If Dr. Bhavin Shah was on his own, he said, he probably would have paid the bill for his broken arm. The 47-year-old physician from suburban Chicago incurred surprisingly steep charges after landing in an emergency room on New Year\u2019s Day 2021. He\u2019d hit an icy patch while skiing with his kids in Wisconsin.<\/p>\n

The $10,563.49 in initial ER charges from a Froedtert South hospital in Pleasant Prairie, Wisconsin, seemed high considering he basically got only an exam, X-rays, pain relief, and an arm splint. His insurer negotiated the cost down to $7,922.62 \u2014 but, with Shah owing $250 for his deductible and 40% of the remaining charges, his bill of $3,319.05 still felt like too much. However, he thought, who was he to question the hospital\u2019s billing department?<\/p>\n

Shah\u2019s wife, on the other hand, is highly qualified to question such charges. Sunita Kalsariya, 45, is the office manager of her husband\u2019s medical practice, a job that includes overseeing billing. She took one look at the hospital charges and decided to investigate further.<\/p>\n

Kalsariya had no way of knowing then that she was embarking on a crusade that would take over a year, send their bill to debt collections, lead her to complain to the Illinois attorney general, and discover that the hospital charged nearly $7,000 for a procedure that was never performed.<\/p>\n

Froedtert South did not respond to multiple requests for comment on the case.<\/p>\n

Here\u2019s how Kalsariya reduced her family\u2019s bill:<\/p>\n

Tip 1: Start Early<\/strong><\/p>\n

Even before you know you\u2019ll be challenging a bill, Kalsariya said, you should ask the hospital both for more information and to pause the billing process. The sooner you do that, the more time you\u2019ll have to track down the details you need to contest a bill \u2014 and possibly reset the clock before it is sent to collections.<\/p>\n

\u201cEven in our case, we waited until the second bill,\u201d Kalsariya said. \u201cStart acting with the first bill.\u201d<\/p>\n

Tip 2: Get an Itemized Bill<\/strong><\/p>\n

Hospitals often have their own internal billing codes, so it\u2019s important to ask for an itemized bill that lists \u201ccurrent procedural terminology\u201d billing codes (CPT codes, for short), which are standardized across the country.<\/p>\n

Depending on the medical procedure, Kalsariya said, a bill could contain an overwhelming number of line items that are hard to understand. She suggested focusing on the items that stand out, such as those with the highest price tag.<\/p>\n

Kalsariya said it took months to get a bill that included CPT codes for her husband\u2019s ER trip. Once she did, one item jumped out: $6,961.75 for CPT code 24505 \u2014 treating a fractured humerus without making an incision.<\/p>\n

Shah didn\u2019t remember having that treatment at Froedtert South. What he did recall was having his arm splinted in a comfortable position and making plans to have surgery the next day at a hospital in the Chicagoland area unaffiliated with Froedtert South. He returned home that night, caught maybe a couple of hours of sleep while propped up by pillows in an almost-seated position, then had a successful surgery.<\/p>\n

Sunita Kalsariya, Dr. Bhavin Shah\u2019s wife, manages his Illinois medical practice and understands the complexities of medical billing. After disputing Shah\u2019s bill for over a year, she was able to get it reduced to about a third of the original balance.(Bram Sable-Smith \/ KHN)<\/span><\/figcaption><\/figure>\n
**Tip 3: Compare Your Charges With Those at Other Hospitals<\/strong><\/p>\n**
Since January 2021, all hospitals have been required<\/a> to make their prices publicly available, although some do so in a way that is difficult to find<\/a>. Still, Kalsariya was able to find the prices that other hospitals in Wisconsin and beyond charged for the same procedure. They ranged from $201 in Boise, Idaho, to $1,300 in Madison, Wisconsin, she said, but all were fractions of the nearly $7,000 that Froedtert South charged.<\/p>\n
The website fairhealthconsumer.org<\/a> has a tool that allows consumers to search for typical patient expenses for procedures in their area. The website estimates that the out-of-network cost for the procedure Shah underwent, within the hospital\u2019s ZIP code, would be $3,863; in network, it would be $1,707. Medicare also has an online tool<\/a> to find national average patient expenses searchable by CPT code. The total cost for that procedure is listed at $1,892, with Medicare paying $1,514 and the patient on the hook for $378.<\/p>\n
**Tip 4: Challenge Your Charges<\/strong><\/p>\n**
**Armed with the information that Froedtert South was seemingly charging more than others for the bone realignment, the couple tried appealing directly to the hospital with no luck.<\/p>\n**
\u201cThe charges incurred on your date of service were both reasonable and within the range usually charged by similar healthcare providers in the area,\u201d the hospital\u2019s response letter read. \u201cMoreover, your insurance company, United Healthcare Choice-Golden Rule, entered into a long-term agreement with Froedtert South knowing the charges for its various services.\u201d<\/p>\n
**The couple sent two complaints to their insurer asking how it could allow itself to be charged such a high amount, but response letters said the claim was processed correctly.<\/p>\n**
\u201cWe expect our in-network providers to bill appropriately for their services,\u201d UnitedHealthcare spokesperson Maria Gordon Shydlo wrote in an email to KHN. \u201cWe paid the claim under the terms of Mr. Shah\u2019s benefit plan based on the information we received from the provider.\u201d<\/p>\n
Fed up, Kalsariya filed a complaint with the Illinois attorney general\u2019s office. After going back and forth, she eventually was told her husband could apply for the hospital\u2019s financial assistance program to reduce his bill. But Kalsariya said they didn\u2019t need financial assistance. They could afford $3,319.05. This, she said, was about the principle of the thing \u2014 she felt they were being egregiously overcharged.<\/p>\n
**Tip 5: Request Your Medical Records<\/strong><\/p>\n**
\n
$\"Dr.$
Dr. Bhavin Shah was left with a $3,319 medical bill after he landed in an emergency room following a skiing accident in Wisconsin. But his wife, Sunita Kalsariya, discovered he was charged for a procedure that never happened.(Bram Sable-Smith \/ KHN)<\/span><\/figcaption><\/figure>\n<\/div>\n
Getting Shah\u2019s medical records proved to be another challenge. Kalsariya said her attempt to access the records on the hospital\u2019s website didn\u2019t work, so instead the couple was required to send hospital officials a form to release the records.<\/p>\n
\u201cThey wouldn\u2019t even accept fax or email,\u201d Kalsariya said. \u201cThey needed it mailed, specifically, and it had to be notarized.\u201d<\/p>\n
It almost didn\u2019t seem worth the hassle to them. But when a KHN reporter responded to the family\u2019s request for help investigating<\/a> Shah\u2019s hospital bill, the couple decided to send in the form to accurately document their saga.<\/p>\n
When the records arrived, they showed the splinting that Shah remembered but not the treatment that was driving up his bill. They appealed the bill to Froedtert South once more in May 2022, this time noting the discrepancy between the charges and the medical records.<\/p>\n
**Tip 6: Tell Collections You Are Disputing the Bill<\/strong><\/p>\n**
Shah had received a letter from a debt collector, which Kalsariya said came in November 2021, over his unpaid medical bill. She asked the hospital to pull the bill from collections because the dispute was unresolved, which she said it did.<\/p>\n
Informing a collections agency that a bill is in dispute can help protect a patient\u2019s credit score. That wasn\u2019t an issue with Shah\u2019s bill from the hospital because the hospital pulled it back after Kalsariya\u2019s call.<\/p>\n
**How It All Ended<\/strong><\/p>\n**
After the couple asked the hospital about the discrepancy with the procedure, Shah received a letter from the hospital dated May 27 of this year, saying it had reviewed the records and discovered the bill was inappropriately coded: The hospital should have used the code for a splint, not a treatment. A month later, Shah got a new bill with a patient balance of $1,214.91 \u2014 $2,100 less than the original balance.<\/p>\n
**Kalsariya still thought the bill seemed high and that the hospital seemed unapologetic about charging for a procedure that was never performed.<\/p>\n**
**But the couple paid the new, smaller bill, and their saga was finally over. Her advice to other patients? When you get a bill, look into it before paying.<\/p>\n**
**\u201cI know it\u2019s time-consuming. It is really taxing on our minds to do this,\u201d Kalsariya said. \u201cBut if everybody makes that effort, then they have to be transparent.\u201d<\/p>\n**
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