fotolia_489865When it comes to health care, be careful what you pay for. Cindy Holtzman of Medical Refund Service Inc. in Marietta has seen hospital bills that included circumcisions — on baby girls. Well, that’s what the hospital bill would have had you believe.

She helped a Georgia State University professor sort out dozens of little scraps of paper held together with straight pins that were bills from an illness his wife contracted while the two were in India.

“I had, like, 150 straight pins,” says Holtzman, a patient advocate who specializes in insurance issues. The pieces of paper added up to two months worth of bills, which totaled 2 million rupees or $10,000.

Holtzman was the fifth member, back in 1998, of Medical Billing Advocates of America, a network now more than 50 members strong. Founder Pat Palmer formed the network in 1997 to help consumers review medical billing errors and correct insurance mistakes. Members specialize in different areas including billing, insurance fraud, medical coding and more.

A few of the more outrageous charges Medical Billing Advocates has discovered on hospital bills are such doozies as:

  • $12 for a “mucus recovery system,” which in reality was a box of tissues that are not billable in the first place and which would cost much less than that if they were billable
  • $57.50 for a little teddy bear sometimes given to patients. On the bill, it was identified as “cough support device.”
  • $57 for a piece of gauze used to wipe down surgical equipment. On the bill, it was identified as a “fog elimination device.” Gauze, by the way, is not a billable item.

One patient was charged $1,004 for a toothbrush.

cindyOne of Holtzman’s recent victories was, as she puts it, taking $75,000 and making it zero. In other words, she managed to erase a $75,000 bill her client owed a hospital.

In his case, the man rushed his wife to an in-network hospital – one approved by his insurance company – when he thought she was having a stroke. That hospital transferred her to an out-of-network hospital for a procedure.

The bill: $230,000. The man’s insurance company paid only $155,000 because his wife had been treated at an out-of-network hospital. Ultimately, Holtzman convinced his insurance company to pay $53,000 more and got the hospital to write off the rest of the bill.

The fact is, patient advocates know, medical billing errors and overcharges occur every day. Many of these advocates, at one time, worked in the area where they now specialize in helping consumers stuck with unfair or inaccurate bills.

One way that patient advocates determine overcharges is to find out what Medicare would have paid for various procedures since courts have established Medicare as the benchmark for determining fair and reasonable prices.

In one example, a colleague of Holtzman’s checked to see what Medicare would have paid for a laboratory bill for $2,000 worth of blood work. For the exact same procedures, Medicare would have paid a mere $412.91.

And that’s how patient advocates help consumers. They know the lingo, they know what the common errors are, they know who to contact and they know how to get results.

Fees for patient advocates vary widely. At Holtzman’s company, she says it depends on the size and age of the case. Some advocates, she says, charge clients 50 percent of what they save the client. One charges $500 to review two pages or 500 pages. Many charge by the hour with rates ranging from $50 up to $150.

“Many times,” Holtzman says, “we can be given a box of papers that need to be sorted first. I charge some type of setup fee since it is very time consuming to organize. After it has been sorted and analyzed, the client decides to call the providers themselves or we follow-up on all the areas that have problems. We can do that on a percentage basis or a set fee.”

The National Health Care Anti-Fraud Association (NHCAA) estimates that 3 percent of all health care spending – or $68 billion – is lost to health care fraud. The most common types of fraud, according to NHCAA, involve a false statement, misrepresentation or deliberate omission that is critical to determining payable benefits.

Most people, Holtzman says, will write a check without first checking to see if the bill is accurate. It’s not wise. When it comes to hospital bills, she says, the hospital itself and the surgeon are the key players.

“Then, there’s what I call the phantom billers,” she says. She uses the acronym RAPE to identify these as radiologists, anesthesiologists, pathologists and the emergency room doctor.

“If you go to the ER,” Holtzman says, “you think you’re covered, but you’re going to get a bill from the ER physician group (RAPE). All these things come in after the fact. You could be covered, but you have to fight it.”

And to do that, you might need a patient advocate.

Says Holtzman: “I have a lot of passion, and I care an awful lot.”

Web site: http://www.billadvocates.com/

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Carol Carter

Carol Carter

A founding staff member of Atlanta Business Chronicle in 1978, Carol went on to become editor of the Chronicle and and, subsequently, seven different Chronicle special publications. She was consumer reporter for WXIA-TV's Noonday Show, and she wrote educational videos for Optical Data School Media. Freelancing now for far too long, Carol wrote the 125-year history of Saint Joseph's Hospital of Atlanta, wrote annual reports for such clients as Delta Air Lines and the Georgia Tech Foundation, and edited a book of short stories for the Emory University School of Nursing. She lives in North Georgia.