Had Dr. Bhavin Shah been on his own, he said, he might have paid the bills for his broken arm. The 47-year-old physician from suburban Chicago incurred a surprisingly steep charge after landing in an emergency room on New Year’s Day 2021. She hit an icy patch while skiing with her kids in Wisconsin.
The initial ER charge at Freudert South Hospital in Pleasant Prairie, Wisconsin, of $10,563.49, seemed high because he basically just got an exam, X-rays, pain relief and a hand splint. His insurer negotiated the cost down to $7,922.62 — but, with Shah owing $250 for his deductible and 40% of the remaining charges, his bill of $3,319.05 still seemed too high. But he thought, who is he to question the billing department of the hospital?
Shah’s wife, on the other hand, is highly qualified to question such allegations. Sunita Kalsaria, 45, is the office manager of her husband’s medical practice, a job that includes overseeing billing. He took a look at the hospital’s complaints and decided to investigate further.
Kalsaria had no way of knowing at the time that he would begin a crusade that would last more than a year, send their bills to debt collection, lead him to complain to the Illinois attorney general, and discover that the hospital had charged nearly $7,000 for a procedure. Never performed.
Freudert South did not respond to multiple requests for comment on the lawsuit.
Here’s how Kolsaria cut his family’s bills:
Tip 1: Start early
Even before you know you’ll challenge a bill, Kalsaria said, you should ask the hospital for more information and to pause the billing process. The sooner you do this, the more time you have to track down the details needed to contest a bill — and possibly reset the clock before sending it to collections.
“Even in our case, we waited till the second bill,” Kalsaria said. “Start acting with the first bill.”
Tip 2: Get an itemized bill
Hospitals often have their own internal billing codes, so it’s important to ask for an itemized bill that lists the “Current Procedural Terminology” billing codes (CPT codes for short), which are standardized across the country.
Depending on the medical procedure, Kalsaria said, a bill can have an overwhelming number of line items that are difficult to understand. He recommends focusing on items that have the highest price tags.
Kalsaria said it took months to get a bill that included the CPT code for her husband’s ER trip. Once he did, one item jumped out: $6,961.75 for CPT code 24505 — treating a broken humerus without an incision.
Shah did not remember that treatment at Freudart South. All he recalled was that his hand was splinted in a comfortable position and surgery was planned for the next day at a hospital in the Chicagoland area unrelated to Freudart South. He returned home that night, slept for a few hours propped up by a pillow while almost sitting up, followed by a successful surgery.
Tip 3: Compare your charges with other hospitals
From January 2021, all hospitals must make their prices publicly available, although some do so in ways that are hard to find. Still, Kalsaria was able to find the prices other hospitals in Wisconsin and beyond were charging for the same procedure. They ranged from $201 in Boise, Idaho, to $1,300 in Madison, Wisconsin, he said, but all were a fraction of the nearly $7,000 that Freudert South charged.
The fairhealthconsumer.org website has a tool that allows consumers to search for typical patient costs for procedures in their area. The website estimates the out-of-network cost for the procedure Shah performed within the hospital’s zip code would be $3,863; In network, it will be $1,707. Medicare also has an online tool to find national average patient costs searchable by CPT code. The total cost for this procedure is listed at $1,892, with Medicare paying $1,514 and the patient paying $378.
Tip 4: Challenge your charges
Armed with the information that Freudart South was apparently charging more than others for bone realignment, the couple tried to apply directly to the hospital with no luck.
“The charges on the date of your service were reasonable and within the range generally charged by similar healthcare providers in the area,” the hospital’s response letter read. “Furthermore, your insurance company, UnitedHealthcare Choice-Golden Rule, has entered into a long-term contract with Freudert South knowing the charges for its various services.”
The couple sent two complaints to their insurer about how it could allow itself to be charged so much, but the response letters said the claim had been processed correctly.
“We expect our in-network providers to bill appropriately for their services,” UnitedHealthcare spokeswoman Maria Gordon Shaidlow wrote in an email to KHN. “We paid the claim under the terms of Mr. Shah’s benefit plan based on the information we received from the provider.”
Frustrated, Kalsaria filed a complaint with the Illinois Attorney General’s office After going back and forth, she was finally told that her husband could apply for the hospital’s financial assistance program to lower his bill. But Kalsaria said they don’t need financial support. They can afford $3,319.05. This, he said, was about the principle of the thing – he felt they were being grossly overcharged.
Tip 5: Request your medical records
Obtaining Shah’s medical records proved to be another challenge. Kalsaria said her efforts to access the records on the hospital’s website did not work, so instead the couple had to send a form to hospital officials to release the records.
“They won’t even accept faxes or emails,” Kalsaria said. “They needed to mail it, specifically, and have it notarized.”
It almost doesn’t seem worth their trouble. But when a KHN reporter responded to the family’s request for help investigating Shah’s hospital bills, the couple decided to send the form to properly document their story.
When the records arrived, they showed the splinting that Shah had in mind but not the treatment that drove up his bills. They again appealed the bill to Freudart South in May 2022, this time noting discrepancies between the charges and the medical records.
Tip 6: Tell collections you are disputing the bill
Shah received a letter from a debt collector, which Kalsaria said came in November 2021, for his unpaid medical bills. He asked the hospital to pull the bill from collections because the dispute was unresolved, which he said it did.
Notifying a collection agency that a bill is in dispute can help protect a patient’s credit score. It was not an issue with Shah’s bill from the hospital as the hospital took it back after Kolsaria’s call.
How it all ends
After the couple inquired about discrepancies with the hospital’s procedures, Shah received a letter from the hospital on May 27 this year, saying it had reviewed the records and discovered that the bill had been improperly coded: the hospital’s code should have used a splint, not a treatment. A month later, Shah received a new bill with a patient balance of $1,214.91 — $2,100 less than the original balance.
Kalsaria still thought the bill seemed high and that the hospital seemed unreasonable about charging for a procedure that was never performed.
But the couple paid new, smaller bills and their story was finally over. His advice for other patients? When you get a bill, look at it before paying.
“I know it’s time-consuming. Doing this is really stressing our minds,” Kalsaria said. “But if everyone is going to make that effort, they have to be transparent.”
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