Medical Overcharges

You trust hospitals with your life and expect them to take care of you, but you don't expect them to overcharge you for it.  However, that's exactly what one Upstate woman says happened to her.

She was charged thousands more than she expected.  When Cindy Girone started having chest pains her doctor told her she would immediately need a stent. She thought she was ready. Even though she doesn't have insurance, she says she had money saved in case of an emergency.

    

Girone explains, "Everything went perfect and then I got the bill.”

Her bill was almost $39,000, not the $10,000-$20,000 she says her doctor told her it would cost.

She says, "I started doing some checking and what I found out that Medicare would reimburse anywhere between $9,000 and $14,000 and that's when we started to try to negotiate with AnMed to get the bill down to a reasonable level. We offered them eighteen thousand, they rejected it."

    

So News Channel 7 went to a medical billing specialist, Nora Johnson with Medical Billing Advocates of America, to find out if $38,700 is a reasonable amount for a hospital to charge for Cindy's procedure. Her answer is no. 



After looking over Cindy's bill from the hospital Johnson explains, "She was charged for items such as a bag of IV solution, a 50 ml bag, and she was billed $138 for that bag of solution. You know in fact the hospitals cost would be in the area of ten to fifteen cents for that bag, so that is a markup that she would have to pay and she would not get any discount. Another thing, they used a stent, she had a coronary stent inserted and they billed her $17,000, almost $17,000 for the stent and in fact their cost would be in the range of $2500 for that stent."

    

According to Johnson, AnMed charged Cindy 332% more than Medicare would pay for the same procedure and 225% more than one of the nation's leading hospitals, John's Hopkins, would have charged. She says the reason Cindy was charged so much is because she is uninsured.

    

"They would discount for most insurance companies the bills and using Cindy's bill that amount would be about thirteen thousand dollars that Anderson Area Medical Center would normally accept from commercial payers.  They would accept a payment of eleven and a half thousand dollars from Medicare, from the Medicare patients and for the same services that their providing to an uninsured patient.  In this case, Cindy, they are demanding thirty-nine thousand dollars from her."

    

News Channel 7 wanted to know why, so we requested an on-camera interview with Anderson Area Medical Center which was refused.  We did get an email from Dan Corrigan, Senior Director of Communications, stating that at AnMed health all patients are charged the same amount.

However, the email goes onto explain Medicaid and Medicare patients actually pay less.

The email says, "The governmental Medicare and Medicaid programs, which typically account for roughly 70% of a hospitals gross revenues, pay fixed fees based on the patient's diagnosis and the procedure performed. This fee is determined by the government and, on average, is less than even the cost of the care provided."

    

In addition the email explains, "Insurance companies and managed care plans, which account for a significant percentage of gross revenues for hospitals, negotiate different discounts based on the volume of business they do with providers."

    

Nora Johnson says that's her point, insurance companies get a discount which adds up to patients like Cindy Girone paying more.

    

 We wanted to know what lawmakers are doing to protect you from hospitals charging too much, so we went straight to State Representative Leon Howard the chairman of the House Medical Affairs Committee.  We asked what is being done right now in South Carolina to fight hospitals that overcharge?

Howard says, "I don't think there are a large number of hospitals that are overcharging that has not been brought to my attention."

He also says right now there is not any agency that polices hospitals to make sure the prices they charge are fair.  We asked what state lawmakers can do about that for the people of South Carolina. 

His response, "One thing I could do if this type of behavior appeared to continue, we could have public hearings to have people come in and testify and bring information in about their experiences being over charged."

He says to do that he needs to hear from you, the taxpayer, about your experiences with overcharging.

As for Cindy Girone, it is now up to a court to decide exactly how much her procedure will end up costing.

Here's how you can protect yourself from being over charged.  First make sure you talk to your doctor and get in writing an estimate of what the procedure will cost you.   There will be some variation, but at least you won't be surprised with a completely unexpected number.

    

If you do feel as though you have been over charged, ask the hospital for an itemized bill, a copy of the pharmacy ledger and a copy of your chart.

    

Discuss with the hospital any charges you feel are unfair. They usually have billing advocates available to consult with you.

    

If that doesn't work, you should contact your state representatives and explain to them the evidence you have found that you have been overcharged.

    

Once you have gone through those steps, let the Medical Affairs Committee know about the problem yourself.  This way they can gather data on hospitals that may charge too much and if they notice a trend they can take action.

If you would like to contact the House Medical Affairs Committee, you can do so by calling 803-734-3046.



Here is a link to the South Carolina Statehouse, so you can find your representatives.  



http://www.scstatehouse.net/html-pages/house2.html     

    

If you would like to find a medical billing advocate to help you understand you medical bill you can find one through this link for Medical Billing Advocates of America. 



http://www.billadvocates.com/