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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Obtaining
simple, itemized bill is like pulling teeth
Jan. 9, 2004
Q:
My
daughter had knee surgery. She originally was going
to have one procedure, but when the surgeon got in there,
he did another procedure. He billed us for both procedures.
The
anesthesia bill was a single bill.
The
surgery center billed us for two procedures as well.
They were billed at $3800 each. The entire operation
took about one hour. I called and asked for a break
down of the bill. I was told that they never do that.
They bill was based on operating notes and each procedure.
They told me it was like going to a dentist when you
have two teeth worked on. I think it is different. The
surgeon gets paid for two procedures but the dentist
office does not charge for using their facility twice.
Is this legal? Is this a common practice?
A:
You
are entitled to know exactly what you are being billed
for. You want the itemized bill which the surgical center
has. It breaks down all of the charges for any procedures
performed. The surgical center needs this information
to send to the insurance companies. I have no idea why
they won't give you a copy of this itemized hospital
bill. The hospital can not reasonably expect you to
pay for services performed when you do not know what
those services are.
You
need to call the surgical center again and speak to
the head of the billing department. Request an itemized
bill. If they still won't give you an itemized bill
and if you have medical insurance, ask for a copy of
the claim they sent to your insurance company. If there
are still problems, call the public relations department
and call the president of the hospital. Ask them how
many $7600 bills they have paid blindly.
If
you have insurance, your insurance company may give
you a copy of the claim. You may also want to call your
local State Insurance Board and any other regulatory
medical boards in your state. They may be very interested
in the fact that this hospital will not give you an
itemized bill.
Since
the surgeon performed two procedures, he should bill
for two procedures. The anesthesia bill is based on
how much anesthesia is used…the longer the procedure
the more anesthesia used. This would be reflected in
a single bill.
The
surgical center bills for the use of the facility along
with the supplies utilized for the surgery. Naturally,
two procedures will result in a larger bill…the
facility will be used longer and more supplies will
be needed. However, these charges need to be justified
and validated by a breakdown of every item so that you
can clearly see how the surgical center arrived at your
$7600 bill. This information is not secret and you are
entitled to it.
The
only similarity between your daughter's surgery and
a visit to the dentist is that trying to obtain this
simple, itemized bill is like pulling teeth.
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