Hospital Billing Concerns: How to Appeal a Bill
I recently had a urology appointment at UIC in Chicago that lasted around 10 minutes. After a quick check of my blood pressure and oxygen levels, the doctor came in and, without any specialized equipment, delivered a diagnosis in just a couple of minutes.
Weeks later, I received my bills, and to my surprise, I was charged twice: one bill for the doctor’s services and another for the use of the facility itself. Essentially, it feels like the doctor is just renting the space and equipment to provide care.
The first bill was mostly covered by insurance, leaving me with a small co-payment of $40. However, the second bill, totaling $460, was only partially covered, leaving me with a $250 out-of-pocket expense.
This second charge has the code 99204 associated with it, which according to the American Medical Association, is meant for “New patient office or other outpatient visit, 45-59 minutes, Level 4.” (You can read more about this code here.)
According to the criteria, this code should only be applied when a detailed history and examination are conducted, along with moderate medical decision-making. Clearly, none of those criteria were met. Even if I downgraded the billing to Level 3, it still requires a thorough evaluation lasting 30-44 minutes.
What steps would you recommend I take to address this issue? Should I try to resolve it directly with the hospital, or will my insurance company (BCBS) be able to assist me? While I’m in a position to pay this bill, it’s disheartening to witness what feels like a systematic problem in the healthcare system. I can’t help but think about those who live paycheck to paycheck and face similar fraudulent issues with private healthcare.
I’m sorry to hear about your frustrating experience with the billing at UIC. It’s understandable to feel overwhelmed and upset when faced with unexpected medical costs, especially when it seems like you’re being charged for services that don’t align with the care you received. Here are some steps you can take to appeal the bill:
Gather Documentation: Collect all relevant documentation, including your medical records, the bill(s) you received, and any communication with the hospital or insurance company. Be sure to keep a detailed record of dates, names, and conversations.
Review Your Insurance Policy: Look over your Blue Cross Blue Shield (BCBS) insurance policy to understand what is covered and any applicable limits or exclusions regarding your specific visit. This could give you more grounds for your appeal.
Contact the Hospital Billing Department: Reach out to the hospital’s billing department to discuss your concerns about the charges. Clearly explain why you believe the billing code does not apply to your visit, highlighting that the time spent and the services rendered do not match the code 99204 criteria. Ask for a detailed breakdown of the charges and any supporting documentation they have for the billing code used.
File an Appeal with Your Insurance Company: If the hospital is unwilling to adjust the bill, you can file an appeal with BCBS. The appeal process typically involves submitting a formal letter detailing your case, along with any supporting documentation. Be sure to include copies of your medical records that demonstrate the duration of your visit and the services received.
Consider a Peer Review: Sometimes, having a peer review conducted by another healthcare professional can help your case. If you can get a statement from another doctor or a medical professional indicating that the procedures billed were not consistent with the care provided, include that in your appeal.
Utilize Patient Advocacy Resources: There are patient advocacy groups and resources that can assist you in navigating medical billing and appeals. They might offer additional support or help you understand your rights as a patient.
Escalate If Necessary: If you still feel that the bill is unfair after your appeal process, consider reaching out to your state’s insurance commissioner or a consumer advocacy organization. They may be able to provide additional guidance or investigate the billing practices of the hospital.
Remember, you have the right to question and dispute medical bills that you believe are incorrect. It’s worth taking the time to advocate for yourself, especially if you’re concerned about the impact on others who may not have the same resources. Good luck, and I hope you find a resolution!