You have finished taking a medical service and your bills are also paid by your insurance company. Now what? After some days youโll receive a medical bill containing all the charges for your service but it makes you only confused as you donโt recall the details about every service and its cost, because it is a standard bill. Here comes an itemized bill hospital that represents a clear picture of the health services taken by you along with their expenditure.
But the point is that itemized bill hospital is only provided when you request the hospital. However, though the decision of whether to ask for the itemized bill or not is up to you, our guide will help you better assess the situation and act accordingly.
Overview Of Itemized Hospital Bill
Itemized bill hospital is a bill that indicates all of the treatments and practices used by the patient along with their exact cost. The bill also contains the hospitalโs internal โRevenue Codeโ (i.e. the code used by hospitals to identify their charges).
Though itemized bill hospital is similar to EOB (Explanation of Benefits), it is still better than EOB and gives a detailed overview of the health services. With the help of this, you can have an idea about what services you utilized and what were the expenses of each.
Why And When It Is Important To Get One?
After knowing the importance of hospital bills, you might be thinking why it is important to get?
Imagine you took a medical treatment and your bill is covered by your insurance plan, now you reach home and relax. Suddenly you receive a bill that contains a much higher cost than you expected. What would you do? Youโll ask for an itemized bill hospital and look at each service cost whether it is charged accurately or misleading.
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There are a hundred cases that happen every day where hospital bills contain false charges of the patient, which when re-checked turned out to be a mistake. So, if you too think that your standard bill contains unnecessary charges, contact the hospital and request the itemized bill.
How To Request For An Itemized Bill Hospital?
Since itemized bills are not sent automatically by the hospitals, you have to request them properly.
After when you receive the standard bill, there will be a contact number mentioned on the bill. Call the hospital and tell them that you would like to have itemized bill hospital. According to the laws, hospitals are obliged to provide you with the bill when you request. There should be no reason for them to deny your application.
Reading Itemized Bill Like A Pro
Itemized bill hospitals provide isnโt very complex to understand but still, a guide can help you have a thorough understanding. There are normally 4 types of charges indicated in the bill:
Total Charges: This is the sum of all the health treatments taken. The bill also contains a list of medical procedures along with their CPT codes and the cost of each individually.
Total Adjusted Charges: This is the cost that the insurance company has been successful in negotiating with the hospital.
Total Payment: This is the amount that the insurance company has paid.
Total Balance: โBalanceโ is the total cost calculated after subtracting insurance coverage. This is the amount that you owe, in terms of insurance these are co-payments or deductibles.
Itemized Bill Terminologies
Besides the above described 4 amounts mentioned in the itemized bill hospital, there are some other terms as well that will help you better read the bill on your own:
Gross charges: This is the second name of billed charges
Chargemaster rate: Billed charges are also known by this name
Contractual amount: This is the second name of the insurance adjustment
Contractual discount: This too means insurance adjustment
Allowed amount: This refers to the insurance payment
Patient portion: This is the amount remaining after excluding insurance adjustment and insurance payments
Revenue code: This is the code that the hospital uses to classify each service and determine the charges. For every service, there is a specific revenue code
CPT or (HCPCS) code: This code identifies what services were provided
What To Do After Getting The Bill?
Once you understand itemized bill terms and determine your balance, do the math. Carefully calculate the cost of each service. Subtract the amount the insurance company paid and find out whether the balance indicated in the bill is the actual amount after excluding other charges. Do this process multiple times to confirm the bill. You could also contact the insurance company and confirm the cost they paid.
There might also be a number of errors in the itemized bill hospital, as these cases are normal where patients have been charged more than the actual amount they owe. So how do you check the billing error? Here are some things to do:
Before Appointment Estimation
This is the step that you should take before getting medical treatment. When you have booked an appointment, contact the hospital and ask about the service youโll take, their codes, and the charges of each. Then discuss with your insurance provider whether your plan covers these health services.
After contacting both providers, estimate the cost that your insurance company will pay and calculate the final amount of the bill that youโll have to pay. After getting the treatment, take the itemized bill and again have a look at the balance amount you calculated and the amount mentioned in the bill, both must be equivalent or even comparable.
Error Checking
If the balance amount you estimated differs from the charge hospital billed you, there must be a sort of error. Contact the hospital and inform them. Also, check if there is any service that is charged twice, as this is the common type of data entry error that happens when creating the bill.
Watch Out Upcoding
Upcoding is a type of fraud or illegal act that some of the unreputable hospitals do. In upcoding, your itemized bill hospital contains wrong service codes, that you didnโt even get. To check this, carefully read the service you receive. There shouldnโt be any service mentioned in the bill that you havenโt taken, if that’s so, it is a type of upcoding scam.
Conclusion
After reading our guide, you must be aware of what is itemized bill is and why it is important to ask for it. Now whenever you get medical treatment and find something suspicious in the bill, contact the hospital and follow the steps we advised.
