A physician releases a patient from ICU to a regular room. A patient is taken to a private room instead of a semi-private room.
Blow the Whistle! A patient should not be billed at a private room rate when a semi-private room is not available or not requested by the patient or physician.

 

9. Bogus Fees:

medical fraudThe hospital charges you an “oral administration fee,” i.e., the nurse handing you medication in a little white cup.

Blow the Whistle! This is considered a routine nursing service and is part of the room and board charge. In the future, alert the nurse that you do not need the expensive white cup.

 

 

10. Unbundling:

During your annual physical, the physician sends you to the lab for routine lab tests. The lab bills you separately for glucose, creatinine, calcium, potassium, and sodium tests. The total charge is $300.

Blow the Whistle! This is called unbundling. All lab tests should be included in a single comprehensive metabolic panel that costs approximately half of each individual test.


We hope you found value in this brief report on the “10 Overcharges”. Unfortunately, there are many more that we help consumers and business with every single day. If you have a question about a medical bill, we invite you to reach out to a representative to get your questions answered at 855-203-7058.

All the best,

Pat

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89 responses to “10 Medical Billing Overcharges to Blow the Whistle On”

  1. suzanne says:

    Love your site. I just saw this: Blow the Whistle! A patient must physically occupy a room/unit to incur a daily room charge. A written order to admit as inpatient does not meet the definition of room occupancy.

    is there an official regulation that I can go to that addresses this??
    Thanks

  2. Angela Garcia says:

    Hello just did some investigating on the healthcare blue book web site and health consumer guidelines. Some thing is not right my husband went to his dr. he ordered labs and sent him to the Paradise valley hospital across the street. We have a 1200.00 deductible and thank God we a medical savings account to pay any medical expenses before meeting our deductible.
    This is what we were charged
    1. cbc auto w/auto diff.

  3. Angela Garcia says:

    My husband went to his dr. for a physical Dr. ordered labs sent him across the street to paradise Valley hospital. We have a medical savings account to pay for medical expenses not covered until we meet our deductible. Paradise Valley Hospital charged us this;
    1. CBC auto w/auto diff 118.00
    2. COMP METABOLIC PANEL 351.00
    3. lIPID PANEL 117.00
    4. THYROSINE FREE 106.00
    5. THYROID STIM HORMONE 202.00
    6. TRIIODOTHYRO T3 TOTL 1.1 6.65
    7. VIT D-25 HYDROXY 10.42
    8. VENIPUNCTRE ROUTINE 43.00
    9. LAB HEMATOLOGY 118.00
    TOTAL TOTAL 954.07

    This is outrageous the consumer guidelines are way below these numbers! what can we do?? Sincerely Angela Garcia

  4. John W says:

    My wife delivered our 3rd baby in June. We received the bill from the Anesthesiologists. $5,160 for the CRNA and $5,160 for the Dr. TOTAL: $10,320!!! For (1) epidural!!! That doesn’t include the needle and medication ($+1,200)
    We received the bill and it cost that much “because we had insurance”. If we were out of pocket (Cash) payers the bill would have been $650.
    We pay an astronomical monthly amount to have insurance only to pay for having it.
    Something is wrong with the insurance in this country and Obamacare didn’t fix anything. We just have more out of pocket expenses!

  5. Melissa says:

    My son bumped his head and subsequently passed out. A CT scan was ordered and we were double-billed (#2 above). Is there something specific that I should put in a letter to the company to aid in my double billing dispute. I was charged $3700 for the ER visit, and 2 CT scans and then I was billed $400 by the radiologist who read it 3 days later. Thanks!

  6. Sharon says:

    I went to the ER cos i could not see from one eye.I was admitted and the doctor called in an optometrist and a neurologist. The optometrist came in the next day to confirm I had retinal haemorage. She charged for her consultation at the hospital and asked that i come to her office the next day. I went and she did similar tests to the one she did at the ER and refered me to her colleague in the same health facility. She charged again for seeing me. The other doctor also examined me and refered me to his private consultancy.Again i was not given treatment but charged.

    I went to the doctors consultancy and had treatment. The first health facility is charging me $900 dollars for seeing me without any treatment.

    And I am being charged 1200 from the consultancy that treated me.

    What do you advise

  7. Michael Price says:

    I appreciate your column on Medical Billing Whistle Blowing. I recently went to a physician here in Houston for my annual physical and noticed that they recently have notices all over the office about if you ask a question, discuss a pre-existing condition etc.. these will all be considered “in addition” to your yearly physical and you will be billed a consultation charge. Seems a bit extreme but considering I only go for my physical once a year and thats it unless im dying I didn’t worry about it.

    Prior to my visit the staff had me come in to get a blood panel done since I missed my free clinic at work. They drew blood and sent it off site. Took 5min. Three days later I came in for my physical. They did the basic checks (breathing, throat, BP and weight) and discussed my heath breifly. They provided me a printout of my lab test and reveiwed results with me. This wasn’t something I asked for. I could have read them myself but I appreciated the time they took.

    Problem was that when I got my Aetna Statement and a bill from the doctors office they double billed me. Aetna covered 100% of the physical which is standard but then the doctors office also billed an Office/Outpatient Visit on the same day for $138.

    When I called to aks about it I was told that was for the diagnostics results that were provided and discussed with me. I questioned this on the basis that it was a single appointment and I did not ask the doctor to discuss these with me she just did in providing me the paperwork. They rested on the fact that this is “their policy”.

    I spoke with Aetna and they though it strange as well and tried to have a patient advocate address the issue with the doctors office for me but they were also told its “their policy” and since the lab results were discussed the fees are due. The allowable for Aetna on this is only 41.28 so i dont want to be petty but I strongly feel this is fradulant billing and am unsure where to go to address my concern.

    The doctors office wont budge. The insurance cannot help.
    I dont want to have credit issues over a bill of less than $42 dollars but this is principal that I think needs to be brought to light and addressed.

    i’m likely to look for another health care provider but asside from that I would still like to see this addressed and the legality of it challenged.
    Can you provide some direction…

  8. Michael Price says:

    Also for clarification the Lab Work was billed seperately by Quest Diagnostics for a little less than $27.00. If the doctors were billing me for the lab work plus consultation I would understand but that was not the case. They were just handing off the paperwork and offering an opinion on it.

    Maybe next time I’ll just make sure I’m at work on free lab work day.

  9. marshall clark-cupp says:

    Medicare was charged 8456 Dollars for a nose polyp removal which was done in the office and took 10 minutes tops. This is fraud, but the taxpayers in this country have no recourse at all. They can’t compete with the bribe money paid to our representatives by the medical establishment.

  10. Carol says:

    My doctor office billed me for 3 office visits. 1 of the visits was to just get blood drawn. She told me I could get it done at a lab close to my house. She said it would be cheaper to have it done at her office. I live over an hour from her office and I listened to her advise.. II see they charged Medicare $70.00 for office visit the day I only had blood drawn. Then charged $150.00 for the real office visit a week later when I got my results. They charge by the minutes. Can’t Medicare see this? Where is the $3 fee for them just drawing blood? I need to have them checked out. Who do you call? This is our taxpayers money! I have never been charged an office visit for just doing blood work. Now I have Medcare and things change.

  11. Dwayne Costello says:

    This an excellent top 10, well done indeed. I can tell you hospital charges versus cost (cost to charge ratio) is epidemic particularly regarding x-rays/mri/ct scans and pharmacy. Many hospitals report cost of 0.04 – 0.06 on the dollar billed for scans, consumers really need to consult experts such as yourself to contest these predatory practices.

  12. Perry says:

    My wife went to the doctor and her doctor told her that her test was going to cost around $170 , but when she go her bill we were shocked to see $2,150.00 She was suppose to only have one test FOR BV and these are the test they did. Please help us.

    CPT Code 87798 Atopobium Vaginae(Non-NY) $150.00
    CPT Code 87624 HPV Plus $150.00
    CPT Code 87798 BV ASSOC BACTERIA NON-NY $150.00
    CPT Code 87798 LACTOBACILLUS SPECIES NON-NY $150.00
    CPT Code 87798 MEGASPHAERA TYPE-1 NON-NY $150.00
    CPT Code 87481 CANDIDA GENUS $150
    CPT Code 87481C. ALBICANS BY PCR $50.00
    CPT Code 87491 CHLAMYD.TRACH BY MULTIPLEX PCR $150.00
    CPT Code 87591 GC BY MULTIPLEX PCR $150.00
    CPT Code 87798 UREAPLASMA BY MULTIPLEX PCR $150
    CPT Code 87798 MYCOPLASMA GENITALIUM MULTIPLX $150
    CPT Code 87661 TRICHOMONAS BY MULTIPLEX PCR $150
    CPT Code 87511 GARDNERELLA BY MULTIPLEX PCR $150
    CPT Code 87529 HERPES SIMPLEX 1 BY MULTI N-NY $150
    CPT Code 87529 HERPES SIMPLEX II BY MULTIPLEX $150

  13. Elaine Padgett says:

    Was so grateful to find this site! I have always just paid bills even when I did not agree or thought it was outrageous. I am standing up for myself this time and hopefully it will help others too.

    On October 20, 2014 I went to the gynecologist for a yearly routine visit. The doctor ended up drawing labs. The following day, on my birthday the doctor’s office called me to tell me my hemoglobin and hematocrit were so low I needed to go the ER to have a 4 unit blood transfusion immediately.
    Being a registered nurse I understood what was going on and had full knowledge of my risks. I am also a prudent consumer of healthcare and knew that if I went to the ER it would be extremely expensive. I asked to have the transfusions scheduled as outpatient infusion procedure to keep the costs down. The first available infusion was the following Sunday October 26, 2014. I would receive two units on Sunday and two units on Monday. The total 4 units could not be given in a single day due to possible reactions to the blood.
    Between the time I found out on Tuesday and the first scheduled infusion on Sunday I researched and gathered as much information as possible about what to expect with costs related to transfusion. My doctor has privileges at Northside Hospital-Forsyth so that is where it was scheduled. The hospital has a billing department where you are able to leave a message with information regarding CPT codes related to your procedure and they will get back to you regarding what you might expect to pay. By the time I discovered this it was Friday. But having administered numerous blood transfusions to patients myself I was confident this was not a major expense. Since I had opted for the outpatient infusion center rather than an inpatient ER transfusion I was being prudent in containing costs.
    On Sunday, I arrived at the infusion center to begin treatment. Blood was drawn to type and cross me for a donor match. An IV was started and within two hours I was hooked up and ready to go. I received two units over 4 hours with no complications. At the end of the first day I removed my disposable blood pressure cuff (a new one is given to each patient) and my pillows to take home and reuse the next day.

    On Monday, I arrived back at the infusion center with patient ID and wristband still on, my pillows, and my blood pressure cuff. I informed the nurse so I would not be recharged for something I did not use. . I also brought my own food and beverages since this is outpatient. I had a nurse in training on this day. This nurse could not start an IV. It took 4 attempts to start an IV. An infusion nurse should be able to start an IV. Once the IV was in I was again started on my two transfusions over four hours. Again, I had no complications or reactions.
    Within the week I had a call from Northside Hospital-Forsyth billing department requesting payment. I did not receive a bill until the following week. As a seasoned nurse, a certified case manager, I was shocked by the amount. The claim was in process to my insurance company, Blue Cross/Blue Shield of GA, so I just waited for them adjust it and send me an EOB. I assumed the insurance company would scrutinize the bill and adjust it to what a reasonable charge should be. Northside Hospital-Forsyth continued to call, now demanding payment.
    I requested a copy of the bill for the breakdown of the individual charges. For a non-complicated, outpatient, infusion-only, simple transfusion I was billed a total of $8,544! My entire time in the hospital required no physician, nothing more skilled than a nurse. I was charged $3,306 for the transfusions. This amount would be understandable if it included what was involved in a transfusion. But everything that is part of the transfusion was billed separately.
    Standard procedure dictates that you receive Tylenol and Benedryl before a transfusion. I received 2 regular oral 325mg on Tylenol at $6.50 apiece. And ONE Benedryl tablet, 25 mg oral, at a cost of $18.50 per tab. The IV catheter was $28. Because I had a nurse training on the second day and was stuck 4 times I was charged $112. As any medical professional would know it would be much easier on the second day to get an IV going since I actually had some blood in me! The IV bags of Normal Saline were $170 apiece. The tubing was $124 apiece. The individual units of blood were charged at $725 apiece. To type and cross(determine my blood type) was $1,299. The charges were billed wholly and then separately.

    After the insurance company adjusted the bill I am still responsible for $4, 497.99. If the bill had started at this amount I would still think it was exorbitant. The billing department just wants to collect the money and there is no one that can review the bill other than “those are the charges, that’s what you owe.” I have offered to pay something fair in full but there is no negotiation and no reasoning as to why the bill is so high. They can offer me a payment plan-on the full amount. They can offer me financial assistance-on the full amount. But my problem is with the amount.
    In no other area of commerce is there zero transparency in costs. I had no information to base my expected costs on. Yes, I signed papers saying I would be responsible for my bill. But I signed this with no predetermined, estimated, or negotiated cost. It is equivalent to going to a car lot and saying I want to buy a car and signing all the paperwork driving off in your new Toyota. Then discover after the fact that the car cost $100,000. Yes, I agreed and signed to buy a car. But my expectations were that the car was $15,000, not $100,000. In healthcare, there is no way to determine how much something will actually cost unless you are able to negotiate up front. My assumption was that this simple transfusion would be LESS than a caesarian section and hospital stay. I was wrong.
    With each call from Northside demanding payment I argued the inflated bill was the reason I was not paying. I am now being sued by Northside Hospital-Forsyth. The amount is the $4,497.99 plus one year’s interest and attorney’s fees. My hope is to be heard in court and finally be able to get a fair price for services I received. I know that I am not alone in being over-billed by this hospital or any other. Millions of people are forced to declare bankruptcy over one trip to the emergency room. Many do not get care because they cannot afford it. Insurance is not the answer. I have insurance. Insurance discounts a hospital bill from extortionate to just exorbitant. The root cause is the billing. Does a tablet of Benedryl really cost $18.50?

  14. Christina says:

    I recently had a routing OB/GYN appointment. I am a smoker and the doctor asked me if I had considered quitting smoking. We had a very brief discussion about it–she volunteered information and initiated the discussion. I just received a bill for $30.00 minus $10.02 that my insurance pays for, and they’re now billing me $19.98 for the difference.

    A small amount, I know, but I did not initiate the discussion–the doctor did. Had I known that I would be charged $19.98 for a three minute discussion where she referred me to a website and local group for quitting support, I never would have answered back.

    What recourse do I have other than calling and yelling at the OB/GYN office for this utterly BS charge?

  15. Beriah says:

    Hi, I searched the internet far and wide but could not find the answer to my specific question. Perhaps you could help me here. I had an ER visit a few months ago and was seen by the resident physician. I did ask to see the attending physician, but was told that he was busy at the moment. I never did get to see him; however, in my clinical notes the attending physician wrote “I personally saw and evaluated the patient. I discussed the management with the resident and reviewed
    the resident’s note. I agree with the documented findings and plan of care.”

    Is this legal? Should I inform someone about this?

    I appreciate your help.

    Beriah

  16. Kay says:

    I have had endless issues with CPAP supplies. I was suppose to get supplies every other month. I would call and call, get every excuse and never receive. They would tell me since I would have to wait for next billing cycle of my insurance, how is this possible when I never received supplies. Even after signing up twice for auto delivery, I did not get supplies. Now, my insurance at the time paid 100 percent of any charges. In four years, I got the equivalent of 1 year supplies, if that. Noone ever serviced my oxygen machines and now, that I have new insurance, I am being billed for the oxygen machine that should have been paid and fully mine two years ago. My thought is that they have been billing all along, never sending supplies and that 100 percent profit for them. Now, I am going to have to call about this bill and I am sure I will get the run around, per always. They owe me so many supplies!

  17. Leticia Garcia says:

    I have not yet been billed by the hospital but I have a situation that worries me. My doctor scheduled me for induced labor based on the information she gathered on my last appointment once I reached 40 weeks. The date came around only to find out that all the information which she based her decision on had changed. The hospital sent me home, but the woman at the registration desk told me they would bill me for the services rendered that day, because my insurance won’t cover it. My question is, once the bull comes, who will be held responsible for it? To me, this smells like medical negligence. The doctor’s attitude made me feel like she wasn’t being professional. I had reached 40 weeks at my last appointment, in which she looked surprised and quickly scheduled me for being induced.

  18. luis del corzzo says:

    I was billed a service for head scan , cost 3,400 evergreen hospital Kirkland W.A , my health insure pay a portion , the Evergreen send me a bill for over 1,500 , I apply for financial application, this bill was close for collection, I make a payment for 47 that I can stop send to collection, when I call my health insure, they tall me that I have to pay only 225 ,KPS my health insure said that they make a mistake and they reduce my bill to 225, how many costumers have to pay to much for this mistakes? when I google the price for another hospital for the same service Everett hospital charge 775, Image scan 550, for the same service !!! EVERGREEN HOSPITAL in Kirkland is not the right decision to go there . CAn I sue this hospital for Over Charge ?

  19. Zachariah Lloyd says:

    My neurologist sent me down the hall after a visit to get a simple blood test that ended up getting me a bill for $181.00….
    I thought this was ridiculous because I had had blood tests in the past many times, and never seen a charge higher than $40. I informed the doctor of this, and he too seemed surprised at the amount, and apologized to me concerning this. I paid the lab company involved $90, which I believed was still way overpriced for the services, but they continue to harass me almost daily for the remaining $91, and are now threatening me with collection actions.
    To add ignorance to thievery, they did not even do the work correctly, and informed my doctor that the results of my blood work were low, when in reality they were high, causing me to spend more money, and more office visits, which are not cheap either before figuring out that they dropped the ball at the lab.
    I do not want my credit adversely affected by this, and would like to know if this is a whistle blow situation??

  20. Steve says:

    My then girlfriend, now wife, recently fractured her arm in a fall on my boat. She had no health insurance at and we have since married and she’ll be covered on mine from now on. At the time We went to a local clinic where she was x-ray’d and given a pain killer which we paid out of pocket. After they saw the fracture the PA at the clinic advised us to go to the emergency room at the local hospital. We checked in there with our already paid for x-rays on a CD. We were shown to a treatment room and sat down. A doctor came in and talked to us and said he was going to order more x-rays before even looking at ours. I informed the doctor of her lack of insurance and he still insisted he needed them. Nothing happened for a while and then my orthopedic surgeon from an injury I had a year or two earlier popped in the room. He said he happened to be on site when they called him. He said he had looked at the CD x-ray and the fracture did not require setting or a cast and said she should just let the arm hang and avoid using it and that would provide the needed traction to properly heal. He said to come see him at his office in the next week or so if possible and he would work with us on the costs. We left immediately afterwords having received no treatment other than the brief consultation. We just got a bill for the visit for $963.00 for the privilege of sitting in an ER for a couple of hours (ER Visit LVL III). What should we do?

  21. C. Ippo says:

    My doctor just started charging a LAB TESTING FEE. Never had this before. The provider is part of my insurance network, GHI. They take a throat culture for a RAPID test of strep. The they send one off to Quest Diagnostics. I get a bill from Quest and pay the copay. But, the doctor charges me $15 LAB TESTING FEE. Insurance doesn’t cover that. Doctor says its the fee they charge for basically handling the specimen and sending it to Quest. I thought that if they’re in the GHI network, they can’t bill more than what the insurance covers.

    The charges are $30 for the RAPID STREP, and $15 for the LAB HANDLING FEE. Insurance only allows $12.60 for the RAPID STREP, and that goes to my CO-PAY. But, they don’t cover the $15 LAB HANDLING FEE at all. So, I get a bill for $27.60 ($12.60 plus $15).

    Is that LAB HANDLING FEE a legit charge?

  22. Kannan says:

    Hi Pat,

    I had a new office visit on January 5th 2016 as I changed from one endocrinologist to an other. The new endocrinologist works with a medical group of a famous Hospital in central New Jersey. I was talking with the doctor for around 30 mins and her nurse for another 20 mins. The Dr. wrote me 2 lab orders, one to use immediately and the other to use after 4-6 weeks. Nothing else happened in that visit. A few days ago, I came to know that they have charged me $447 and some cents. I have a high deductible and I have to pay this completely out of my pocket. I spoke to my insurance and they said that is what is the contracted rate for that new office consultation with that Dr. I feel, I am over charged here for a 1 hr new office consultation. I have requested their billing dept to check with the doctor for some reduction. In the meanwhile, I am planning to appeal to my insurance. If nothing works, should I go to small claims court? Am I overcharged or is it the right amount for a 1 hr new office consultation? Usually specialist visit in medical group amounts to $100. Even the estimated cost thru my insurance is around $360.

    Thanks,
    Rk.

  23. JB says:

    I went for my annual well women’s exam and had my annual pap smear – all done in my physician’s office. My insurance covers this visit in full as it is considered preventative medicine. Obviously the labwork is sent offsite, so I later received an invoice from the lab company for a charge for “pathologist review” associated with the pap smear (all results were normal, so nothing advanced that I consented to beyond the typical pap smear). My insurance covered this but I was billed for a “specialist co-pay.” Is this practice legit?

  24. Abby says:

    In late December, I had a visit to a local urgent care clinic. I had been dealing with a cough/sore throat for 10 days, and decided I need more than over the counter meds to help it resolve. I was in the building less than 40 minutes, less than 10 of which was spent with the doctor. I had no fever, and had a negative strep test. The diagnosis was bronchitis. I was billed using CPT Code 99204, and charged 300 dollars (plus an additional fee for the strep test). I have researched 99204 and I don’t see where my visit meets ANY of the requirements for this code (or the outrageous fee). I do have insurance, but this was my only doctor visit for 2015, so I hadn’t met my deductible and will be paying this bill out of pocket. Also an item of note, the doctor’s name on the bill and the doctor my insurance EOB says I saw, is not the doctor I actually saw. Any tips for fighting this case of upcoding?

  25. Athena says:

    A couple months ago I went to an urgent care after I messed up my knee. They took X-rays (wasn’t broken) and gave me a knee brace to wear for 2 weeks. I just got the bill for it over $900!!! My insurance kicked in some but I still owe $540. Online that companies brace sells for only $130. I am being billed directly by the knee brace company not the urgent care. I tried calling the company to ask why the over charge and they were very rude and said I had to talk to the insurance. I called my insurance and they said all they are responsible for is paying out. What can I do? Are they allowed to mark up the price that much?

  26. Sam says:

    Here’s my conundrum:
    My wife went to an oral surgeon (recommended by our regular dentist) for tooth extraction and implant. Front desk asked her for insurance at the initial consult, she didn’t have the dental insurance card, but told them to get the info from our regular dentist. Oral surgeon examined her, put her on a device that looked like the regular panoramic x-ray machine, pushed the button, 20 seconds later she was off the chair. Scheduled appointment a week later for the procedure. No one told her an estimated cost (granted, she should have asked). Week later, she goes for the extraction and the implant, procedure is done in half hour (not under full anesthesia, just local and some nitrous), put her back on the machine, 20 second scan, off the chair, goes to the front desk, they tell her she has to fork $2k out of pocket (about what I expected in New York City), she leaves.
    I get a bill on my Dental Insurance (still being processed) pretty much in line with what we expected (about $3k total, $2k paid already at the front desk, after discounts and all probably we’ll get back something like $1k from the insurance, again, as expected). Now here comes the fun part – I get two separate charges, one for $3k and another for $5.5k for “radiology” presumably for the two panoramic scans she received on the initial consult and after the surgery!!!! Both of these were charged to my regular health insurance (separate entity from dental) and my wife never provided them with that information (checked with my dentist and they only provided the dental insurance, didn’t even have the health). Health insurance automatically disburses funds from and MRA (Medical Reimbursement Account) and sends them checks for about $1.2k, not covering the rest as these jokers are out of network (duh). Any words of wisdom on this, as I am going to go deafcon 5 on them Monday morning in person? Thing that pisses me off the most is they never ever told her about the costs, even if this is legit.
    Sorry for the rant, but needed it to lower my blood pressure.

  27. REGINA says:

    My husband had to get a sleep apnea test. We didn’t have insurance at the time and it was a requirement for him to continue working as a driver. He went for the test overnight and said everything was fine but we received a call a day later stating the the test didn’t read and was inconclusive. This test was $3837. He returned to have the test done again but this time it read his results. This test cost $3269. Now, he had the same test on 2 different nights but the price was different. This falls under rule 7 of the medical bill over charges. The machine didn’t read his sleeping patterns the first night. This company reported these charges to the credit bureau and it is affecting his credit score. What can we do?

  28. RK says:

    My Daughter went to the ER for a head injury. No bleeding, she just felt sick and our primary physician told us to go to the ER. Waited 4 hours for the doctor to see us. He told asked us the symptoms and we told him she feels sick and tired. He said all common symptoms of head trauma. She just needs to rest it off. No tests were done. They charged us $1300 and the doctor literally saw us for 3 minutes. Pretty outrageous. On top of that I already researched all the symptoms and knew that its common for head trauma. Not to mention we went to our primary physicians office and she told us the same thing. I guess going to ER was pointless but our primary physician had to tell us that so she doesn’t get any blame in case something does go wrong. Going to the ER is fine and was the wise choice but the bill is ridiculous. I mean if they ran all sorts of tests and things, I can sort of justify, but literally he came in, asked us the symptoms, looked at her and said how many fingers am i holding up and said shes fine, get rest and you may now leave. LOL $1300!!!! The Rate would be $433/Minute. I’m in the wrong field.

    Mark Shkreli is probably one of the worst persons in the world but ER is no different. Even for common medication they charge some few hundred percent over the going price of the medication.

  29. carol says:

    I had surgery and has an HMO she was approved for everything with an auth. The anesthesiologist who was working that day was out of network and my insurance only paid some part. Now he is billing me the rest. My question is I never signed anything or was told that I would be liable for the rest that my insurance paid or I was not made aware that he was out of network. I have made an appeal to my medical group and insurance company but my question is can the anesthesiologist charge me? can I ask for documents that state they made me aware that he was not in my network? please help!

  30. Becki M. says:

    My daughter went to the ER this summer for extreme pain in her pelvic region. The doctor saw her for about 5 mins and told her that she had chlamydia, with out testing for it. Putting her in more emotional distress. She then went to our family doctor the next day and was told her that she did not in fact have this STD. I feel that the ER visit was ridiculous and the billing for this was outrageous. Can I fight the bill in this situation as they misdiagnosed her?

  31. Nikolaite says:

    I am a self-pay individual. I recently saw a nurse practitioner for what I now know is macular edema. She was more than 30 minutes late to my scheduled visit. The triage nurse spent about 5 minutes with me. The nurse practitioner spent about 5-10 minutes with me while I described my symptoms. The nurse practitioner’s statement to me was that I should see an optometrist and that she could do nothing for me. After that I went to pay my bill. It was always below $70.00 at prior visits, and much lower than that (or nothing charged) at visits where nothing was done other than time taken. The total charge on the visit was $110.00 minus the in-office payment discount. I asked for clarification on the billing and was told that I was being billed that much because I hadn’t visited the office in two years.

    Long story short, the cost per visit had gone up and policy had changed on applied billing. I paid the money, but believe I actually owed nothing as I received nothing.

  32. Michael says:

    I recently went in for an x-ray. I have insurance as well. I had the x-ray done in January and now I find out my insurance did not cover my x-ray. So I have a $1900 charge I have to pay. Should I have been let know that my insurance was not covering the service before the procedure taking place? If I had known it was not going to be covered, I would not have had the service provided.

  33. V says:

    Hello, I went to an endocrinologist at Northwestern Memorial Hospital in Chicago. The consultation consisted of him asking me to raise my hand and shining light in my eyes. No explanation or possible treatment of my problem was given, no blood or other tests were done. The whole visit lasted no more than 20 mins.

    The hospital charged me $330 for that. The insurance usually pays around $100 for physician visits but refused to pay this bill because the condition I was complaining about was not covered on my plan.

    Now I am supposed to pay $330 for 20 minutes of nothing. I suggested they rebill the claim with different diagnosis “abnormal hormones” but the hospital didn’t do it.

    Do I have grounds to sue them for overcharging?
    Is that acceptable in USA to have one charge for insurance company and several times larger charge for a patient without insurance?

  34. V says:

    I once went to ER. It was almost empty but I waited two hours until they decided to accept me. They gave me 3 pills and the doctor was pushing for blood tests. I figured out that the price for blood tests at ER would be enormous, and these tests could be done later, so I refused the tests. At the end they billed me over $1000 for waiting on them 2 hours and handing me 3 pills. I told them that I am outraged and would sue the hospital for overcharging. They instantly dropped the charge to $0. Be ready to sue them!

  35. Lisa B says:

    I have a question that I can’t seem to get my insurance and the hospital to understand. Both my husband and daughter had an appendicitis within 4 months of each other. Both went to the ER, then from the ER to surgery. For my husband, the hospital billed my insurance $40,000 plus for the surgery, the surgeon, the supplies, the ct scan, all radiology performed, all labs and also listed anesthesia. When everything was said and done, I had a bill from the surgeon, 2 bills from anesthesia, one for a CRNA and one for the Dr. According to my insurance it all should have fell under the ER copay. Now I am having to come up with $2100.00, for the entire surgery when I believe I should only have to pay $150.00.

    On my daughter, she also went to the ER, where they gave her fluids, a CT scan and then when the surgeon came in the next morning (we went in at 1130pm, and he came in at 600am the next morning), he said she needed surgery and proceeded to take her up. I have not received a bill from the hospital yet, but I have received a bill from the surgeon, for $678.00, post adjustment from insurance, a copay for the surgeon for a new pt visit, and again the 2 separate anesthesia bills for the CRNA and Dr. According to my benefits this should all be inclusive, but then I’m also told the surgeon and anesthesia can bill separate. I’m so confused. What would be your suggestion and any help you could advise to get these bill amounts done would be so appreciative. I can’t wait to get the ER visit bill, which ironically hasn’t been submitted to the insurance co yet, even though it’s been over 3 weeks since the procedure. Thanks!

  36. Cheryl says:

    While on vacation in Florida, I had severe stomach pains and cramping. Since it was 10pm and the clinics were closed, I decided to go to The ER in Naples. Many test were performed and medications were given and I was later released. Upon receiving my bill, I received several bills. One from the hospital for the ER visit and one separately from the ER Doctor. The ER Doctor charged $1,690 for his services, but my insurance provider (Aetna) only covered around $250. The balance is “my responsibility” according to the Aetna claims statement. The reason in the remark section stated that the $250 payment is what is allowed for this geographic region. Hence, I am being charged for over $1,400 for the doctors bill. This is in addition to the $7,000 bill which we received from the hospital due to the ER visit. Is there anything we can do. We already paid a copayment of $200 for the ER visit. Thank you in advance for your assistance.

  37. Alphonse says:

    Hello,
    thanks for setting up this website, i do have several questions and hope you could help me out;
    in December 2015, i had some back pain and was thinking it was only some normal pain; until the day i could not take it anymore and i had to go to the ER in network; the Dr, after an x-ray told me it was only a muscle strain and prescribed NAPROXEN. few days later the pain was more than imaginable, i ran to an Urgent Care to make sure it was only a muscle pain, at the urgent care the Dr checked and asked me to do an Ultrasound in a private place that would be sent to his attention later on; he also prescribed CODEINE and a muscle relaxer. Since that day i did not hear from that urgent care; after several days i had to call them an inquire about it, the lady i got on the phone told me that my results were in and everything was fine (so far i did not talk to the doc who ask me to do the Ultrasound). the same week on Friday night i could not sleep due to the pain; i went back the next day early at the Emergency care and after explaining to the same Dr my condition he asked me to do some movements and after touching the side where i was feeling pain told me that i was an appendicitis ND I would need a surgery; i went back then to the hospital i mentioned on the top (the one i went for the first time ) for the surgery. admitted in the ER, they first made a CAT scan and confirmed that i would need a appendectomy and i would be ready to go home after max 2 or 3 days after 2 hours waiting i finally got the surgery. i stayed in the hospital and after the second day the pain would not ease, nurses told me that i was gas and would go away; meanwhile i was receiving a lot of laxative but my pain was there and my belly was getting bigger and bigger. after 4 days in the hospital with the pain and my belly getting bigger and bigger, i called out for my Dr because i felt that something was going really wrong, finally when he came, he asked for a second CAT scan and then found that i had some fluids inside that needed to be drained even they did closed me up after the surgery.
    i have then to go for a second surgery to have the fluid removed by fixing a drain tube (i did kept that drain for +3 weeks before he finally removed it.
    now i am ok but sometimes i do feel pain on my stomach (maybe post surgery side effects).
    Recently i did receive 2 bills for the anesthesia i did receive for the 2 surgeries total of $800 after insurance coverage and the hospital didn’t send their bill yet.
    my questions first is my should i receive two bills from that third party? and should i get billed for the second surgery because if the first was done right and the tube fixed for drainage i would not have a second surgery.
    please advise before i call to make arrangements, because it’s not i don’t want to pay, but i don’t want to pay for what i believe is a mistake.
    thanks.

  38. Lucy N says:

    can surgeon charge for operating room service if procedure was done in the office?

  39. Lisa says:

    Hi, just found this site. It has a lot of helpful information. I just visited a new doctor and received my bills, which I am a little confused on. This was my first visit and the only thing done was talking to the doctor about my symptoms, blood pressure and diabetes. He did not prick my finger in the office. I received two insurance claims from his office. One states Medical care and charged $400 (w/insurance my cost was $167.93, which was covered I guess because my portion was $0.00). The other claim stated Surgery and billed as follows
    surgery – 10.00 (my portion 3.15)
    Other medical services – 40.00 (my portion 32.31)
    Lab/pathology – 33.00 (my portion 13.24)
    Lab/Pathology – 22.00 (my portion 8.83)
    Lab/Pathology – 11.00 (my portion 4.32)

    I also received two bills from LabCorp (blood was drawn in same facility, but not in doctors office). These bills were as follows:

    First bill
    Microalb/Creat Ratio, Random Ur – 129.00

    Second bill
    Comp.Metabolic Panel (14) – 46.00
    Lipid Panel – 98.00
    Vitamin B12 and Folate – 194

    I’m expecting another bill shortly from LabCorp because I had to go back in for more tests for my thyroid.

    I guess I’m more confused with the doctor’s claim, why would he bill me with a claim that states surgery and then send another that states labs and pathology when none were done in his office?

    You’ve done such a wonderful job explaining other issues, can you help me with this one? Thanks in advance and have a wonderful weekend.

  40. Nancy says:

    Facts. 2003 I had mastectomy reconstruction surgery. In Nov. 2015, a cardiac CT scan saw a possible ruptured implant. Had surgery in Dec. to clean out the rupture and implant a new implant. Btw, it did not stay put,and another surgery is scheduled for May. I received several checks for the Dr.s involved, Here’s the kicker. The surgeon billed for a total of $156,000.00! I balked at giving him the last huge Check. My insurance company said that they paid whaT is reasonable. They didn’t want to hear about my concerns. They paId him 20,000.00 to remove the ruptured implant twice! There were actually two implants on the mastectomy side. When I spoke to the doctor, he explained that he doesn’t refuse cancer patients,and that costs even out with insurance reimbursements from “Good” insurances and from “lesser” insurance companies! My insurance paid him a total of $81000.00. For that I should have a complete new model’s body!!!!! WhaT a rip-off! Am sure my premiums will go through the roof!

  41. Swati says:

    My son had a oral cyst removed at oral surgeon’s office. I paid for the service and facility fee for that. Then I got an bill for pathologist close to 300$ which I also paid. Now I’m getting a bill of 165$ for a facility fee for path report. Is that appropriate?

  42. Bill Cullis says:

    I got double billed by an anesthesiologist and a CRNA for a getting a Pacemaker implanted in my chest. I was not intubated and only had supplemental oxygen through a mask. The procedure at best lasted an hour. I remember the CRNA telling me on the table he was assisting the doctor. Is this legal and can I do anything about it?

  43. Lizz says:

    Can an ICU patient be put in “icu overflow” in PCU unit with a semi private instead of private room and be charged for icu room?

  44. Kayla says:

    I recently experienced severe abdominal pain that left me going to the ER a few weeks ago. My boyfriend and I waited 30 minutes to be called in by the triage nurse only to spend 4 minutes maximum in there. I was only asked my name, address, and insurance information (of which I had none at the time). This was follow by 3 questions by the nurse, not even anything in depth like my previous health issues but just very basic things like height and weight. They put a band on me and sent me back outside. My pain was increasing from having to sit up straight in the waiting room chairs and so my boyfriend asked them how long it would be before anyone else would see me. They quoted him with a 2 hour wait. I physically couldn’t take the pain and so we left to go to another ER. I was seeing within 15 minutes/taken to the back again within 30. All around much better experience. I expected to get charged maximum 150 from the first hospital but they sent me a bill today for 670 dollars. I received no IV, no meds, nothing. Just a wristband and for me to tell them information they could have gotten on their own by having me stand on the scale and taken my height information. I have no idea what the heck to do, as I am already waiting for the final bill from the second hospital that ACTUALLY did testings on me. Is this normal?

  45. W. Barrett says:

    I found this article from a google search. I feel that I have been a victim of “unbundling” Maybe I missed it in this article… But where exactly should I report the unbundling? I would like to blow the whistle.

  46. tameka says:

    I went to the hospital to the emergency room the hospital charged me one bill and I got a separate bill from the physician that saw me is this right

  47. Tano says:

    My sister was charged 870 when all they did was check her blood pressure. They did nothing else. She told them of her symptoms they just put the blood pressure bag thing over her arm and told her she’s fine and than they mailed the bill.

  48. Valery says:

    I recently requested a medical opinion from my specialist doctor’s office and they are wanting to bill me $1500.00 dollars to summarize my medical care. This is high way robbery!This is needed for the Office of Injured Employee Counsel to assist with fight for my medical care. There is no way I can afford this bill, although, I am in need of having the medical opinion. For now on, I will exercise full due diligence when choosing health care providers.

  49. Matt says:

    Hello,
    My wife needed an emergency Scleral Buckel / Retina reattachment surgery. She’s covered by Anthem BCBS; she’s a teacher. Surgeon recomended we have the other eye done for perventative reasons. So, after 2 eye surgeries, she’s left with $24,000 in hospital bills. Does this figure seem right? Are we being overcharged or is her insurance just not covering it?

  50. Good website. I will be in touch soon and need your’re expertise.. Thank you!!!

  51. Debbie says:

    My husband had a stroke and went to the only hospital that is in network in our area, which is 30 minutes away. He went to rehab and went back to the hospital for a few days because he had another stroke. During the second hospital stay, he had alot of labs done to test if other things were going on, aside from the stroke. The labs were over $2,000. The hospital charged the insurance for these labs and my insurance paid, but the pathologist who signs off on the tests is not in network so I am getting a separate bill from him. He is also charging for every time my husband got a finger stick when he was in the hospital and rehab. I think this is a way to ‘double dip’. The first time he was in the hospital he wasn’t charged, just the second time and from then on in rehab, which is also owned by the hospital. I don’t think I should have to pay this bill. Any advice?

  52. Srini says:

    Thanks for providing such a nice website. I was just wondering if a Physician at an ER could bill for his Evaluation & Mgmt service(CPT 99284) and the ER facility for ER visit (CPT 99283) for the same day? I think it’s duplicate billing!!

    Thanks in advance for your response!

  53. […] extortionate bills people are given, which are generated less on the cost of the treatment and more what the hospital think the insurance will pay. When health insurance doesn’t come through for you – or has a significant percentage […]

  54. Brittany B says:

    If a crna administers an epidural and the “supervising” physician never steps foot in the room during the entire hospital stay are they both allowed to bill for an epidural?

  55. KV says:

    My family of four had a rabies exposure (woke up to a bat in our room, therefore unsure if bitten or not) and had to receive initial prophylactic treatment at the ED. We had to have three follow-up visits at a clinic for the remainder of the immunizations. My questions are: Our emergency room visits were coded as level 4 – is this right? Also, is it appropriate to charge each person a room charge for every visit even though we all used the same room? Our ED room charges were over $800 per person and each clinic visit room charge was $90 per person per visit, so it adds up quickly to over $4000 just in room charges. We were also charged injection fees in the ED – two each (one for the immune globulin and one for the vaccine) per person at $73 apiece. Is this ok to be charged separately and not under the room charge? Thanks in advance for any help.

  56. Gretchen D says:

    Recently a left arthrocentesis injection of depo-medrol was done in orthopedic office for left knee pain. This was a planned procedure and I never left the clinic room at all. On my bill it stated;Hospital/Clinic Services-Orthopedic Surgery DX1:M25.562, Med-Sur supplies (270) $3.40,Pharmacy w/cpt code (636) $21.00, Pharmacy/Generic (251) $3.00 and Treatment room/Obs room (761) $60.00 for a total bill of $87.40
    Here is my problem…When I received my bill from the clinic it clearly stated all the above information,however it also added a Medicare advantage adjustment of +$159.01 making the total billed amount to Medicare as $246.41. I paid my $40 specialist co-pmt as per my insurance contract, however because they are considering it a surgical procedure they state I am responsible for 20% of the approved amount, which since they billed the Usual & Customary charge of $246.41 (by adding additional charges on the bill as an adjustment), the insurance company paid 197.13 and state I have to pay $49.28 (of which I already pd $40). My problem with this is that I feel if I needed to pay 20% for a procedure done then why is it not on the actual charges instead of inflated usual & customary charges that were not incurred or simply the specialist co-pmt ?? I have asked for a review and also appealed it through our medicare advantage plan but they still insist that we pay the other $9.28 because the clinic is entitled to receive the inflated U & C payment even though this means I am actually paying nearly 57% of the actual charges rendered.

  57. Tracy N. says:

    I recently went to the ER and was admitted for pneumonia, but no hospital bed was available so I was kept in the ER for over 12 hours until I couldn’t take it anymore and asked to be discharged. I was discharged from the ER but when I rec’d my bill there was a charge for the ER and inpatient room and board plus labs, x-ray, medications etc. My insurance carrier paid a set DRG for pneumonia, but my c-pay is 10% of the lesser of which in this case is the hospital charges. The room and board charge is $2350 for one night and I find it ridiculous to pay a percentage of this when I did not occupy a inpatient hospital bed. Is the hospital correct to bill me this way?

  58. […] Hospitals and care providers set the pricing for their services. Not only do they set the pricing, they also itemize according to a series of billing codes. Not only is the cost of services then billed, but built into that is the cost of staff to process each claim. Insurance companies regularly try to negotiate breaks in price and discounts, but even then, the costs are high. People are so used to having the insurance companies pay for it, they don’t even think to look for fraudulent overcharges! […]

  59. Corie B says:

    I see a pain management doc once a month. With that I take a UA once every three or four months. So they can make sure I am not selling or abusing my pills. I took a UA Sept 2016 the clinic charged me 500$ just for the test cup and then i got a bill for 78$ for the processing thru the lab. Fast Forward to Jan 2017 I take another UA. Again the clinic charged me 500$ for the test cup but this time I am charged 1200$ for a different lab to run it. Thats insane. Im baffled by being charged that much for the test on top of the amount to run it. Thats extreme. 1600$ for a UA? My parents pay for my step sisters drug testing(custody case) and they only pay 900$ for a toenail test. Is this legit? Can I be charged that much? The difference in labs prices is crazy. Any help would be appreciated

  60. Beth says:

    I just received a bill from a Dr. I haven’t seen since spring of 2012. The date of service is 12/31/2013 which is suspicious to begin with as it is the last day of a year.

    The bill is not itemized, there is no ICD code and even if I had seen the Dr. I had excellent insurance at the time. I no longer have the same insurance as my husband switched jobs

    The Dr is in Alabama and I don’t even live there anymore!

    What can I do about this?

  61. Starlynn says:

    Hi Pat,

    I just have a question about pathology fees and bills I receive every time I have lab drawn. Lab is covered 100% if I have it drawn at the HCA hospital where I work. The Pathologist in the same hospital is out of network-why, I have no clue, so every time I have lab drawn I get a separate bill from him! I don’t understand what he even looks at. The lab is thyroid function tests, that is all, every 6 weeks as my doctor is trying to get me on the correct dose of medication.

    I am so frustrated by the fact that I have no choice to not have my blood work go through this Pathologist . Like I said I don’t even know why he needs to looks at it. Is there anything I can do about this? Request no pathology? I never get any pathology reports.

    Thanks so much,
    Starlynn

  62. Adam says:

    My daughter had an operation. There is one fee not covered by insurance. It was a $425 fee. I called the doctors office. They told me it was a fee for general medical supplies and administration. And they told me that the insurance companies do not pay for that. I have never been charged a fee like this for having any type of operations. Is there anything I can do?

  63. Lana says:

    Hi Pat,
    I went to see my PCP in January and she performed laboratory testing in her office. After reviewing my schedule of benefits the cost sharing for lab tests performed at a PCP office is $15.00. I paid a copay at the doctor’s office at the time of the visit. The blood samples were then sent to a lab, so would I also be responsible for paying the lab a copayment? Also, is remittance advice mandatory for billing?

  64. Angie says:

    Have questions about insurance and Drs

  65. Holly says:

    I was give order by my doctor to get Echo Doppler on my neck (possibly thyroid issues). I called around to hospitals to find out how much they charge and was told that they cannot quote and that I would have to contact my insurance company. Anthem customer service stated they could not give me price but to use their ‘cost estimator’. Using their cost estimator, i scheduled with a local hospital. I was billed 3 x more than what was quoted from their website. I submitted appeal/grievance and also filed complaint with Kentucky Dept. of Insurance. I submitted copies of the website quote and was still told that they billed correctly. Per hospital grievance i was told they processed claim correctly (which was not what my complaint was about, because they did process my deductible information correct) and the KDOI told me there was no violation of insurance laws. I am completely in disbelief that hospitals and insurance companies can charge what they want. I will not be using their hospital or affiliates anymore but this completely reduces my options if there were ever an emergency. I will now have to cross the bridge into Indiana in order to be serviced.
    In the grievance process, the letter states that additional charges can incur if additional services are incurred. I was not told they completed additional services as it was a 12 minutes Echo Doppler on my neck. This makes no sense and i have lost all trust in the insurance process.
    Hopefully one day something can be done to reverse this process of overcharging.
    Holly

  66. Tabtiha says:

    I have a question regarding an ER visit I had last year. I went to the ER around 10am that day, paid my ER copay, ended up being admitted for observation and brought to another ER room (which was in the OB/GYN dept of the hospital) stayed there about 2 hours, then was finally transferred to my inpatient room to stay for the observation. My question is, with my insurance plan it stated the ER copay would be waived if admitted, which I was, but I never received a refund for the copay and now I’m receiving a bill stating that I owe money and nothing was paid. Is this correct? Should my copay have been applied to the charges or refunded? Any info would be helpful – thank you!

  67. Marie says:

    I went in for a routine check up because I had a horrible cold. I had a $35 office co-pay, but I saw online on my insurance claim that the urgent care office billed my insurance company $600! Meanwhile if you didn’t have insurance, an office visit would have been about $150. I also did a swab test for a flu, which took 48 hours to get back. Those tests only take less than 24 hours, but I kept calling the office for follow up. At one point, the receptionist picked up and hung up the phone. They billed my insurance company $1000 for that test. I feel that this is fraud and their way of collecting more money. Can I blow the whistle on them? Insurance companies also shouldn’t have to be overpaid.

    • says:

      Hi, Marie. Can you give us a call so that we get a few more details? Our Consumer Division line is 855-203-7058. Thanks!

  68. Ravana says:

    Hi Pat,

    I am an international student in the USA and have purchased Aetna student health insurance as it was recommended by my school. Last month I got UTI and it happened at night and it was my first time, so I rushed myself into Action Urgent Care, San Jose. The doctor took sample and tested it and confirmed it was indeed UTI and prescribed medication along with care. She never even examined to see any complications and was confident with her assessment. She reassured me that it’ll be gone in 7-10 days. I wasn’t cured in that time and it got worse, so I went back to the same place. This time that same doctor wasn’t available so they brought in a new doctor, who again took a sample and came into the room to tell me it was a UTI. I told her that I already knew that and the medication that was given did not help. So she wrote stronger meds for me. I asked her specifically if they’re going to charge me again for this visit, as it was the same ailment that was never cured. I even mentioned that I am a student and clearly mentioned that any amount above my insurance coverage would be too much for me to manage. Se reassured me that I needn’t worry. My earlier diagnosis was not accurately addressed with its severity, so this visit will not be charged.
    I got a bill today (a month later), asking me to pay $214. It’s a lot of money for me to manage now and so I took it up with the billing and when they couldn’t help, I visited the clinic again so talk face-to-face with the provider. The receptionist did not allow me to have the conversation and said the provider wasn’t available to contact for the next month. I asked them to give her a call and confirm what she told me, so they can ask the billing team to correct the charges, but she just plain refused.
    I am lost and feeling cheated here. What is the guarantee that the doctors are purposefully not treating well, just so patients return again? and every visit consultation is $385! In the second visit, the doctor did nothing other than give me the same conclusion, one I knew. Please help, this is a scam!

    • says:

      Hi, Ravana. Thanks for reaching out. Could you give us a call at 855-203-7058 so that we can get more information to assist?

  69. Steve says:

    Hi Pat, I found your page and really appreciate this information. I do have a problem with a medical bill and not sure where to turn next. My wife was seen in an emergency room back in August of 2016. She was admitted into the hospital for 4 days. Since we only have SS income and no insurance the hospital wrote off a bill of about $18,000. But we received a bill for almost $1600 from the emergency room doctor. It has no details as to what it is for other than states emergency room services. On three occassion I have requestd a line item detail of the charges and heard nothing from the doctor’s office. Finally I sent a registered letter on March 21, 2017,to get the details and still have not heard anything. I demanded line item details and said I would need 30 days to review once I received. I was not denying we owe for services but wanted detail. I said if they turn this over to collection I would seek legal recourse, as we have acted in good faith. They turned in over to a collection firm and they has since filed negative reports on our credit files, which we have good credit. Now I get a letter from an attorney seeking to collect. What should my next step be? In Georgia we have the “Patient’s Right To Now Act”. Can you give me any suggestions? Thanks

    • says:

      Steve, thank you so much for reaching out. Good for you for knowing to request a detailed, itemized statement of charges! We’ll be happy to try to help. Just give us a call at 855-203-7058 so that we can get some more information. Thanks!

  70. Maria says:

    What types of medical issues would warrant a Level 5 Code at ER? I was waiting in the waiting room for hours (not a private room) and didn’t actual see a Doctor until 6am for about 10 min. While waiting, I had EKG, blood work and xray. I request a itemized summary of the $2700 ER visit. There’s no way I could be at level 5 when most of the time was spent waiting in public area.

    • says:

      Hi, Maria. Thank you for reaching out. A level 5 ER visit is for life threatening conditions. I’m not sure what your symptoms were, but typically, a level 5 visit would mean that measures were taken to help save your life. We would need more information to review what happened in your specific instance. Would you mind giving us a call so that we can get more details? Our Consumer Division can be reached at 855-203-7058.

  71. Evan says:

    Okay, so my wife was seen last week at the hospital for pain that she was having in her abdomen. She was advised to go to the ER by our regular doctor for a CT scan. Once the scan was performed, we were made to wait in a patient room until the results came back. Well, three hours later, after asking several times, they finally told us the results (they knew for those three hours). They then told us that they admitted her for the night, without asking us. Well, this in itself wouldn’t be all THAT bad, but the reason for them admitting her was to have her recieve antibiotics via IV for the night, antibiotics that we had told them she was allergic to before she even received the CT scan! The only treatment they gave her was administering fluids via IV and an anti nausea medication that we requested they not use, due to her not being nausious, but they administered it before we could stop them. All in all, they did nothing for my wife asside from a CT scan and IV fluids. I feel that the practices were very deceptive. We recived a bill today for 7500 dollars relating to the ER visit, and since she doesn’t have insurance, we are responsible for all of it. Based on your experience, is there any grounds for a rebuttle of the charges? If so, how should one go about handling this situation?

    • says:

      Hi, Evan. Thank you for contacting us! First, did you request an itemized statement of that $7,500 bill? Make sure you look over the detailed charges very closely. We would like to talk to you more about this to get more information. Could you give us a call? 855-203-7058.

  72. Emel says:

    We are currently dealing with an ENT provider that continues to bill significantly lower rate to big insurance companies, and hikes up the rates when billing us. My question is, can that be done.

    this provider is also notorious for billing the same amounts for both physician, and surgery center fees and again, charges a significantly higher.

  73. Jenna Espino says:

    Hello, I am interested in disputing some medical bills from my recent birth and would so appreciate any help or insight you can offer!

    For my most recent baby I had planned an out of hospital birth center birth. Unfortunately at 36weeks we verified that my baby was still breech and were told a csection would need to be scheduled for 39weeks.

    March 15th comes around (I am 39 weeks) and I go to the hospital for my scheduled c section. I am admitted to triage, labs are drawn, a liter of fluid is given and a portable u/s is done to verify position of baby. During the U/S it is determined the baby had flipped and was no longer breech so I requested to be discharged since I was not in labor. I was there a total of 1.5 hrs.
    I received a bill from the hospital for 1300 dollars! The EOB from my insurance broke down the charges and showed I was being charged for the OR (which I never entered), Room and Board (I was never in a room and was only in a curtained off area for an hour and a half), a lab draw (im fine paying that) and misc. charges. Are they able to charge me room and board and OR charges???

    • says:

      Hi, Jenna. You can only be charged for services that were rendered, so if you have charges for items and services that you did not receive, I would certainly try to dispute them. If you would like help in doing so, please give us a call at 855-203-7058.

  74. wullimann says:

    Hello,
    I have had three surgeries in the last 1 year and all were under general anesthesia. Every single bill has a charge of CRNA and anesthesiologist that are equal amount (around $600 each). I had no idea that this could be a possible overcharge by charging me double!
    I tried to dispute the last anesthesiology bill and they were rude and uncooperative. They told me they bill based on the units, so they bill for time of the provider spent in the room. SO basically the anesthesiologist doctor is there and does not much, the CRNA is doing all the work, and both get paid full amount!!! Are they sing the system? Why even have a nurse there? I would rather have just an anesthesiologist and skip the nurse, if that would save me 50% of the bill. I am furious and I am angry how those people overcharge me and then expect me to pay such atrocious amount.

  75. Sushma says:

    Hi,
    I had a Same Day Outpatient Surgery for Tubal Ligation in a nearby Hospital which is in network of my Insurance. I had done some research online to know how much it would cost and all sites almost showed up a max of $7000. But my Hospital charged me $19,000+ to my Insurance, and after all coverage I need to pay $2600 out of my pocket. I feel, the hospital has overcharged me just because I have this Insurance. The Billing department of Hospital is not responding properly. I see in the detailed bill provided by them, that they have charged 12,000 for Operation Room charges, for me being there for 45 min. $4500 have been charged for being in Recovery room for 45 min. and $1000 for anesthesia. rest of them are for Injections, medicines and IV I was given at various levels. Altogether I was in hospital for only 4 to 5 hours.. My doctor told the surgery took only 5 to 10 min. I am not sure why I was kept in Operating room for 45 min, and my Husband told that they forgot to move me out of there, till he went and enquired about me, and then they realized I’m still there, so they moved me to recovery area after that. But all the medical records they have created as if I had to really spend time in OR for 45 min. Is there anyway we can dispute this bill?

    • says:

      Hi, Sushma. Thanks so much for reaching out! We hear of this type of situation on a regular basis. We would be very happy to talk to you in more detail about this so that we can try to assist. Please give us a call at 855-203-7058.

  76. Connie says:

    My husband was referred to a hematologist who charged him for the initial office consultation $455 minus $100.86 insurance adjustment & $35 copay. Then there were lab charges totaling $868 minus $675.53 insurance adjustment. And there was also a $212 Clinic fee charge. Then this hematologist asked my husband to come back in to go over his lab tests. We were charged $359 minus $103.59 insurance adjustment & $35 copay and another $212 Clinic fee for this follow up visit. Our total out of pocket is $1156.02. Please advise if we can at least dispute the two charges for the $212 Clinic fees.

  77. Jesse says:

    I was in a fairly remote location this 4th of July. Had a sore throats so bad was having hard time even swallowing. Ended up going to local hospital. They administered a strep test which came back positive and gave me a shot. Bill came today and was 1600.00. Is this normal?

  78. Patrick says:

    My Dr. recommended and prescribed and an Xray of my right hand and a blood test, bot of which I took at St Michaels Hospital in Newark, NJ.
    The only reason I took the Xray and blood test was because I asked for, and was given a quote before I paid out of pocket. The cost seemed very reasonable and I was NEVER alerted, notified or informed of ANY OTHER charges and this has really pissed me off. I did not sign anything that stated I would be paying additional fees and there is NOTHING posted that this is not the final bill and there are additional fees. The following is the initial bill and then the followup unannounced charges. WHAT CAN I DO?

    INITAL CHARGES:
    Xray: $100.35 (turns out its just for, well I don’t even know what it was for now, see below by $1642)
    Blood work: $143.78 (turns out it was just for drawing the blood at the hospital)

    OUTRAGEOUS UNANNOUNCED CHARGES:
    $1642 (hospital called me stating that it’s for hospital facility use but they don’t know what services it’s for)
    $210 (pathology lab for testing the blood work, I negotiated and paid 40% off to $126)

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