Idaho

Hospital Billing Errors Not Rare Most Of Them Appear To Be In The Hospital’s Favor

Boisean Jennie Dirksen could not believe it when she tore open the $12,000 hospital bill from her recent surgery.

The bill for Dirksen’s hysterectomy was not right. Dirksen, 59, was billed 84 times for a pharmacy item she used only once. She should have been charged $82.98. Instead, the tab was $6,970.

St. Alphonsus Regional Medical Center did not catch the mistake. It slipped past Blue Cross of Idaho. The error was discovered because Dirksen questioned why the surgery cost so much.

Errors in hospital bills are not unusual. The General Accounting Office estimates up to 99 percent of hospital bills nationwide are wrong.

“The findings have been consistently that 90 percent or more of the bills have errors in them, and 75 percent are in favor of the hospital,” said Charles Inlander, president of the People’s Medical Society, a national consumer advocacy organization based in Pennsylvania.

“I don’t think they’re doing it on purpose,” he said.

Patients cannot count on their health insurer to catch overcharges, he said. Because, the way many policies work, patients pay 20 percent of their bills, after they meet their deductibles, and the insurers pay the remaining 80 percent.

In recent years, many insurers have negotiated discount deals with hospitals. So, while the patient pays 20 percent of the full bill sent out by the hospital, the insurer may not pay the remaining 80 percent.

Instead, the insurer pays 80 percent of the negotiated, discount rate.

That doesn’t happen at Blue Cross, spokeswoman Tracy Andrus said.

And Blue Cross, the state’s largest health insurer, does scrutinize hospital bills closely, Andrus said.

Of the 6,800 claims that come to Blue Cross’ offices each day, 1,500 are checked manually for accuracy. Twenty-four staff members pore over 60 to 65 bills each day, including all hospital bills totaling more than $5,000, Andrus said.

Dirksen’s bill just slipped past, Andrus said.

Precise figures are unavailable on how many hospital bills in Boise, or the state, are inaccurate.

At St. Al’s and at St. Luke’s Regional Medical Center, officials said undercharges are about as likely.

Each showed records showing very few errors, of very little financial significance, on the bills patients get in the mail.

Only a small portion of those bills undergo detailed scrutiny by outsiders. Insurers say that’s because it’s not cost-effective.

St. Al’s no longer sends itemized bills for inpatient hospitalizations, unless customers ask. That’s because patients find blow-by-blow breakdowns confusing, said Valerie Bowyer, charge audit analyst at St. Al’s.

That doesn’t mean patients have to throw up their hands. Officials at both Boise hospitals say they are happy to go over bills with patients.



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