All hospital bills should be reviewed - even if an insurance companyis going to pay for all or most of it. 

Every study the author has seen indicates a high percentage of hospital bills have errors in them -- high beiing more than half of the bills. It's not difficult to understand why. Hospital bills tend to be long and complex.A bill for a five-day hospitalization can include at least 10 pages of single spaced entries. Hospitals have thousands of numerical codes covering medical procedures, lab services, medications and other charges. Billing mistakes often occur when the numerical codes are confused.

As a patient you are entitled to an itemized bill.

An insurance company can spot some errors. But you are the best source of knowing what services you did (and did not) receive, by whom, and when.

• Look for obvious errors, such as surgeries you didn't receive or days you weren't in the hospital.
• Review the details of the bill. Keeping a log while you're in the hospital will make this process much easier.
• If the bill is not understandable, ask the hospital for explanations.
• If you need help reviewing the bill, there are professional services available -- some of which only charge a percentage of the money they save.

If you want help finding errors, consider working with a service such as CoPatient . 

If you find errors, work with the hospital and your insurer to correct them, or engage a service such as CoPatient to do the negotiating for you or speak with your lawyer if you have one..

Some insurers pay a reward if you find and report errors.

The U.S. General Accounting Office estimates that Americans overpay for healthcare by more than $10 billon a year.

For more information see:

• When I Look At A Hospital Bill, Where Do I Start?
• Terminology In A Hospital Bill To Look For
• What Should I Do After I Discover Errors In My Hospital Bill?
• Insureds With Bills For Care Provided In The Hospital By Doctors Who Are Not In The Plan's Network Or Whose Services Are Not Pre-Approved
• If You Need Help Revising A Hospital Bill: Professional Claims Assistance
• Debt Collectors and Creditors: Your Rights

If you want even more information about hospital bills, consider reading the following:

• The Medical Bill Survival Guide, by Pat Palmer, Warner Books. This book is filled with informative and practical advice about interpreting and reviewing your hospital bill, and saving money in the process.   
• Get Your Claim Paid, by James Walsh (Silver Lake Publishing)

NOTE: You can negotiate hospital bills. To learn how to negotiate a hospital bill, click here.

• Mistakes happen. Studies indicate that hospital bills are frequently inaccurate - and that most errors are in favor of the hospital. According to Charles Inlander of People's Medical Society, some of the most common errors to watch for are the following:
  • Double billing - being charged twice for the same service or medication.
  • "Up coding" - changing the description of a service from a lower-cost one to a more expensive one. An easy to understand example is being charged for an expensive brand name drug when what you received was the less expensive generic version.
  • "Unbundling" - charging for one service as if it is two. For example, removing two growths at the same time, and charging as if there were two procedures instead of one.
  • Services or medications that were not provided.
• Disputes with a doctor or hospital can affect your credit rating if you are sued or if a bill is turned over to a collection agency.  
• Hospital costs are one of the main reasons for increased medical costs, including premiums and co-pays. 
• If you are covered by insurance:
  • You may be responsible for a deductible or a percentage of the bill. 
  • The higher your deductible, the less incentive your insurance company has to provide oversight on your claim.
  • It is doing your part to help keep health costs - and ultimately your premium - down.

If you have kept a daily hospital log, compare it to the itemized bill. It will assist you in detecting charges for tests, physician visits and medication services that you did not receive.

Following is a list of the most common errors to look for:

• The dates you were hospitalized, including days spent in special units such as the intensive care unit.
• The charges for time spent in the operating and recovery rooms.
• Obvious goofs such as two or more casts for one broken arm.
• Duplicate billing. This often happens with minor items and un-requested items. Check the description for each item on the bill Something could be given different descriptions and then billed more than once.
• Look for un-requested or unauthorized charges.
• Charges for services that were not provided and items that were not delivered.
• Confirm that the charges are the same for similar tests.
• Watch for "bundled charges." Bundled charges known as DRGs (Diagnosis-related groups) are used increasingly by hospitals (and are required by Medicare.) Often a treatment will involve only a few of the components of a procedure. The billing department may assume you had every component.
• Detecting overcharges for medication can be difficult, but look for medication charges that increase dramatically in a single day.
• Check charges that are described with very general terms like "nutrition" or "anesthesiology." All general terms like this require further investigation.
• Too many "miscellaneous" charges may indicate a billing problem that needs further investigation.
• If you had surgery, check for services that weren't provided. You may have needed less than the "standard."
• You should be charged for the type of room you requested, even if you ended up in a different kind of room. If you were in a room for two, you should be charged for a room for two, even if there was no other patient in the room. Or if you were put in a private room because no semi-private room was available when you entered the hospital, you should be billed for the semi-private room you requested. The lack of room availability is not what should determine your billing.
• Question billing for duplicate items.
• Duplicate testing may have been medically necessary, but it could also arise from the doctors' failure to coordinate their work. Paying for redundant testing should not be your responsibility.
• For other charges, was it because the second charge was to repeat a service that was not correctly performed the first time? You shouldn't be billed for fixing an error.
• If you receive an Explanation of Benefits (EOB) from an insurer, compare it with the hospital bill.
• Don't pay for the discharge day if possible. Being discharged early in the morning, for example, does not justify you being billed for your last "day" in the hospital.

Also look for charges for treatment for medical errors or preventable conditions. For instance, a preventable condition is Stage 3 or 4 bed sores (medically known as "Pressure ulcers"). In fact, you may even be able to recover money for your damages due to such actions or inactions. If you have a question, consult a lawyer.

If you see the following terminology, check carefully. You might be paying an inflated charge for some very common items. Following are a few examples we've heard about:

• Cough support device -- We recently heard of a patient who awoke after surgery with a teddy bear tucked under his arm. His nurse told him that the bear was to be pressed against his chest, when coughing, to avoid pain. He was later billed almost $60 for the teddy bear, for which the hospital paid less than $10. Neither the patient nor his doctor had requested the bear and an ordinary pillow would have worked at least as well.
• Mucous recovery system -- Boxes of tissues billed at $10, for which the hospital paid $2.
• Gauze collection bag -- An ordinary trash bag can become an $18 "gauze bag," if someone tosses in a piece of gauze.
• Lab handling fee -- A fee that is charged when a technician walks the test tubes to the lab.
• Oral administration fee -- A fee that is charged when a nurse hands a patient a pill. Nursing services are supposed to be covered under the hospital room rate.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits hospitals, requires that every hospital have a mechanism in place for dealing with billing disputes.

• Put your concerns in writing and attach specific documentation for the suggested corrections. 
• Call the billing department and get the name of the head of the department.
• Write a letter to the department head describing the mistakes. Ask for a corrected bill within 30 days. Mail the letter in a manner which provides a receipt (such as certified mail, return receipt requested.) If you are insured through a private company or Medicare, send the insurer a copy of the letter. Keep a copy with your files.
• If you are not happy with the response, contact the hospital administrator's office.
• If you are still not happy with the response, request a "utilization review" from your insurer for an in-depth accounting of your hospital stay.
• Do not be intimidated if the hospital suggests that in order to review a particular charge, it will require an audit of the entire bill - and then goes on to tell you that an audit may result in an even larger bill. Audits usually work in the patient's favor.
• If you receive no satisfaction, contact the consumer protection office of your state's Attorney General. You can find the phone number at the National Association of Attorneys General: www.naag.org

People in a managed care plan may be denied coverage for services provided in the hospital by doctors who were not in the company's plan and not pre-approved. If this happens to you, you have to deal with the insurance company rather than the hospital.

First determine whether the doctor actually provided some sort of healthcare. If you kept a log, it will be easy to find this out.

If the doctor did provide a healthcare service, call the phone number on the statement and ask if the doctor has an agreement with your insurance company.

• If so, call the insurance company and point out the error.
• If not, call the insurance company and explain that you were attended by the doctor while you were in the hospital and that you had no control over which doctors treated you. 
• If a call doesn't work, consider using the insurance company's system to appeal. You do not need a lawyer to appeal. 

If you are not able to decipher your hospital bill

• A registered nurse or other healthcare professional can help make sense of the medical codes and jargon. 
• Your local disease specific non-profit organization should also be able to help or at least point you in the right direction.

If you want help auditing your hospital bill

• If you have insurance, speak with the insurer before engaging a professional. Many insurers have professionals who can conduct the audit at no cost to you.
• If you are not insured, or if the insurance company audit is not satisfactory, consider hiring a professional claims assistance professional (also known as medical billing advocates). Many of these professionals work for a percentage of the recovered charges so it basically doesn't cost you to use them.

Because the profession is new, there is no standard certification in place or state licensing. Anyone can say he or she is a professional. Look for a professional with experience in the particular area in which you need assistance. For example, if you think you are being overcharged, look for an advocate who has worked previously in a hospital or medical provider's billing office.

Check the amount of the person's fees. Also check their ability by speaking with at least two people the professional helped before engaging a professional claims person. (If the professional won't give you the names of two satisfied customers, look elsewhere). Fees are usually on an hourly basis or a percentage of whatever costs they save. The initial consultation should be free.

A good place to start the search is from staff at your doctor's office, family and friends, and other members of support or self-help group. 

Following is a list of sources we know about, but have no practical experience with. If you use one, please share your experience.

• The Alliance of Claims Assistance Professionals is a not for profit corporation that specializes in hospital bill audits. They can be reached toll free at 877.275.8765 or www.claims.org .
• Medical Billing Advocates of America at 540.387.5870 or www.billadvocates.com  (lists advocates by state and specialty)
• MyMedicalControl.com is a for-profit company that is a "claims adjuster." They will review doctor and hospital bills for a fee. They claim to know the lowest fee charged for a procedure by a hospital or clinic.
• www.hospitalbillreview.com charges a fee of $149 for a written report.