Woman fights to crack medical bill coding

Print
Email
|

by Janet Roach, 13News

WVEC.com

Posted on May 7, 2013 at 6:17 PM

Updated Thursday, Oct 17 at 2:53 PM

VIRGINIA BEACH--The issues for Krista Dietz began after two visits to the emergency room last year for an infected finger.

She received a bill from the hospital but what she couldn't understand was another bill she got for $541 from Emergency Physicians of Tidewater.

After trying to get the bill itemized, so she would know exactly what she was paying for, she got another bill cluttered with codes and numbers. Then, her quest got more confusing, when she questioned a customer service agent.

"One lady told me, 'Well, no one ever questions our bills,'" says Dietz.

13News Troubleshooters introduced Dietz's case to the Patient Advocate Foundation in Hampton. The agency specializes in solving insurance and health care access problems and has helped resolve 117,000 cases nationwide.

PAF Mission Delivery President Beth Patterson says it is not unusual to find billing errors.

"Often times, the billing errors occur because the incorrect code was applied by the facility. In that instance, it's their responsibility to go back and correct the code." 

Patterson says patients should always ask for a decoded itemized bill.

In order to interpret Dietz's bill, a PAF staff member referred to a thick medical resource book no ordinary patient has on his or her bookshelf.

Dietz learns the meaning of several codes on her bill.  For example, 401.9 means high blood pressure, 682.4 means cellulitis and 914.1 stands for abrasion or burn.

The new information gave Dietz the ammunition to dispute the bill because she says she never had an abrasion or burn, but an infection.

PAF stepped in to help her fight back and the bill was thrown out.

Emergency Physicians of Tidewater Executive Director Robert Hundley says they see 1,000 patients a day and are always willing to help interpret bills. Hundley adds that the first bill is always itemized but subsequent ones may not be. 

Because of her inquiries,  Dietz's Sentara bill was also wiped out.  Dietz learned that Sentara had a charity assistance program for the uninsured and she qualified.

Patterson says hospitals rarely volunteer information on their charity programs, so you have to ask.

According to Sentara spokesperson, Dale Gauding, charity care policies are posted on the wall in their emergency departments. Brochures on the policies are also placed on registration counters. Patient bills include a phone number to Sentara's financial counseling.

Patterson also recommends that patients, especially the uninsured, negotiate their bills.

"Uninsured consumers, unfortunately, are typically charged on a national average more than insured beneficiaries because they don't have the benefit of contracted rates," said Patterson.  

Patterson says patients should ask what rates insurance companies are contracted to pay and ask for those rates.

Print
Email
|