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Sorting out Medical Bills

A consumer visited a hospital emergency room to seek treatment for severe abdominal pain. She had expected one bill, but instead was surprised to receive a bill for $785 from the hospital, one for $340 from the doctor who performed a sonogram, and another bill for $134 from the doctor who treated her in the emergency room.

Sorting out your medical bills after a stay in the hospital can be confusing. Don't be frustrated if you receive multiple bills that look like they are for the same thing. Take a closer look and you'll probably find you are being billed for different services.

Doctors who provide specialized services in a hospital generally bill independently of the hospital using an arrangement known as separate billing. Your emergency room doctor, radiologist, anesthesiologist and pathologist commonly bill separately. You'll also receive a bill from the hospital for use of drugs, supplies and services of nurses and others.

How it Works

Suppose you suffer a serious illness that requires surgery. Here is an example of what might happen:

You enter the hospital emergency room where the emergency room doctor examines you. This doctor provides immediate care and determines what follow-up care and consultations you need.

X-rays are taken and a radiologist interprets the results. You are sent to surgery where an anesthesiologist controls pain and monitors vital body functions during surgery. During surgery, tissue is taken from your body and a pathologist examines the sample in the laboratory.

When you get home, you will receive a statement from the hospital listing charges for use of the hospital and services. But the services of the specialty doctors who treated you (the emergency room doctor, radiologist, anesthesiologist and pathologist in the example above) are generally not included in the hospital's daily room rate.

Most of these doctors are not paid by the hospital. They make themselves available to the hospital with the understanding they will bill the patients they serve.

Billing Language Varies

Every medical procedure is assigned a number known as a CPT (Code of Procedural Terminology). The CPT identifying the procedure may appear on the bill your doctor sends you. The bill also may describe the services provided, or itemize every procedure separately

Most hospitals must provide you with a summary statement of your account within 30 days after you are discharged. If you request an itemized statement within one year after receiving this summary, the hospital must provide it. An itemized bill must briefly and clearly describe each item and the amount charged for it. Having an itemized bill makes it easier to understand the related bills from specialists.

Finding and Solving Problems

Here are some steps you can take to better understand your bills and to solve a billing problem:

1. Look closely to see exactly which provider sent the bill. Sometimes provider groups have names that resemble the name of the hospital in which they practice.

2. Remember you may receive bills from doctors with whom you had only brief contact - or even doctors you never actually met. For example, most of an anesthesiologist's services are performed during surgery while you are unconscious, and a pathologist's services are performed in a laboratory.

3. Check your bills for accuracy. Make sure the dates on the bill match the dates you were hospitalized. Ask the provider's billing office about any charges that are misdated or not clearly identified on the bill.

4. If you feel the hospital's or doctor's bill contains a mistake, contact the billing office of the provider as soon as possible. Usually the telephone number appears on the bill. Keep a record of the people you talk to, what they say and the dates of the calls.



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