Medical Billing Errors: What can go wrong? What can you do?

CLEVELAND, Ohio -- There are lots of places where something can go wrong with your hospital bill. By our count, 289 of them.

That's how many people who can play a part in creating a bill before, during and after a hospital stay.

There are the intake workers who take information, doctors and nurses who record treatment on a chart, coders who use those notations to assign billing codes, and many others along the way.

Each person who enters information in a medical chart must make sure the notations are mistake-free, complete and tell a story. Any missing, or excessive, detail can affect charges on a final bill and determine how much is covered by insurance.

Then there are people at insurance companies who decide if your treatment is covered, hospital billing employees who review charges and, in many cases, collections workers whose job is to make sure you pay.

The opportunities for mistakes are astronomical, and a mistake early on can compound exponentially. Mistakes can be as simple as human error or as complex as interpretation; some seem inexplicable.

As part of an ongoing series, The Plain Dealer plans to feature stories over the next year about the problems patients encounter with medical bills. We want to hear from you.

When Kevin Theiss, a vice president at Summa Health System, told The Plain Dealer last month that he estimated 250 people or more could play a role in creating a single hospital bill, we set out to find out who they are and what could possibly go wrong.

So here, we trace a step-by-step path of a hypothetical bill that is based on a patient who is referred for surgery by a doctor and is admitted to the hospital for four days, a common length of stay. And with each step, we tally the number of people involved.

Here, too, are the stories of patients who had issues with their medical bills. Some challenged the system and got satisfaction. Others remain perplexed over how their treatment was billed and why it cost so much.

As one patient told us, "I can order food in a restaurant and know exactly what I will pay, but when it comes to getting medical care, I don't know what it will cost me until it's all over."

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