Millions of Americans are trapped in a maze of inflated hospital fees and opaque billing codes. Yet they either pay these crushing bills or watch their credit score plummet.
But what if patients could decode hospital charges and gain the upper hand? Armed with such knowledge, they may reveal errors, negotiate costs, access aid programs, and protect themselves from crippling medical debt.
Patients Pay the Price as Hospitals Fail Billing Standards
Recently published research in the Journal of the American Medical Association analyzed data from a 2022 survey by The Leapfrog Group. This nonprofit issues an annual review assessing the quality of care and billing accountability standards across U.S. hospitals.
The analysis focused on responses from 2,270 hospitals. It found that 754 facilities (33.2 percent) had taken legal action against patients who could not pay bills in full or on time. Additionally, over 1,000 hospitals failed to provide itemized bills within 30 days, possibly violating legal billing requirements.
The bill most patients get in the mail is usually a consolidated summary, “making it impossible to assess whether you’re charged correctly or not,” Patrick Haig, CEO and co-founder of Goodbill, a startup dedicated to making hospital bills transparent and affordable for patients, told The Epoch Times.
Furthermore, 125 hospitals (5.5 percent) lacked billing representatives who could investigate errors, offer price adjustments, or discuss payment plan options. In total, 1,415, or over 60 percent, of the facilities surveyed did not satisfy all three critical billing quality standards.
Over 50 percent of hospital bills reviewed by Goodbill contain inaccuracies, according to Mr. Haig. These range from coding mistakes to charges for unnecessary medical procedures.
“That’s kind of crazy when you think about it,” Mr. Haig said, “because so many people feel like they have no choice but to just pay their bills, or they go into debt because they can’t afford to pay their bills.”
Vague Hospital Invoices Hide Behind Fake ‘Itemization’
If you have concerns regarding hospital charges, request an itemized bill within 30 days. This line-item invoice details all services and supplies involved in your care.
An accurate itemized bill includes standardized diagnosis, procedure, and billing codes that determine costs, Mr. Haig said—specifically, Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and others. These codes clearly convey how insurance companies reimburse hospitals, enabling “apples-to-apples” charge comparisons with other providers, he added.
“For example, a charge for an acute emergency room visit might go by different names, depending on the hospital—like ‘Level 5 ED visit,’ or ‘ER visit Lvl 5,’ but universally has only one CPT code: 99285,” he said.
If the itemized bill lacks sufficient coding detail, request the UB-04 claim form submitted to insurers for payment. It contains the clearest procedure coding available, according to Mr. Haig. Simply requesting the hospital’s proprietary “itemized bill” could yield useless internal classifications rather than standardized descriptors.
“We’ve seen that hospitals sometimes have their own version of an ‘itemized bill’ with internal codes that aren’t helpful at all,” he said. “Requesting your UB-04 claim form is a much more specific ask that is difficult to misconstrue.”
Emergency Care Springboards People Into Debt
According to a nationwide poll by KFF, formerly known as the Kaiser Family Foundation, a nonprofit organization focusing on health care and health policy research and analysis, the medical debt crisis extends far beyond hospital bills alone. Factors like credit cards, personal loans, and borrowing from friends used to pay outstanding health care fees were also considered.
Key findings reveal that about 25 percent of adults with medical debt owe over $5,000. About 20 percent said they believe they’ll never pay it off. For many, the initial debt stems from one-time or short-term emergency care.
Additionally, nearly 50 percent of adults couldn’t afford an unexpected $500 medical bill without taking on debt. Over a third currently owe less than $1,000—an amount with serious financial consequences.
Up to 40 Percent Qualify for Hospital Aid, but It Goes Unused
However, up to 40 percent of the medical debt seen by Goodbill qualifies for hospital financial assistance, Mr. Haig said.
“Nonprofit hospitals, which comprise the majority of hospitals in the United States, are required by law to offer financial assistance to patients who fall below certain household income thresholds,” he added. “At some hospitals, that threshold can be well over $100,000.”
However, qualifications go widely unadvertised, and many patients don’t know to ask. “Patients can save up to 100 percent off their portion of the bill,” Mr. Haig said. “It’s one of the most underutilized benefits in health care.”
Other ways to protect yourself against inflated medical bills include the following:
- Seeking pre-approvals for covered care.
- Negotiating costs even if correctly billed.
- Understanding new surprise billing guardrails.
The No Surprises Act shields insured patients from many unexpected medical bills. This includes bills sent by out-of-network providers that were beyond the patient’s control.
The new rules enable uninsured and cash-pay patients to access good-faith cost estimates before receiving care.
Finally, if you have a problem with debt collection due to surprise medical billing, you can submit a complaint online to the Consumer Finance Protection Bureau (CFPB) or call (855) 411-CFPB (2372).
