The Hunt for Mom’s Detailed Hospital Bill

I would guess that not many Americans have actually seen a detailed hospital bill? Why would they given that the detailed hospital bill is only shared between payers  (private health insurers and government) and the healthcare businesses that deliver health care. Most patients have to go out of their way to get a copy of a detailed hospital bill. To make matters worse, the detailed hospital bill is filled with a lot of medical shorthand and code and, therefore, can be difficult for patients to decipher.

the detailed hospital bill

A good question to ask me is “why am I hunting for my mom’s detailed hospital bill?” First of all, when a hospital makes it difficult for me to see the detailed hospital bill, I think there must be something there that they don’t want me to see…which I have to admit makes me want to see it even more.  In addition, the detailed hospital bill will show me exactly what treatments, tests, and pharmaceutical drugs were given to my mom. This is all information that I can use to ask her doctors informed questions about my mom’s health. Lastly, I am curious about the actual healthcare prices being charged and if there is any overcharging or billing errors.  Estimates of the number of hospital bills containing errors run as high as 80% (and I would guess that those that undercharge are few and far between).

The detailed hospital bill is a treasure trove of information about why Americans spend twice as much as all other industrial nations. Patients should be looking over every detailed hospital bill they generate because only they (or their patient advocate) are in a position to confirm that all that was billed was in fact delivered. Third-party payers do not ask patients to verify the accuracy of bills and even keep payment details largely hidden from patient scrutiny.

Before Electronic Health Records (EHRs), the only way a patient could see a detailed hospital bill was by obtaining a copy from the hospital’s billing department. Some hospitals are finally placing the detailed hospital bill on the patient’s EHR removing the need to make a separate trip to the hospital to see it.

Let’s explore together how I obtained mom’s detailed hospital bill for her using online resources only.  My hunt for mom’s detailed hospital bill begins by accessing the billing information available from my mom’s health insurer (Medicare) online.  When Medicare (mom’s insurer) came up short in providing the detailed hospital bill I sought, I went to the hospital’s Electronic Health Record. Luckily, I didn’t have to physically pay a visit the hospital’s billing department (with my healthcare power of attorney in hand) in this particular situation.  If your hospital’s EHR doesn’t include the detailed hospital bill, you will unfortunately have to make the extra trip.

Hunt for the Detailed Hospital Bill and Medicare

My mom gets Medicare Medical Summary Notices (MSN) mailed to her whenever a healthcare business sends a bill to Medicare for services rendered. Part of mom’s MSN for her hospital bill is reproduced below (with personal information removed for privacy).

mailed Medicare MSN not detailed hospital billAs you can see in the figure above, the MSN for my mom’s hospital bill only provided two pieces of information (how many days she was in the hospital and how much Medicare paid). If they have determined the amount Medicare paid, I would have thought that what the patient’s cost-share (maximum you may be billed) as well as the total hospital charge could have been easily provided in this MSN.

This MSN is so abominably lacking in even the minimum hospital billing information that it was not worth the time or money to send it. My mom simply tossed it in the trash.  Could you imagine buying a new car and the bill you receive is one that only shows the final price paid? We all know that hidden in a final bill are lines of charges that we might not be willing to pay if we had been asked.

Private insurers send out documents called Explanation of Benefits (EOBs) which are comparable to Medicare’s MSNs. Both documents are designed to show patients how much was charged, how much the insurer paid, and how much the patient is responsible for. MSNs and EOBs are not designed to share any details about hospital billing or specific care received.  These documents assume that patients are only interested in how much they have to pay out-of-pocket.

Mom’s online MSN (see the figure below) was more complete than the mailed copy. Without the help of her more internet-savvy children, my mom would never see the online information available.

online Medicare MSN not detailed hospital bill

To access a more detailed hospital bill, I clicked on the “see claim” link (shown with a red arrow in the figure above) and found the more detailed hospital bill given below. I was not entirely surprised that Medicare does not provide a “print” or “save” button for this information.  The information in the figure below was pieced together using the print screen feature of my computer.

detailed hospital bill Medicare online grouping by revenue codes

The hospital charges in the figure above are grouped under 17 revenue codes.  The pharmacy (which does not include IV drugs administered) and operating room categories are highlighted.

When looking at a hospital bill, it is important to understand that this bill does not include many services delivered by individual healthcare professionals who use hospital facilities, but bill as separate incorporated entities.  These professionals act as independent contractors to the hospital and are mostly medical doctors.  My mom’s additional hospitals bills from these medical doctors (and one nurse) are shown in the figure below. If the hospital had directly employed these medical doctors and nurse, their services would not have been billed separately. The list shown below was generated by doing an advanced search on the Medicare website for all claims submitted for services during the days my mom was in the hospital.

hospital contractors bills not covered in detailed hospital bill

Unfortunately, the detailed hospital bill that I was hunting for could not be found on the Medicare website. Our government invites patients to help them fight fraud but does not give patients enough information to be effective crime fighters. They do not even spell out what fraud actually entails. If our government really wanted to fight Medicare fraud (as well as overtreatment, over-testing, and overcharging), it would fully enlist and “incentivize” patients rather than the half-hearted window dressing it does practice.
When I say “incentivizing” patients, I mean that they might give patients a reward (or percentage of money recovered) for any overpayment they discover.  Medicare has no problem with “incentivizing” doctors when they want something done (for example under the HiTech Act of 2009).

The Detailed Hospital Bill from the Hospital

My hunt for a detailed hospital bill turned out to be easier than I expected once I went to the hospital’s Electronic Health Record (EHR).  Here I was able to download the bill as a pdf file. The detailed hospital bill runs seven pages and has over 200 individual charges listed. The largest number of charges (over 100) was for pharmaceutical drugs (both in IV and oral forms). Was my mom informed about the safety and potential side effects of all 100 drugs given?  You already know the answer to this question.

Detailed Hospital Bill and What I Plan to Do With It

I have to admit that many hospitalized Americans will never want to see their detailed hospital bills. The medical and billing shorthand is too complicated to understand so why bother. These Americans have no immediate financial “incentive” (like a reward) to reduce their individual healthcare bills.  Americans do not fully understand (or appreciate) that reducing health spending today will reap a more affordable healthcare system and reduce their health insurance premiums and out-of-pocket costs. Helping to root out overcharges, bill errors, and other billing abuses geared toward maximizing income and profits for healthcare businesses can only benefit all American healthcare consumers.

The detailed hospital bill, a document rich in information, shows exactly what treatments, tests, and pharmaceutical drugs were given to the patient. This is all information that can be used to ask doctors informed questions about the details of care. The detailed hospital bill (including the bills from all independent hospital contractors) is a window on how the United States got to a place where we spend twice as much as all other industrial nations for health care.

Patients (or their patient advocates), and not third party payers, are the only people who are in a position to confirm that the bill matches what was actually done to them. Third-party payers today do not ask patients to verify the accuracy of bills but rather operate to keep payment details largely hidden from patient scrutiny. This is a byproduct of a healthcare system that runs primarily on financial gain rather than on what is best for patients.

If enough Americans raise their voices in what they find, we might even be able to change how our government and private insurers do business. We might even become true stakeholders in our own health care!

I will be showing you through several subsequent blog posts how it is possible to use the detailed hospital bill to get better health care and to be more fully engaged healthcare consumers.

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