74ºF

'Over 50% of medical bills are wrong,’ local patient advocate says

Find out how to check your medical bills for potential over payment

POINCIANA, Fla. – You’ve probably received a medical bill at one time or another whether it’s for a doctor’s visit or recent hospital stay.

But according to one patient advocate, if you don’t check that bill line for line, you could be paying too much and have a hard time getting that money back.

“Over 50% of medical bills are wrong, not because someone’s trying to be deceitful, but because the system’s become complicated,” said Susan McPhail-Taylor, an independent patient advocate in the Orlando area.

McPhail-Taylor said she spent more than 40 years as both a nurse and administrator and now uses her expertise to help patients know what they are being billed for. She said she can relate with a lot of patients, since she too was overbilled for a procedure four years ago.

“Somebody hit the button 10 times,” McPhail-Taylor said. “You can’t turn it over to your doctor, you can’t turn it over to anybody else, you have to be involved in your health care.”

She said most medical billing mistakes simply happen by accident, because a few years back, the national coding standards changed and the number of diagnosis codes doubled.

Susan McPhail-Taylor is an independent patient advocate in Orlando.
Susan McPhail-Taylor is an independent patient advocate in Orlando. (anurseonyourside.com)

“Every kind of thing they do to you has a code attached to it,” McPhail-Taylor said. “It certainly made things more specific, but it also made the errors more easy, because there’s a lot more things to choose from.”

This former nurse said that’s why it is so important to ask questions about your medical bill, and make sure you check it line by line.

One Central Florida man who did just that is Bill Carr of Poinciana. He said he discovered an error on his 2017 lab bill and fought for more than two years to get a refund with no results.

Carr said he got charged for a blood test that had been covered in the past.

The cost was $148.48 -- a decent chunk of change for the retired Army veteran. He said even though his case was under appeal, he was forced to pay the fee during his next visit to the lab.

"So I wrote them a check," Carr said.

Carr said he appealed the charge to his insurance and won.

So, when Medicare ended up paying its share, he expected a refund pretty quick.

He said that didn’t happen.

"And that's when I started collecting documents," Carr said. "Over the 2 1/2 years I've been working on this, I have 19 pages of documents. It's something that you can't give up on."

He showed News 6 how the insurance company even sent three letters to Quest Diagnostics, demanding a refund, and threatening Quest with a $2,000 fine. Nothing happened.

Two weeks after we reached out to Quest, Carr finally got his check.

Just in time for his 74th birthday.

"If it wasn't for you guys, I wouldn't have this check," Carr said.

A spokesperson from Quest Diagnostic sent News 6 an email, stating they could not find a record of ever refunding the bill and thanked us for bringing it to their attention.

Here are McPhail-Taylor’s top four tips for making sure you’re not being over billed:

  1. Assume your bill is wrong and ask questions.
  2. Never pay a summary bill. Instead, ask for an itemized bill.
  3. Ask for a review of charges from a nurse or patient advocate.
  4. Be more responsible. Double check everything. Know what your insurance covers and make sure your provider does, too.

McPhail-Taylor said people who have both Medicare and a secondary insurance, if you leave one of them off, you’re going to get a bill.

She said that’s because Medicare usually only pays 80% and sometimes they don’t cover a procedure or prescription at all. That’s why McPhail-Taylor said it is so important for you to know exactly what kind of insurance you have, and know exactly what it covers.

Feeling overwhelmed? That's where a patient advocate can step in and help.

“A lot of people are older, and they don’t have access to computers or don’t know how to use them,” McPhail-Taylor said. “And a lot of information is being delivered that way, so they often need somebody to help them interpret it.”

McPhail-Taylor said while a patient advocate isn’t free, they could end up saving you hundreds of dollars in medical fees.

“And I recommend an independent advocate, not somebody attached to the hospital or the doctor’s office but somebody’s who’s independent and can look at both sides,” McPhail-Taylor said. “But in the long run, it may save you money - or your life.”

A Google search or a group like Advoconnection, which has a national database of patient advocates, can help you choose for you or your loved one.

McPhail-Taylor also suggests you look for an advocate that has been board certified. As for cost, she said they can vary anywhere from $80 to $150 an hour.


About the Author: