5 Hospital Billing Scams That Can Cost You Thousands

 You go to the hospital to get better — not to get financially blindsided. Yet every year, millions of Americans open their mailboxes to find medical bills that make them gasp: $8,000 for a few hours in the ER. $3,500 for lab work. Thousands more for doctors they never met.

Hospital billing in America has become so complex that even experienced healthcare professionals struggle to decode it. Hidden in that complexity are practices that can quietly cost patients thousands of dollars — often without them realizing they’ve been overcharged.

Here are five hospital billing traps you need to know about — and the simple questions that can protect your wallet.

1. Upcoding: When a Routine Visit Becomes “Critical Care”

One of the most common billing abuses is known as upcoding — charging for a more serious and expensive level of care than was actually provided. For example, a relatively straightforward emergency room visit for a minor injury or shortness of breath may be billed as “critical care,” dramatically increasing the charge. The difference between billing codes can mean hundreds or even thousands of dollars.

Hospitals bill insurers — and patients — using CPT (Current Procedural Terminology) codes that determine how much gets paid. If the code reflects a higher level of complexity than your visit warranted, you pay more.

Question to ask:

Can I get an itemized bill with CPT codes?

Once you have those codes, you can compare them to your medical record — and dispute anything that doesn’t line up.

2. Surprise Out-of-Network Charges — Inside an In-Network Hospital

You did everything right. You chose an in-network hospital. You checked with your insurance company. You confirmed coverage.

And you still get billed.

Even when a hospital is in-network, certain providers inside the hospital may not be — anesthesiologists, radiologists, emergency room physicians, pathologists. You don’t choose these doctors. You may never even see them. But you can still be billed at out-of-network rates. While federal law has reduced some forms of “surprise billing,” gaps and gray areas remain, particularly for ground ambulances and certain specialty services.

Question to ask (before a scheduled procedure):

Will all providers involved in my care be in-network?
If the hospital can’t answer clearly, push for specifics — in writing.

3. Duplicate or Phantom Charges

Hospital bills are long, dense, and often nearly impossible to decipher. That’s partly why duplicate or phantom charges slip through.

Watch out for duplicate charges and bills:
 

• The same lab test billed twice
• Charges for medications you never received
• Supplies you didn’t use
• Procedures that were canceled but still billed

Sometimes these are honest clerical errors. Sometimes they are the byproduct of fragmented hospital billing systems. Either way, patients pay if they don’t catch them. Studies consistently show that a significant percentage of hospital bills contain errors --
and those errors often favor the hospital.

Question to ask:

Can you show me where this treatment is documented in my medical record?
If it’s not documented, it shouldn’t be billed.

READ THE FULL REPORT HERE

https://cmpi.org/in-the-news/five-hospital-billing-scams-that-can-cost-you-thousands