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High overcharge likelihood detected
This bill contains multiple serious overcharges across six distinct categories. The patient balance of $4,840 is significantly above fair market value. Insurance adjustments appear absent, and three charges are duplicated. The gross charges exceed Medicare benchmarks by 240–680% across nearly every line item. Based on our analysis, a fair resolution range is $980–$1,420 — a potential savings of over $3,400.
🚩 Flagged Items6 found
Billed at the highest possible ER complexity level ($1,842) vs Medicare rate of $215. Most standard ER visits qualify for level 3 or 4, not level 5. Requesting downgrade to 99284 could save over $1,500 on this line alone.
Critical care codes require documentation that the patient's condition was immediately life-threatening. Billed at $580 vs $218 Medicare rate. Request the medical records to verify this code is justified.
Routine blood draw billed three times ($95 each) for a single visit. Medicare pays $13 per draw. One draw is standard unless three separate venipunctures are documented — request itemization and documentation.
Billed at $485 vs Medicare rate of $26 — charged at 1,865% of benchmark. This is one of the most commonly overcharged items in ER billing. Standard facility rate should be $33–$60.
EKG billed at $312 vs Medicare benchmark of $19. At 1,642% of the government benchmark, this is significantly above fair market value for a routine 12-lead EKG.
Eight 10mL saline vials billed at $40 each ($320 total). These are commodity supplies that cost hospitals under $0.50 each. Medicare reimburses $4 per vial. Total markup: 5,333%.