Hospitals do not like to have their bills audited. Some hospitals go to considerable lengths to prevent the auditing process from working properly or working at all. One way to describe a few of the games that hospitals play is with an extended analogy. It's not a perfect analogy, of course, but we believe that it is instructive.

You go to what appears to be a nice restaurant for a meal. You place your order with the waiter. The waiter brings the items that you ordered. You eat the meal. Then the waiter presents you with the check. The following items are listed:

You ask to speak with the manager. He comes over to your table. You explain to him that you neither ordered nor received an appetizer; that, according to the menu, the entrée comes with a salad at no extra cost; and that you had a $5.00 glass of wine, not a $14.00 bottle of wine. You say that no other restaurant has ever charged you for silverware, table linen and kitchen equipment, which should be included in the price of the meal, and that being charged separately for those items is outrageous.

You say that your check should, therefore, be $23.00, not $40.00. You ask him to adjust it accordingly. He says that he needs to speak with your waiter. After he does, he makes one of the following statements:

•  "The check is correct as written. Please pay the $40.00 immediately."

•  "I will knock 25% off your check, reducing it to $30.00, if you pay it without any further discussion and then leave the restaurant."

•  "You shouldn't have been charged for the salad, but your waiter says that the rest of the check is correct. That reduces your total to $37.00. We charge for use of the silverware, the table linen and the kitchen equipment as a matter of restaurant policy, which is not open for discussion. Please pay $37.00 immediately."

•  "You shouldn't have been charged for the salad. I don't see a wine bottle on your table, so we can't prove that you received more than a glass of wine. There's no way of proving that you received an appetizer, but your waiter insists that you did, and that's good enough for me. That reduces your total to $28.00. We charge for use of the silverware, the table linen and the kitchen equipment as a matter of restaurant policy, which is not open for discussion. Please pay $28.00 immediately."

•  "This restaurant is one of a chain of restaurants. Our head office is located 100 miles from here. You will have to write to our head bookkeeper at our head office to resolve this matter. Before you leave the restaurant this evening, we will need to make an imprint of your credit card. We won't charge your credit card now, but we won't let you leave until we have the information on it. Don't expect a quick response from our head bookkeeper. It may be several months before you hear anything. It's even possible that you'll never receive a response. But don't worry, we won't turn the matter of your unpaid check over to our collection agency until at least sixty days have passed."

•  "This restaurant is one of a chain of restaurants. Our head office is located 100 miles from here. You will have to go to our head office in person and speak with our head bookkeeper to resolve this matter. Before you leave the restaurant this evening, we will need to make an imprint of your credit card. We won't charge your credit card now, but we won't let you leave until we have the information on it. Our head bookkeeper won't meet with you unless you first pay the entire $40.00 check plus a nonrefundable $10.00 nuisance fee for wasting his valuable time. If it turns out that you were overcharged, our head bookkeeper will send you a refund check in the mail within a week of your meeting with him. If you haven't made an appointment with our head bookkeeper (and paid your entire $40.00 check) within sixty days, we'll turn the matter over to our collection agency."

As a fine, upstanding citizen, you know that you have an obligation to pay for your meal, but you also know that you have no obligation to pay for anything for which you shouldn't have been charged. You are particularly upset at being charged for the use of silverware, table linen and kitchen equipment. You probably don't think that any of the manager's statements is satisfactory.

If instead of a restaurant check the subject in question were a hospital bill that you were responsible for paying, you wouldn't know which of the items listed on the bill the patient had actually received. You wouldn't have seen the hospital's "menu" and wouldn't know which items were "salads" that shouldn't be billed separately. There is a good chance that the hospital would refuse to discuss its charges for certain items, just as the restaurant refused to discuss its charges for silverware, table linen and kitchen equipment.

You might be told to go to a hospital office located many miles away from you and to pay an audit fee for the privilege of pointing out to the hospital the errors in its bill. If you wrote to the hospital, you wouldn't know whether you'd ever receive a response. You might be told that your bill would be turned over to a collection agency before you even had a chance to speak to anyone about it. You might even be told, "The bill is correct. Pay it!" without one word of explanation, let alone any documentation.

Hospitals play all sorts of games with hospital bill auditors every working day. We've learned how to win such games, but we're able to win them only when our clients support us fully in our efforts to remove inaccurate and invalid charges from their bills.

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Hospital Billing Practices

The Kinds of Errors Hospital Bills Contain

Games Hospitals Play

ERISA and Hospital Bill Auditing

Third Party Administrators

The Importance of Medical Records

Our Position on Hospital Audit Policies

A Few of Our Success Stories