CT Residents May Want to Take a Second Look For Overcharges on Medical Bills - NBC Connecticut
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CT Residents May Want to Take a Second Look For Overcharges on Medical Bills

Checking Medical Bills for Overcharges

(Published Wednesday, Dec. 23, 2015)

An East Hartford man took a second look at his bill and learned he didn't owe anywhere near what he was being charged.

Robert Valerio put up a fight against a $581 bill he got from St. Francis Care.

"Frustrating," said Valerio. " What can I do to get this thing resolved?"

He said the charges were for an annual ultrasound on his legs.

Last year, the same procedure cost just $68.00 after Medicare paid its portion of the bill. Valerio knew the hospital had made a mistake.

"I called them up and told them, and they said I was responsible for paying that bill," said Valerio.

Valerio said he tried explaining to a billing representative that he only owed $51.00 after checking his Medicare plan online.

He said billing representatives for St. Francis asked that he prove to them that the bill was wrong. After submitting paperwork he printed out from the Medicare website, Valerio recalled it taking St. Francis almost two months to finally get his bill correct.

Now, he doubts their charges all together. He also questioned a smaller bill they sent his wife.

"Her bill was $86 dollars and change," explained Valerio. "I was ready to make a check out for that when I said gee, St. Francis Care, maybe I should look into this. In the end all she owed was $5.46"

Fed up, he complained to the Attorney General who in turn sent a letter to St. Francis asking for an investigation. They responded explaining the mix-up happened because an "adjustment code" was left off Valerio’s account, triggering the $581 bill. St. Francis explained that Mrs. Valerio was overcharged because her insurance information wasn't sent in with her lab work, so she was "subsequently registered as self-pay."

Valerio said a rep. for St. Francis assured him they rarely make billing errors.

"They had looked over their billing and that my wife and I were the only two that had those problems," he recalled. However, he said he doesn’t believe that is true.

A spokesperson for St. Francis tells NBC Connecticut their investigation into the coding error on Robert’s bill: "Found no further instances of errors based on this type of automatic adjustment."

Demian Fontanella, healthcare advocate for the State of Connecticut , said they get calls every day from people questioning their medical bills.

"They’re confused why maybe the balance is so high," said Fontanella.

But how do you really know your bill is too high? Most health insurance companies don’t give you an estimate of what it should cost you, like Medicare does.

“For the average non-Medicare person there is no such place to go to get these numbers,” said Fontanella.

However, with the rising cost of healthcare, Fontanella said vaguely written medical bills need to change.

"There needs to be greater clarity so that anybody looking at it will know what the charge was for specifically."

Saint Francis tells us they returned about $10,000 to patients for various reasons last year, but they don’t how much of that amount was due to billing code errors.

"I really feel that an external audit should be made," said Valerio.

According to the American Medical Association, 7 percent of medical bills in 2013 had errors.