Two bills for the price of one? Surgery bill may be more than you bargained for

Posted at 10:31 PM, Nov 22, 2016
and last updated 2016-11-22 23:32:18-05
One surgery for the price of two?  A local woman couldn't believe her bill and was having trouble getting answers, so she called the I-Team.  
If you don't pay attention to your medical bills this story might make you more diligent. Experts say always go over an itemized list of charges before you pay.  
Karen Lake works on a computer all day. About a year ago, she said typing became painful.  
"I had a cyst on this knuckle and a cyst on this knuckle," she said.
In early August, Karen had an outpatient procedure on both fingers at the Orthopaedic Hospital of Wisconsin in Glendale. Everything went well, until Karen got the bill.
"I thought, that's not right," she said.
Karen said she knew, going in, her doctor would charge for each finger. She didn't expect the hospital to do the same.
"I found that they had charged me twice, for the surgery. I only went into the surgical suite once and possibly was there 20 minutes," she said.
Karen's explanation of benefits shows the two charges, around $4600 for each finger. Her insurance paid toward the bill. Karen now owes the hospital more than $3,000.  
"I want to know how they came up with that bill and I am never given any explanation," she said. "It's taken a lot of my time, a lot of my time."
Which is where an expert, like Jane Cooper can help.  
"People end up really at the mercy of the system," Cooper explained.  
Cooper is the CEO of Patient Care, a Milwaukee-based company she started in 2001. It helps people navigate the healthcare system which includes billing errors.
"When we investigate a claim or billing issue 28 percent of the time we find a mistake," she said.
Something Cooper said should be handled by insurance, but that's not always the case. We reached out to Patient Care about Karen's bill.  
"There's a big question about the legitimacy of billing twice for basically what is a very similar procedure in the same operating room," Cooper said.
Brian Cramer, the CEO of the Orthopaedic Hospital of Wisconsin, does not dispute it was billed as two procedures.
"She was charged for what happened.  An IV antibiotic and a procedure on her right middle finger and a procedure on her right index finger," he said.
A billing procedure that doesn't break any laws, according to Marquette Law School Professor Alison Barnes.
"You can certainly argue that seems too expensive," Barnes said.
Barnes said it's important to keep in mind hospitals are businesses, "rather than what they used to be which were charities, and so they're in it to make a profit." 
Karen is determined to fight half the bill and hopes her story makes people more diligent.
"Don't just get a bill from a doctor or hospital and see maybe a $40 bill or a $1,000 bill and think that really is your portion," she said.
TODAY'S TMJ4 checked with other surgery centers in southeast Wisconsin about how they bill using the same procedure code. Several were at a less expensive rate. Anywhere from a couple hundred dollars to more than a thousand less.  As far as charging patients for each finger, some facilities bill the same way. Others discount the second procedure and a few others indicated they only bill the code, once. 
Doing your research before an elective procedure is important. Experts recommend:
-Find out what it will cost. 
-Compare hospitals to find the best quality price.
-Understand what your benefits will pay.
-After the procedure, don't just pay the bill. Always get the itemized list of charges.
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