SPECIAL REPORT: Bogus Billing

Special Reports

BAY COUNTY, Fla. (WMBB)- Medical billing can become confusing especially when you receive bills for services you believe you already paid for. 

Taking a trip to the emergency room or a family physician can add up, but how do you know if the bills you’re paying are accurate? At the time of the incident, the first thing a patient is thinking about is care, and the last thought that comes to mind is billing. 

“You get your services in the emergency room because it’s probably an emergency. You’re not looking whether your doctor is in service or not and then once you get those services, you end up getting a supplemental bill by an emergency physicians group which is not what you expected and you anticipate when you buy insurance that your services would be covered by the insurer,” said Florida’s Chief Financial Officer, Jimmy Patronis. 

We spoke with Panama City residents who say the fear of being sent to collections over an unpaid bill is real, and because of that fear, they’re prone to pay any bill that comes addressed to them. 

However, CFO Patronis says you should be wary of any statement you receive.

“You can’t always take what you get in the mail as the spoken gospel, question it if you have concerns,” said Patronis. 

CFO Patronis’ office specializes in insurance claims. Often times, his staff looks into suspected fraud when it comes to insurance practices and billing. 

In the 2017-2018 fiscal year, Patronis’ office received 15,593 suspected fraud referrals. Of those referrals, they opened 2,108 cases and closed 2,063 of them. Of the 2,063 cases, 984 arrests were made. These numbers not only include healthcare complaints, but also fraud in other areas such as life insurance and disability. 

Specifically pertaining to healthcare, the types of cases opened vary, but in total, they received 882 complaints in the 2017-2018 fiscal year resulting in 44 arrests. 

Patronis says most of these billing errors turn out to be just that, simple mistakes such as improper coding on a certain procedure or visit. 

“It’s humans taking care of humans. There’s a reason that they call medicine a practice. There are going to be mistaken from time to time but it’s our job just to root those mistakes out from what’s generally a mistake and what is potentially wrongdoing on behalf of the citizens of the state of Florida,” said Patronis. 

He says it’s their job to investigate these claims and even if they end up being nothing, it’s worth it to make sure you’re paying the proper amount and that the party responsible is functioning lawfully. Some residents say they always take it upon themselves to double-check any bill. 

“I always check it out, but it always said not a bill so I didn’t worry about it,” said Panama City Resident, David Bradshaw. 

CFO Patronis even encourages checking out bills that are covered by your insurance and making sure that those services being paid for are those of which you actually received. 

“You always got to read whatever you get from your physician and/or from your insurance carrier to ensure that those practices are standardized by also that you actually showed up,” said Patronis. 

Most of these surprise fees come from a billing procedure called “balance billing”, also commonly referred to as surprise bills. Balance billing happens when a provider bills a patient for the difference between the amount that is being charged and the amount that a patient’s insurance actually pays out. However, this practice isn’t always legal. 

For providers that are in-network with a facility, balance billing is not legal because the provider has agreed to accept any negotiated fees as payment in full including any applicable deductible, co-insurance or co-pay.

It’s always good to call your insurer with any questions regarding the bills you received. When your insurer can’t assist you when it comes to a questionable bill, reach out to CFO Patronis’ office. 

“So anything that looks sketchy or questionable to you, I would call our office. Let us start an investigation for you, that’s our job. Our people are there around the clock to do exactly that,” said Patronis. 

All in all, the best practices to avoid overpaying would be to keep documentation of services you received, double-check every bill, and follow up with your insurance company after a visit to a medical provider. Most importantly, don’t be afraid to ask questions regarding your billing statement because the majority of the time the error can be a simple mistake. 

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