Consumer Publications List

Sorting Out Medical Bills After a Trip to the Hospital

As much as we try to avoid them, illnesses and accidents do occur. Being sick is a difficult and stressful enough experience without having to worry about the inevitable bills you'll receive later. Hopefully, the information below will help with any medical bill confusion.

Following hospitalization, it is not uncommon to receive several bills that appear to be the same. It is easy to assume you are being billed twice for the same service when you receive two bills for a single service performed in the hospital, such as an X-ray. However, frequently what appear to be duplicate bills are actually bills for different services related to the procedure. Doctors who provide specialized services in a hospital generally bill for their services independently of the bill for the hospital's services using an arrangement known as separate billing.

What Is Separate Billing?

If your bills seem confusing at first, compare them with the different doctors who treated you and services you received during your stay at the hospital. Don't forget to include services provided by specialists during a non-emergency hospital visit, or during an outpatient visit, in your comparison.

When you come home, you probably would expect to receive a statement from the hospital. This statement lists charges for the use of the emergency room, drugs, and supplies. Nurses and technicians are included in the room and board rate.

However, the charges for the attending specialty doctors who treated you may not be included in the daily room rate. Many doctors contract with the hospital to serve patients and to staff the hospital's various departments. These doctors are not hospital employees and may bill patients separately for their services. Therefore, you may receive separate bills from each doctor who treated you, as well as a bill from the hospital itself.

Billing Language Varies

Every medical procedure is assigned a number known as a CPT (Current Procedural Terminology). The CPT number identifying the procedure may appear on the bill your doctor sends you. The bill may also briefly describe the services provided, or itemize every procedure separately. There is no standard language all doctors are required to use on the bills they send. Therefore, two different doctors specializing in the same area could send bills that look different.

Hospitals do not have standard billing language either. However, Maryland hospitals must send an itemized bill that briefly and clearly describes each item and the amount charged. Maryland hospitals must also provide you with a summary statement of your account within 30 days after you are discharged. You may request an itemized statement of your account up to one year after discharge, and the hospital is required to provide it to you within 30 days. Having an itemized hospital bill should make it easier to understand the related bills you receive from specialists.

Insurance companies pay varying amounts for emergency room services. Medicare and many other insurers may not pay for some services delivered in an emergency room if the insurer determines that the services could have been provided in a doctor's office and were not, therefore, a true emergency.

If you are a member of an HMO, keep in mind that the law may protect you from being billed beyond your applicable co-payments or deductible, a practice called balance billing. Medicare providers who accept assignment are also prohibited from balance billing.

Identifying and Solving Billing 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, you may never meet the radiologist who reads your X-rays and most of an anesthesiologist's services are performed during surgery while you are unconscious.

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 that the hospital or doctor's bill contains a mistake, contact the billing office of the provider involved. 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.

5. If the problem is still not resolved or clarified over the telephone, send a certified letter to the provider involved. Clearly explain the problem and enclose copies of all relevant documents with the letter. Keep all your originals. Request a reply within 10 days.

6. Match up any Explanation of Benefits (“EOB”) from your insurer to the bills you are receiving. Call your insurance company if you need help understanding what it has or has not paid. Call your insurance company to make sure it received and processed all your bills, or if you have bills but do not have EOBs that reflect the services for which you are being billed.

7. If you feel the amount your insurance company paid is insufficient, contact the company and ask for an explanation of the payment decision.

8. If you still receive no response or cooperation, contact the Health Education and Advocacy Unit (see “How You Can Reach Us”).

9. When paying a bill, make sure you write on your check the account number shown on your bill to assure that the billing office properly credits your account.

For more information regarding medical billing, please contact the Consumer Protection Division's Health Education and Advocacy Unit at 410-528-1840 or toll-free at 1-877-261-8807.