The $90,000 hospital bill that should never have been sent
A hospital sent a widow to collections for $90,000 because it submitted her late husband's claim as outpatient care when the surgery could only be billed as inpatient. Medicare denied it, and Blue Cross Blue Shield denied it for the same reason. The fix was to recode and resubmit. Her balance went to zero. The billing office could not see the problem, and neither could the hospital president.
- Hospital bills the surgery as outpatient care
- Medicare and Blue Cross Blue Shield both deny the claim
- Widow sent to collections $90,000
- Claim recoded as inpatient and resubmitted
- Widow's balance $0
What happened?
A man arrived at an emergency room with a dissecting aortic aneurysm, went straight to the operating room, and died. He had two insurers: Medicare, and a Blue Cross Blue Shield plan. Both denied the claim. The hospital then sent his widow a collection notice for $90,000. The bill was sent to me with one question: can anything be done about this?
Why did both insurers deny the claim?
The claim was denied because the hospital billed it the wrong way. The surgery was one Medicare pays only as inpatient care, and the hospital had submitted the claim as outpatient. Medicare rejected it, expecting the hospital to correct the billing code and resubmit. Instead, the hospital sent the claim to Blue Cross, and Blue Cross denied it because Medicare had. Rather than fix the claim, the hospital sent the balance to collections.
A denial like this one says nothing about whether the care was necessary or the charges were fair. It is a paperwork error. Corrected and resubmitted, the claim would have been paid.
How was the bill undone?
I called the hospital's billing office and explained the error. The people there did not understand what I was telling them. So I called the president of the hospital, explained it again, and told her exactly what to do: recode the case as the inpatient stay it was and resubmit it. Her answer was that she did not understand medical billing. I told her that I did, and walked her through it again. The widow's balance went to zero.
What this means for a bill in litigation
A large balance on a hospital bill is not proof of anything. It can be the price of the care, a hospital list price, or, as here, the result of a claim that was never billed correctly. Before a medical bill is argued over in a case, someone should check whether it was billed correctly in the first place.
If there is a hospital bill in dispute in your case, read what DRG audits find in hospital bills, see my case results, or send me the bills in your case.
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