Exposing Unfair Medical Billing Practices: How to Avoid Unethical Charges in U.S. Healthcare

Unfair medical billing practices are a common issue in U.S. healthcare. This issue can lead to inflated expenses, insurance complications, and financial strain for healthcare organizations. These practices are the cause of anxiety for patients as well as badly affect on financial health of the hospitals.

In this blog post, we will discuss some unfair medical billing practices and tips to avoid them. Further, we suggest you connect with professional billing companies to avoid unethical issues in U.S. healthcare organizations.

Unfair medical billing practices:

There are the following common unfair medical practices. You should these practices in your clinical setup and solve them appropriately.

Upcoding:

Upcoding is a practice in which the cost of a service is charged more than its actual charges. It can quickly increase costs, especially for minor procedures or consultations that are billed at higher-than-necessary levels.

Real-World Example:

A study published by the Journal of the American Medical Association showed that some hospitals have constantly billed Medicare for higher-level services, even when their patient records showed fewer intensive treatments.

Balance billing:

In balance billing, the biller bills the patient for the remaining balance that insurance does not cover. Mostly, it occurs when patients use out-of-network providers.

Real-World Example:

Usually, in an emergency, patients get treatment from out-of-network providers. Thus, they get unexpectedly high bills. It creates a lot of problems for patients. Even though some legislative acts are present to manage this issue, it exists in many hospitals.

Duplicate billing:

Duplicate billing is one of the most common unfair medical billing practices in U.S. healthcare. In this practice, the healthcare provider bills for the same service or procedure multiple times. It can be intentional, and sometimes it is due to unintentional mistakes. Thus, patients pay for services that they did not receive.

Real-World Example:

A 2022 audit found that many healthcare facilities had billed twice for the same patient services, leading to millions in excess payments. Such practices can also impact individual patients who might not notice these duplicate charges on their bills.

Inflated service charges:

Healthcare providers can sometimes charge unreasonably high prices for certain services. These prices are well above expectations and customary rates for any specific treatment and procedure.

Real-World Example:

News outlets have reported cases where patients were billed hundreds of dollars for basic supplies like gauze pads or saline solution, items that cost only a few dollars in a retail setting. Such inflated charges contribute significantly to rising healthcare costs in the U.S.

Sometimes a medical provider can charge $7 for a Tylenol and $30 for a simple bag of ice labeled as a Thermal Therapy Kit.

Ways to Avoid Unethical Billing Practices in US Healthcare:

Here are some steps you can take to protect yourself from unfair medical billing practices:

Review Medical Bills:

Carefully and closely examine the medical bills that you receive and never hesitate to ask questions. If you spot anything suspicious or unclear, abruptly inquire about it. Now compare these charges with your insurance coverage and then make sure that you are only billed for the services that you receive.

Asking questions:

Never be afraid to ask questions! It is your right to inquire about any clarity that you require in your medical bills. You should always be billed for the services you receive, not anything extra. You have the right to ask for a pre-treatment estimate of charges. If you receive a bill that is higher than the original charges, ask freely for an explanation.

Understanding Insurance Policies:

Review your insurance policy and health coverage plan very carefully.  Check all the clauses, coverages, deductibles, copays, and out-of-pocket maximums. If you know the details of your insurance plan, you can quickly identify anything suspicious regarding the instances of billing.

Compare Charges with Your Explanation of Benefits (EOB)

The insurance provider has an Explanation of Benefits (EOB) which can help you determine the billing details, insurance coverage, and the amount you owe in the end. You can then compare the EOB with the medical bill to make sure the details align or not. This can help you point out any illogical upcoding, duplicate billing, or unapproved charges

Seek Professional Support:

While encountering these issues, you can always seek the support of someone who has experience with medical billing services and could detect something suspicious for you. It will help you prevent Inflated service charges, duplicate billing, and similar difficulties.

Ethical Medical Billing Practices: Trustworthy Companies

Working with a reputable and transparent medical billing company can help you avoid these hiccups in the long run. You can avoid unethical medical billing practices by choosing the best company in the business. The company you choose should prioritize compliance with the law and must have a track record of working closely with major healthcare providers and patients too.

SysMD can be your go-to choice in this regard. It is a leading medical billing and management company with a team of experts who specialize in providing medical billing services. These experts help healthcare organizations navigate through complex tasks of reimbursements and billing.

SysMD is registered with HIPAA Laws uses state-of-the-art technology, a strict compliance process, and a very deep knowledge of industry regulations and trends to provide its services. It ensures that the bills you receive are accurate and fair.

Conclusion:

There can be serious consequences of unfair medical billing practices for patients as well as healthcare organizations. On your side, understanding the unethical behaviors, reviewing the bills carefully, and choosing a trustworthy billing partner can help you prevent any mishap.

Be proactive while engaging in medical billing services. Educate yourself, ask questions, and get the billing services that always prioritize compliance and patient health above all.