Utilizing Mediation to Solve Medical Billing Problems

The first step should be information to the patients that they need to review their bill closely for errors. An estimated 14 million Americans are struggling with medical bills that they believe were sent in error to collection agencies, according to the Commonwealth Fund, a nonprofit health care research group. Nearly half of all collection accounts that appear on consumer credit reports are unpaid medical bills.1 Eight out of every ten medical bills (80 percent) contain mistakes according to Medical Billing Advocates of America.2 Patients should take the time to correct these errors regardless of whether insurance is paying the invoice or not.

There can also be a problem with submission of the medical bill to the insurance company. For example one of the authors received a bill from Children’s Hospital for $500.00, told the insurance company had denied coverage. Children’s Hospital reported the author had a deductible, which was untrue. The billing specialist advised this author to contact their insurance company to resolve the problem. When the author contacted the insurance company they apologized because it was an error - they had improperly denied coverage. However, at present much depends on the patient to navigate the medical system without assistance from the hospitals and insurance companies that are in a better position to provide assistance.

The hospital is the source of the medical bill and interacts with insurance companies when insurance is involved. By working together the patient can benefit by decreasing debt and the hospital can benefit by the payment. In addition, there is an impact on the hospitals’ reputation. In a study in regards to public reporting of hospitals performance in Wisconsin, there was the discovery of the reputation of hospitals being affected when the hospital shows concern for their professionalism and protecting the consumer.3 By improving billing practices within the hospital setting, improving professionalism, can lead to nonprofit hospitals being able to increase their fundraising.4

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by Cynthia Pasciuto J.D. & Jessica Nagle J.D.

[1] Walecia Konrad, Protecting Your Credit Score From the Medical Bill Maze, December 17, 2010, Last accessed on April 8, 2012 at http://www.nytimes.com/2010/12/18/health/18patient.html
[2] Medical-Bill Errors Becoming More Common, Associated Press, October 29, 2007, Reprinted on MSNBC.com, Accessed on April 8, 2012 at http://www.msnbc.msn.com/id/21527433/ns/health-health_care/t/medical-bill-errors-becoming-more-common/
[3] Health Affairs, Hospital Performance Reports: Impact On Quality, Market Share, And Reputation, (Aug. 2005). Accessed on April 8, 2012 at http://content.healthaffairs.org/content/24/4/1150.full.
[4] Id.

Cynthia Pasciuto is an attorney, consultant, mediator and educator in Massachusetts who has taught at Bentley University, NIWH and NESA.