Oh no! Your 8 year-old son just fell on the playground at school and hurt his arm. You aren’t sure if it’s broken, but he’s in a lot of pain and can’t stop crying. You dutifully inform your boss that family calls, and you need to leave. You pick up your son from school and do what you assume is the responsible, logical thing: you take him to the emergency room.
Oops. There are way better options out there for you that involve less waiting around and more personal care. But we’ll cover that in another article later.
So you’re at the hospital. You wait around for 3 hours in the waiting room with everyone coughing around you and your son crying and writhing in pain. Finally, you and your son get to go to a treatment room where you wait another 45 minutes for a doctor to come in and tell you what you already knew: your son needs an x-ray on his arm. Another half hour later, an x-ray tech comes to the room and brings your son down the hallway to take the pictures. You wait another hour, and the doctor comes back in to tell you that the arm isn’t broken. It’s only a badly sprained wrist. He writes you a prescription for pain meds, a nurse wraps the arm in a support, and they send you home. Not a very satisfying experience.
Then it gets better. Several weeks later, you get three bills in the mail. The bill from the hospital says you owe them $3,400. The bill from the doctor says you owe him $1,200. The bill from the radiologist says you owe him $250.
$4,850 for an x-ray, some pills and a wrist wrap! Seriously?! You aren’t alone in your surprised aggravation. This scenario plays out several times a day in every hospital across the country. You’ve become a victim of a practice called upcoding. Technically it’s illegal, but it’s so common that only rarely does anyone do anything about it.
Without diving into the arcane world of medical billing in the United States, upcoding in the emergency room happens when the hospital and doctor document your visit as a much more serious emergency than it really was. There are 5 levels of emergency room visit where Level 1 represents the least complex cases and Level 5 represents complex, life-threatening emergencies. As you might imagine, a Level 1 visit is the least expensive, and Level 5 is the most expensive.
While very few hospitals publish their prices in public, the Cleveland Clinic publishes their charges for various services online. If your local hospital does publish this information, it’s a good piece of info to have. Regardless, it’s not like you’re going to start shopping prices with an 8-year-old in the back seat screaming, ‘It hurts mom!’
So what do you do with that unexpected bill? You are ultimately responsible for the legitimate charges for the care, but you absolutely have the right to make sure the charges on your bill are correct for the services you received. Here’s how to do that:
Steps For Ensuring Emergency Room Charges Are Coded Correctly
- Call the billing department listed on the bill and ask them to send you a copy of the superbill. This is a more detailed listing of all the charges that add up to the total bill you’ve received. It should list specific codes and descriptions, including the level of visit they’ve charged for you. BTW, it will probably say ‘Emergency Department’ rather than ‘Emergency Room’.
- Compare the level on your superbill to the best description of your visit listed in this chart.
- Assuming you’ve been charged for a higher level than you believe appropriate, call the billing department again and tell them you want to dispute the charges and why. This will initiate a review process at the hospital where they will go back and check the documentation.
- Usually, this is all you need to do, but sometimes the hospital refuses to change the level billed. If this happens to you, then ask them to provide you with the documentation supporting their decision to code the visit as they did.
- By this time, most hospitals have figured out that they’re dealing with an informed medical consumer, and they’ll do the right thing. If they still won’t update the charges, this is when you may need to contact a consumer attorney to write them a nice letter. It may cost you a few dollars, but it can turn out to be a savings of a few thousand.