Minor cut turns into $5,000 bill because of medical coding error: Action 9 investigates

ORLANDO, Fla. — A Marion County woman claims 50 minutes at the ER for a minor injury turned into a $5,000 bill. She called Action 9 consumer investigator Todd Ulrich, who got results and investigates the common mistake that can inflate medical bills.

“Here are the codes,” said Linda Caldwell as she showed Ulrich her medical bill.

Caldwell refused to give up after a local hospital charged thousands to treat her husband's minor cut. She took her husband to the Quick Care Center at Ocala Health in West Marion County. The couple didn’t spend much time there.

“How long were you there?” Ulrich asked.

“Forty-five to 50 minutes,” Caldwell said.

“How many stitches?” Ulrich asked.

“Four tiny stitches,” she responded.

Caldwell said the ER and doctor's bills totaled $5,000. She suspected something was wrong.

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“I knew to ask for an itemized statement,” Caldwell said.

That's how she uncovered the medical code. Her husband was billed for a level three emergency which meant extensive decision making or a specialist was involved.

“Did anyone treat this as a high-level emergency?” Ulrich asked.

“No, absolutely not,” Caldwell replied. “No X-rays. No lab work. No specialist.” She felt that code inflated the bill from hundreds to thousands.

Caldwell said she disputed the charges with the hospital, her insurance company, and state regulators. They're response left her feeling ignored.

She said the hospital lowered the bill some but denied any error.

Caldwell contacted Action 9 and Ulrich sent a letter to Ocala Health. Within a month the ER and doctor bills were lowered.  What started at $5,000 dropped to $800.

“Got a letter from the hospital that said we made a mistake,” Caldwell said.

“Your new code was what?” Ulrich asked.

“Level one,” Caldwell replied.

Consumer experts said medical codes determine billing and the wrong ones can be costly.

“I think our responsibility is to know there are different levels and to know to question the bill,” said Teresa Brown, a medical cost expert with Medliminal.

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Ocala Health apologized for the Caldwell's hospital billing experience and said that was not typical.

“Once they got your letter it was like a magic wand,” Caldwell said.

Ocala Health told Action 9 that billing can be confusing and its patient services team can help.

Caldwell also blamed the insurance company for not responding. She said that left them unsure how big their share of the bill would be.

Medical code definitions can be found online, which could help patients better understand their billing.

Ocala Health response:

We understand healthcare bills can be confusing at times. To help patients understand the billing process, we provide resources on our website and have a Patient Financial Services team to assist. Another important resource for consumers is their insurance provider since insurance coverage typically plays a significant role in determining a patient’s out-of-pocket expenses. If any consumers have questions about the billing process, they can visit our website at ocalahealthsystem.com to get connected with our team.

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Cox Media Group