Hospital Billing Concerns: How to Appeal?
I recently had a urology appointment at UIC in Chicago that lasted about 10 minutes. I was briefly checked for blood pressure and oxygen levels, answered some questions about my health history, and then the doctor provided a diagnosis within just a couple of minutes—without using any specialized equipment.
Weeks later, I received two separate bills: one for the doctor’s services and another for the facility itself. Essentially, the doctor “rented” the room and equipment to deliver the service.
The first bill was mostly covered by insurance, aside from a small co-payment of $40. However, the second bill was for $460, and after adjustments, I’m left with a $250 out-of-pocket expense. This bill is associated with CPT code 99204, which is meant for “new patient office or outpatient visits lasting 45-59 minutes” and requiring a thorough evaluation and management.
According to the criteria linked here, this code should not apply, as none of the conditions were met. Even if I were to downgrade to Level 3, that still requires a visit of 30-44 minutes along with a comprehensive examination.
I’m looking for advice on how to address this situation. Should I try to negotiate directly with the hospital, or could BCBS assist in resolving this issue? While I can manage to pay the bill, it’s incredibly frustrating to feel like we’re getting taken advantage of, and I can only imagine how challenging it must be for those living paycheck to paycheck. Any suggestions?
I can understand how frustrating and concerning this situation is for you. Here are some steps you can take to appeal the bill and advocate for yourself:
Gather Documentation: Make sure you have all relevant documents in order, including the bills, your insurance statements, the description of the services provided, and any notes you took during your visit.
Contact the Billing Department: Call the hospital’s billing department and ask for a detailed breakdown of the charges. Politely explain your concerns about the billing code used and how it does not reflect the actual services provided. Ask them to review your case.
Request an Appeal: If you believe the charges are incorrect, formally request an appeal through the hospital’s billing department. Many hospitals have a specific process for disputing charges, so ask for their procedures and follow them closely.
Contact Your Insurance Provider: Reach out to your BCBS representative. Explain the situation and ask if they can assist with disputing the charge. They may have specific procedures for handling appeals and can often provide additional guidance or support.
File a Complaint: If you find the hospital is unwilling to cooperate, consider filing a complaint with your state’s department of health or the relevant regulatory body. You can also file a complaint with the state insurance commissioner if you believe your insurance company is not adequately addressing your concerns.
Patient Advocate: Consider reaching out for help from a patient advocate. Many hospitals have patient advocacy services that can help you navigate billing issues. There are also independent patient advocacy organizations that may provide you with assistance.
Stay Organized: Keep a record of all communications, including dates, names of representatives you spoke with, and what was discussed. This documentation can be crucial in resolving your case.
Explore Financial Assistance Programs: Some hospitals have financial assistance or charity care programs. It’s worth inquiring if you qualify for any help, given the nature of your experience.
Consider Legal Advice: If you feel the situation is not being resolved fairly or you believe there is fraud involved, you may want to consult with a healthcare attorney for legal guidance.
While it’s unfortunate that many encounter similar situations with medical billing, taking proactive steps can often lead to a resolution. Good luck, and I hope you find a satisfactory outcome!