Request Your Medical Records Before You Pay That Hospital Bill

It’s your right to access all of your hospital records — and the best reason to have them might be financial.

If you’re hit with a huge medical bill that you think is erroneous or fraudulent, these records can prove you right or wrong. They’re the best account of what actually happened, more reliable than your memory or the doctor’s. In fact, hospital bills are often based on these records, and sometimes nothing else.

“Most of the time, medical coders don’t actually work at the hospital or talk to the doctors,” says Cheryl Welch, president of Hudson Valley Medical Billing Advocates, a firm that helps consumers lower medical bills.

When you receive a high medical bill, the coding department might not be to blame. But if your money is on the line, it’s worth requesting your records and comparing them with your bill.

When — and when not to — audit your medical records

Medical care is often expensive, but it doesn’t always make sense to compare your bills to your records. In general, you can skip this step if you’ve just had a short outpatient visit or a doctor’s consult. These visits likely result in only a few, uncomplicated charges that you can verify without the aid of your record.

Medical records help with more complicated visits, such as surgeries, emergency room care and overnight hospitalizations. Bills for these visits have more charges, and are more likely to contain errors. If you want to dispute one of these bills, have your initial, itemized medical bill handy and check your explanation of benefits to verify your insurance claim was processed correctly.

How to get your medical records

Your doctor and hospital should both have access to your electronic health record, or EHR. Most providers will require you to fill out and sign a form to release your records and charge you a fee to process your request. The cost is up to your provider, but most states limit how much you can be charged.

Once you submit the form and payment, the provider will send your records within a few days to about a month. Each state has its own guidelines.

What to look for when comparing

Don’t worry about all the codes on your bill when comparing it to your medical record, Welch says. Instead, match the charges on your initial, itemized medical bill to procedures, tests and visits in your chart.

All of your charges should have medical documentation, so if you had a long hospital stay, this may take a lot of time.

Look for these red flags:

• Duplicate charges. This includes anything that you can find only once in your hospital record that appears twice or more on your bill.
• Canceled tests or drugs. Often, providers cancel orders for medications or procedures, such as blood tests. Any drugs you took, as well as results from imaging or blood tests — and not just orders for them — should be in the record.
• Medical terms you don’t understand. Lines on the bill that are unclear to you should still match a description of a procedure in the chart. Not all unfamiliar terms are overcharges, but it’s easier to miss hidden charges if you don’t understand them.
• Incorrect room classifications and dates. Check the dates on your room charge. Most hospitals don’t charge room fees for the discharge day; if yours did, you can ask to have it waived. If you shared a hospital room, make sure you weren’t charged for a private one.
• Discrepancies between anesthesia and operating room times. Operating rooms charge by the hour. If you had surgery, compare the time you spent in the operating room and under anesthesia according to your record with the times indicated on your bill.
• Differences between medication names, units, and dosages. Check that your itemized bill lists the same names, doses, and units of any drugs you received as your chart does. If your doctor ordered a drug by brand name, but you received a generic version, that should be in the “medications” section of your chart.
• Charges for central supply items. Charges for items such as cotton balls, Band-Aids, and tongue depressors should be included in your room fee, and not billed independently.
• Upcoding. Many visits are assigned a “level” for billing that may appear in the chart. If you have a level 3 emergency room visit in your record, make sure your bill doesn’t reflect a level 4 or 5 ER visit. These errors might be difficult to spot without the help of a professional or without searching for a code or two online.
• Charges for procedures you declined. Your records should reflect any treatments or tests you declined. It’s easier to remember the things you didn’t agree to than the things you did, so these errors might stick out without your medical records.

Hopefully everything on your hospital bill is reflected in your chart, with no errors or overcharges — but if you find charges that don’t seem quite right, call your hospital’s billing representative. If you prefer, you can also schedule a sit-down with the billing manager.

Contesting your bill and avoiding collections

Negotiating medical bills and contesting charges is often a long process — and some hospitals give patients only 30 days to pay before considering a bill late. By the time you’ve received your itemized medical bill, your explanation of benefits and your medical records, and have had a chance to audit them, you might already be getting calls about an overdue bill. If you won’t meet the 30-day deadline, call your provider and insurer and explain that you’re verifying the charges yourself.

Being open with the billing staff will help you avoid late fees and collections. As a measure of good faith, you may want to send payment for the charges you think are fair and that you can afford. If you do this, note which charges you’re paying and which you’re contesting for the biller.

Just because your hospital bill is unaffordable doesn’t mean it’s wrong, but it still might be unreasonably high. Check the fair and sensible charges for any services you’re questioning on a site like FAIR Health, show your hospital the results, and ask it to match those. Providers often will.

If the hospital’s unwilling to lower your bill, it might be time to hire an advocate to negotiate on your behalf. Most charge only if and when they’re able to reduce your bill, usually as a percentage of those savings, Welch says.

There’s no denying that comparing medical records to a bill is a long, sometimes difficult task, but if you can correct a mistake, you could save thousands.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.