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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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Hospital
billing procedures can be confusing
Sept 3, 2004
Q:
My
daughter was hurt this summer and admitted to the hospital.
Supposedly the hospital bill was worded wrong when it
went to my insurance company. The hospital told me that
since the bill was already submitted, the hospital can
not go back and bill the hospital stay correctly. The
insurance would have paid more if it would have been
billed for "in-patient" instead of "out-patient
with observation." Is there anything I can do about
this?
A:
If
there is a billing mistake, it can always be corrected.
Each insurance company would have their own particular
procedures to follow to correct a billing error. However,
it would be up to the department of the hospital where
your daughter was seen to change this bill and request
that the hospital billing department resubmit a revised
bill.
Being
an in-patient and being admitted to the observation
unit are two different things. A lot depends on exactly
how many hours the patient spends in the hospital. It
sounds like your daughter was admitted to the observation
unit which can be a twenty-three hour bed and then was
discharged. It is up to the emergency room doctor to
determine what kind of care best suits your daughter's
medical needs. And it can be very confusing for a lay
person to determine if someone is actually an in-patient
or is in the observation unit. If your daughter was
actually admitted into the hospital as an in-patient
and mistakenly billed as an out-patient, then, of course,
the bill has to be resubmitted to the insurance company.
The hospital is obligated to charge accurately for every
procedure. If there was an error and the hospital won't
correct their mistake, inform your insurance company.
Since
an in-patient hospital stay is different than an out-patient
stay in the observation unit, these hospital stays are
billed with different procedure codes. The amounts billed
by the hospital for both of these procedures are not
the same. So it may not be necessarily true when you
say that your insurance company would have paid more
for an in-patient hospitalization as opposed to an out-patient
hospitalization. Keep in mind if your daughter's bill
is resubmitted as an in-patient, the charges will be
different. And just to make things more complicated,
there are different levels of hospital observation services
and hospital in-patient services. Each level has its
own procedure code and charges. Your daughter also might
have been an inpatient in the hospital long enough to
incur a hospital discharge service too.
And
so are we still wondering why medical bills are so confusing?
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