If you’ve ever received a complicated bill for a complicated medical procedure, you may not be surprised at all to hear that studies find as many as 80 percent of medical bills have errors – including billions of dollars in overcharges for consumers.
After a surgery or hospitalization or emergency-room visit comes a blizzard of confusing paperwork -- often labelled “This is not a bill’’ -- full of incomprehensible codes and procedure names and incomprehensible columns like “non billable to member,” “non covered charges,” and “plan allowance.’’ Then at the end: “Amount you owe provider.’’
Trying to figure out if you're getting ripped off and how to fight back is all but impossible for most consumers. But it’s what a Boston startup called CoPatient.com is all about – and it’s already saved, it says, over $3 million for consumers by challenging hospitals, physicians, pharmacy groups, and insurance companies to fix errors.
“Any consumer can submit any set of medical bills to us, and we'll review them at no charge and give them a savings estimate to identify if there are any errors or opportunities for them to save on that bill,’’ said Rebecca Palm, co-founder and chief strategy officer for CoPatient. To analyze bills, they use a network of medical-billing experts with an average of over 30 years in the field.
“One of the things that our advocates bring to the table for consumers is they bring a lot of experience and expertise in speaking this foreign medical-billing language,’’ Palm said.
How it works: You submit your medical bills to CoPatient electronically, by mail or fax, or through a smartphone app. They scrutinize them and tell you how much they think they could save you. You pay them a fee of 35 percent of what they do save you, so effectively 65 percent of the savings they identify come straight off your obligation. You don't have to pay anything unless they deliver you savings, the company stresses.
CoPatient can’t guarantee it will get you the potential savings its analysts identifty. “It is just an estimate, but it's our experts' best estimate of what we think their expectation should be in terms of savings,’’ Palm said. “Sometimes it's a little more or less than that.’’
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One of the principal sources of billing errors CoPatient finds is a hospital or doctor charging more than you what your insurance contract with them allows. As we found in this story http://www.necn.com/news/business/Money-Saving-Mondays-Medical-Expenses-281301701.html prices for medical procedures or diagnostics can vary wildly based on who’s doing them, at what facility, and who’s paying for it.
“There's a ton of variation in pricing depending on who your insurance company is, so different insurance companies have negotiated different rates with all the different providers in your area,’’ Palm said. Not surprisingly, whether inadvertently or not, hospitals and doctors often bill you a price that is higher than what your insurance company allows them to charge, and CoPatient can find and reverse those overcharges.
Palm also said as a general rule, bills for long hospital stays, medical episodes that involve lots of physicians and tests and medications, or emergency-room visits are more likely to lead to errors and overcharges. “In general, the larger, the more complexity there is involved,’’ Palm said, “the more opportunity there probably is for them to save.’’
With video editor Lauren Kleciak and videographers Daniel J. Ferrigan and Abbas T. Sadek. NECN producer Pamela Bechtold contributed to this report.
