Over-billing by Doctors & Hospitals

Reviewing and negotiating medical bills is my job and I've been doing this for many years. Almost 95% of the time, I find that doctors, pharmacies and hospitals over-bill their patients and patient's insurance companies knowing that they will pay it without questioning the charges. Is it legal for them to do that? Absolutely. I've always wondered how many people are actually aware that there is such a thing as an Official Medical Fee Schedule or OMFS which simply means, the corresponding reasonable charge for each CPT (Current Procedural Terminology) code set forth by the American Medical Association. For example, your doctor ordered you to get an MRI of your spine as he suspects an orthopedic injury. A couple of weeks later you get a bill from the facility where you had the MRI done either because you do not have medical insurance to begin with or that particular test is not covered under your insurance policy or maybe because your insurance carrier found no medical necessity for an MRI. You are now stuck with $2,200.00 bill for a diagnostic procedure represented by the CPT code 72148. You have either 30 days to pay or be sent to collections. Are you going to gladly pay the $2,200.00 or allow some collection agency to harass you or even possibly damage you credit score? Would it cross your mind to check if the charge for the MRI is reasonable and fair? Probably yes but would you have been able to figure out the actual OMFS value of that charge, I doubt. According to the OMFS, MRI of the lumbar is $640. In other words, the medical facility is charging over $1,500.00 than what they are really suppose to be charging you. Thank you for reading my blog. If you have had a similar experience with any form of medical bill, please feel free to share.