How to fight medical overpricing in Florida's hospitals

How to compare charges with "fair prices"

TAMPA, Fla. - People are often asked to pay hundreds of dollars out of pocket for hospital bills. But ABC Action News found out some of those bills may be inflated in an effort to get you to pay up.

When Julian Rashas started complaining of stomach pains, his father, Michael Rashas, had no idea it was much more than a simple stomach ache.

"You're not thinking about money," he said. "That is probably one of the last things."

Rashas and his family ended up taking Julian to St. Joseph's Hospital, where doctors determined he needed to have his appendix out.

The surgery left Julian with a scar and a story. But Michael Rashas was left with a shocking discovery: how much the hospital charged for some items.

"It was just astronomical," Rashas said.

Rashas said his explanation of benefits, or EOB, showed total billed charges of more than $46,000.

With his insurance, he owes a little more than $1,100 out of pocket.

ABC Action News had him request an itemized bill to see everything the hospital listed as a charge.

Then, we compared the family's hospital charges with what Healthcare Bluebook says is fair.

Healthcare Bluebook is a non profit that calculates "fair prices" from a nationwide database of medical payment data sorted by zip code.

For IV fluids, the hospital charges $853. However, Healthcare Bluebook says a fair price is around $108.

For anesthesia, the hospital charges $1,182. However, Healthcare Bluebook says a fair price is $51.

St. Joseph's Hospital couldn't share much with ABC Action News about Rashas' itemized list of charges due to patient privacy laws. However, they said in part that amount you actually owe will depend on the benefit plan you have, whether you have met the deductible and your  out-of-pocket limit.

St. Joseph's Hospital also recommend asking for a price estimate prior to a procedure.

Attorneys with Dolman Law, based out of Clearwater, says medical overpricing happens more often than most would think.

"It's a cash cow," said Matthew Dolman, an attorney with the firm.

Dolman said any hospital bill can be negotiated, especially for patients who do not have insurance.

"You can't get blood from a rock," he said. "If people don't have the ability to pay, how are they going to pay you?"

Dolman said first ask the hospital for an itemized list of charges, just like Rashas did.

Then, compare the "fair price" for the procedure on a website like Healthcare Bluebook. Then, call the hospital to negotiate the price you think you should pay.

"Negotiate down and then enter into a billing plan," Dolman said.

Rashas is still in the process of negotiating his son's bill.

FULL STATEMENT AND HOW TO REVIEW EOB AND CHARGES FROM ST. JOSEPH'S HOSPITAL

1)    Understand what you are looking at.
 
An explanation of benefits (EOB) is not a bill, but it may look like one. It is generated by your insurance company and could include information including the date of service, the code used to bill a particular service to the insurance company, the fee charged by the health care provider, the patient’s responsibility under the terms of their coverage, the payment made by the payer, and the contractual write-off. The final entry of each line item is usually titled something along the lines of, “what you owe,” or, “your responsibility.” This is why some patients confuse an EOB with a medical bill.
 
When using any resource to compare health care costs, it is important to know that:
·         Cost and charges mean two different things.
·         “Bundled” pricing is different from individually priced services.
·         When you need hospital care, you will be charged by the hospital as well as by medical specialists, such as a radiologist or an ER physician, who provide services during your hospital stay. You will be billed separately for these services.
·         Each insurance company has a different fee schedule with each provider they cover.  This reflects discounted rates that serve as the basis for what the insurance company pays and what the patient pays.
·         The amount you actually owe will depend on the benefit plan you have, whether you have met the deductible required by your individual plan and your defined maximum out-of-pocket limit.
 
2)    When possible, get a price estimate before your procedure.  If you are insured, uninsured or self-pay, contact the facility where you will be treated.  The cost estimate line for St. Joseph’s Hospital is (813) 852-3116.
 
3)    If you are not able to pay your bill in full, contact the number on your statement to discuss arrangements for a payment plan as soon as possible.
 
4)    At St. Joseph’s Hospital, we provide superior health care for all patients, regardless of their ability to pay.  We provide charity care for those whose annual income is less than 250% of the federal poverty level and we also offer up to 50% discounts for self-pay patients.  For more information about financial assistance programs, please call (855) 233-1555 or visit BayCare.org/FinancialAssistance[baycare.org].
 
5)    If you have questions or are not sure about something, call the number on your statement.  At St. Joseph’s Hospital, we also know that medical bills can be hard to understand, and we will help you navigate the process.
 
6)    Keep notes on dates of conversations with the billing department, insurance company and others you contact regarding your medical bills.
 
 

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