Linda Brandwin, R.N. 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.

Get hospital to explain $55,000 bill
August 22, 2003

Q: My father suffered a severe heart attack and was admitted to the emergency center. He then underwent angioplasty and stent placements in his arteries. Now we are left with the total bills running over $55,000. I am trying to learn and solve the CPT codes to see if there are any billing errors. Unfortunately, I haven't seen any book helping me with this. Would you suggest a book or website where I can learn more?

I have found the same CPT code on both the physician bill and also the hospital bill. Is this considered double charging? What is code 92980? Is there anyway I can reduce the over billing of tablets that we were charged $2.15 a piece and you can get at a pharmacy for 49 cents? I know hospitals have overheads, but is there any limit on how much the overcharge can be? We can not afford an auditor.

A: I am assuming since your father's bill is $55,000 that he does not have any healthcare insurance. Therefore, the burden of making sure that his medical bills are correct lies with you and not an insurance company. This puts you at a disadvantage because you don't have the medical or coding background necessary to verify the accuracy of these bills.

CPT is the abbreviation for Current Procedural Terminology. Every medical procedure performed has its own CPT code. All medical claims consist of these procedure codes. Every medical bill identifies its charges by using a CPT code. Yes, there are CPT books you can buy. You can get information about purchasing a CPT book on the web. However, I do not recommend this. I don't think having this book will help you understand your bills. Without a medical background and a medical coding background, a CPT book may just make your bills more confusing. For example, I will quote a CPT book for the 92980 code you mentioned. It reads, "Transcatheter placement of an intracoronary stent(s) percutaneous, with or without other therapeutic intervention, any method; single vessel."

Instead of buying a CPT book, call the hospital. Ask for public relations department and ask them for assistance. Tell them you have a very large bill and you need help understanding it. Many hospitals provide this service. If the public relations department can not offer you any help, call the billing department. If they can not help you, call the vice president or president of the hospital. Explain your problem and ask them how you should solve this. Explain that you don't want to pay a bill like this unless you understand it. Whether your bill is for $55 or $55,000, you are entitled to a satisfactory explanation of what this bill means.

You can also call any or all of your doctors asking them to help interpret these bills for you. If you still can not find anyone to help you understand these bills, call your state or local Medical Society. They should be able to give you some direction.

As far as the hospital charging $2.15 for a 49cent pill…well, there are just some questions I have no answer for. Perhaps the hospital pharmacist has the answer.