Get that itemized hospital bill!

By Marshall Allen  ·  Jun 22, 2021

Please note this article suggests ways for any patient to take greater responsibility with regard to their medical bills. In terms of sharing bills in Samaritan Classic and Basic, while codes can be helpful, itemization (in English) of descriptions of service are required. For more information on requirements for sharing bills please view samaritanministries.org/guidelines.

Imagine if your grocery store receipt showed a lump sum total instead of the price you paid for your eggs, fruit, and other individual items.

You would never stand for it. A non-itemized receipt would make it easy for the grocery store to rip you off. You would not be able to tell if the store charged you for goods you did not buy. And it would be impossible to see if they overcharged you for things you did put in your cart. You’d also have no way to compare the prices for individual items between stores.

And yet, this is what happens almost every time we go to the hospital. It’s rare for a hospital billing department to offer a bill that shows the individual charge for each service or treatment the patient received. You usually need to ask for it. Sometimes you must demand it. It’s your right to have an itemized medical bill—and you must get one and check it for accuracy. This is especially important for members of health care sharing groups such as Samaritan Ministries that require itemized bills. Not checking bills for possible upcoding and fraud could cost your fellow members big money by leading to Share increases.

I spent five years in full-time ministry and earned a master’s degree in theology before becoming an investigative reporter. As a journalist I have spent 15 years investigating the health care industry on behalf of patients. I’ve been continually astonished by the deceptive ways the industry takes more money than it should from the public. My new book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, equips patients to be empowered health care consumers.

Let’s start with how an itemized bill protects you from billing mistakes that could cost you money. Professional medical bill reviewers tell me that most bills contain some type of error. They’ve also given me colorful examples. How about the two cases involving unnecessary pregnancy tests? One involved an 82-year-old woman. Another involved a younger woman who no longer had a uterus. In other cases, they caught the same patient being billed twice for a thyroid removal, or more than one circumcision on the same patient. Impossible. Many more mundane mistakes are taking place every day. You need to watch for those types of mistakes.

You may not have heard of “upcoding,” but it’s common and it’s driving up the cost of your health care. Medical billers—or billing software—assign a billing code for each service provided to the patient. But the billing code they choose may vary, depending on the intensity of the service, or the complexity of the care provided. For example, an examination in the doctor’s office or emergency room can be billed from level one, for a simple case, to level five, for the most complex. Upcoding occurs when a higher code is used than is warranted. In one case I’ve documented, a young, healthy woman went to the hospital for three stitches on her index finger, and even her medical records said it was a “simple” procedure. But the hospital sent her a bill for a much more costly level three emergency department visit. That code requires an expanded examination and moderately complex medical decision making. She was only able to catch the error by looking at her itemized medical bill. 

And then there’s fraud, which is estimated to consume about 10 percent of all health care costs in the United States. Hospitals and other medical providers may bill for visits that never occurred or for services that were never provided. I’ve talked to more than a dozen health care fraud investigators and they shake their heads about how common fraud is. But they said it’s rarely enforced outside of the government-run health plans because insurance carriers don’t have incentive to police it. Your itemized bill will allow you to verify that you were only charged for the services that were actually provided.

The billing department for your hospital or doctor’s office will be able to provide you with an itemized bill. Make sure it contains the billing codes that are being used to describe each service that was provided. Then look up those billing codes online and read their descriptions to confirm that they accurately depict what happened. I know it sounds difficult, but it’s actually quite easy to do with some simple internet searches.

You can check prices, too, to make sure the amount you were billed for each service is fair. Hospitals are now required by the federal government to post their prices online for common procedures, so check nearby facilities with a service such as Healthcare Bluebook to see if your bill was priced fairly, or call around to ask other providers about their cash prices. (Not every hospital is complying with the federal requirement, so if yours is not, check other nearby facilities to see their prices.) Only patients and their caregivers have the incentive, and the first-hand ability, to verify that their medical bills are accurate and priced fairly.

If you don’t get an itemized bill and check it, you could pay hundreds or thousands of dollars more than you should every time you undergo medical care. So get those itemized bills—and check them! 

Marshall Allen founded Allen Health Academy (AHA), to offer his book Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win and on-demand video curriculum to empower you to save big money when you undergo health care.