Hospital refuses to allow me to talk to their billing department - are there any laws/regulations that I can use to help them change their minds?

Question

Background here: Hospital billed me for services that I explicitly refused. Are there any legal ramifications for hospital?. In short, my wife visited a hospital and was grossly mis-billed. In total we were charged about $2000 for services/procedures that either didn't happen or were explicitly refused. As an example, a doctor said that he would do an abdominal ultrasound and then, if that did not give him clear answers, would follow up with a transvaginal ultrasound. The transvaginal ultrasound was not necessary and did not happen (and in case you're not familiar, it is not the sort of thing that a doctor does without you noticing). However, there was almost $1000 on my bill for a transvaginal ultrasound (as well as a smaller charge for the abdominal ultrasound that did happen).

I've been talking to the hospital to get these charges off my bill but I don't feel like it has been going well. In particular, I would now like to go through the entire bill with someone from their billing department to make sure that they haven't misbilled me for other services that I haven't noticed. All the billing information is in hospital codes, so while I've made sense of some of it, I haven't made sense of all of it. I came into their billing department to discuss this and discovered that their billing team does not talk to customers under any circumstances. Instead only their "Customer Care" team does. They don't know anything about billing codes (I was told that if I wanted to know what I was being billed for I should "google" it) and can't make any changes to my bill - only flag it for a dispute.

I'm very unhappy with this arrangement. I would very much like to talk to someone from the department that screwed up my bill this badly. I would very much like to talk to someone who can actually walk me through my bill. I plan on calling them next week, expressing my unhappiness with the situation, and do everything I can to get a billing person on the phone. I suspect that what they are doing is perfectly legal, but I'm certainly no expert, so I figured I would come here to ask.

Are there any laws or regulations which I can use to convince a hospital's billing department to talk to me, despite the fact that they have a clear policy otherwise?

Answer 1

Disclaimer: I am not familiar with US law, so this answer is from a general perspective. It should apply in most jurisdictions, though.

Are there any laws or regulations which I can use to convince a hospital's billing department to talk to me, despite the fact that they have a clear policy otherwise?

No, I don't think so. A company or organization is generally free to decide for themselves who will or will not communicate with you - I don't think there is any law giving you a right to choose. How would this even work? What if the people you ask to talk to are overworked, on vacation or just not qualified?

However - you do have another, more important right: To be considered valid, a bill must provide credible evidence that the charges are justified. You cannot just ask someone to give you money, you must actually provide a reason why you are owed money.

In this case, this means the hospital must send you a bill that you can understand and verify. To get this:

• First, stop bugging them over the phone. Once a point is reached where legal action seems likely (like in your case), any information you get is only really useful to you when in writing. So do everything in writing. It's fine to talk to them if it helps solve the problem - but insist on getting things in writing afterwards.
• The first thing you need to write is a formal letter that you refuse to accept the bill, because you cannot verify it. Outline in details what parts you cannot understand/verify, and ask for the information you need (such as what the codes mean).
• Once you have received a satisfatory explanation of the bill (which may take multiple letters), you go through it with a fine comb, and dispute any items that you think are unjustified.

You may need the help of a lawyer to exercise these steps, but in principle you can probably do it on your own, too. Whether you get a lawyer is ultimately a trade-off (making a mistake may cost you money, but hiring a lawyer costs money, too). A first consultation with a lawyer is probably not too costly (ask first!), and may help you to decide whether you need more assistance.