10 things your hospital won't tell you

"Sometimes we bill you twice."

Crack the code of medical bills and you may find a few surprises: charges for services you never received or charges for routine items such as gowns and gloves that should not have been billed separately. Clerical errors are often the reason for mistakes. One transposed number in a billing code can result in a charge for placing a catheter in an artery versus a vein, a difference of more than $3,900, Stull says.

So how do you figure out if your bill has incorrect codes or duplicate charges? Start by asking for an itemized bill with "miscellaneous" items clearly defined. Some telltale mistakes: charging for three days when you stayed in a hospital overnight, a circumcision for your newborn girl or for drugs you never received.

Ask the hospital's billing office for a key to decipher the charges or hire an expert to spot problems and deal with the insurance company and doctors (you can find one at Medical Billing Advocates of America). Their expertise typically will cost up to $65 an hour, a percentage of the savings or some combination of the two.

If you want to be your own billing sleuth, talk to the highest-ranking administrator you can find in the hospital finance or accounts office to begin untangling any mistaken codes.

"All hospitals are not created equal."

How do you tell a good hospital from a bad one? For one thing, nurses. When it comes to their own families, medical workers favor institutions that attract nurses. But they're harder to find as the country's nursing shortage intensifies; by 2020, 44 states could be facing a serious deficit. Low nurse staffing directly affects patient outcomes, resulting in more problems such as urinary-tract infections, shock and gastrointestinal bleeding, according to a 2001 study by Harvard and Vanderbilt university professors.

Another thing to consider: Your local hospital may have been great for welcoming your child into the world, but that doesn't mean it's the best place to undergo open-heart surgery. Find the medical center with the longest track record, best survival rate and highest volume in the procedure. You don't want to be the team's third hip replacement, says Samantha Collier, the vice president of medical affairs at HealthGrades, which rates hospitals.

The American Nurses Association's Web site lists "magnet" hospitals -- those most attractive to nurses -- and a call to a hospital's nurse supervisor should yield the nurse-to-patient ratio, says Gail Van Kanegan, a registered nurse and a co-author of "How to Survive Your Hospital Stay."

She also suggests calling the hospital's quality-control or risk-management office to get infection statistics and asking your doctor how frequently the hospital has done a certain procedure.

Though reporting these statistics is still voluntary, more hospitals are doing so on sites like the U.S. Department of Health and Human Services, which compares hospitals against national averages in certain areas, including how well they follow recommended steps to treat common conditions, says Carmela Coyle, the senior vice president for policy at the American Hospital Association.

How to improve your odds

"Most ERs are in need of some urgent care themselves."

A 2006 study from the Institute of Medicine found that hospital emergency departments are overburdened, underfunded and ill-prepared to handle disasters as the number of people turning to ERs for primary care keeps rising.

An ambulance is turned away from an ER once every minute due to overcrowding, according to the study; the situation is exacerbated by shortages in many of the "on call" backup services for cardiologists, orthopedists and neurosurgeons. And it's getting worse.

If you can, avoid the ER between 3 p.m. and 1 a.m., the busiest shift. For the shortest wait, early morning -- anywhere from 4 a.m. to 9 a.m. -- is your best bet. If you are having severe symptoms, such as the worst headache of your life or chest pains, alert the triage nurse manager, not just the person checking you in, so that you get seen sooner, says David Sherer, an anesthesiologist and author of "Dr. David Sherer's Hospital Survival Guide." Triage nurses are the traffic cops of the ER and your ticket to getting seen as quickly as possible.

"Avoid hospitals in July like the plague."

If you can, stay out of the hospital during the summer, especially July. That's the month when medical students become interns, interns become residents, and residents become fellows and full-fledged doctors. In other words, a good portion of the staff at any given teaching hospital is new on the job.

Summer hospital horror stories aren't just medical lore: The adjusted mortality rate rises 4% in July and August for the average major teaching hospital, according to the National Bureau of Economic Research. That means eight to 14 more deaths occur at major teaching hospitals than would normally without the turnover.

Another scheduling tip: Try to book surgeries first thing in the morning and preferably early in the week, when doctors are at their best and before schedules get backed up, Sherer says.

"Sometimes we don't keep our mouths zipped."

Contrary to what you might think, sharing patient information with a third party is often perfectly legal. In certain cases, the law allows your medical records to be disclosed without asking or even notifying you. For example, hospitals will hand over information regarding your treatment to other doctors, and they will readily share those details with insurance companies for payment purposes.

That means roughly 600,000 entities that are loosely involved in the health-care system have access to that information. These parties may even pass on the data to their business partners, says Deborah Peel, the founder of the Patient Privacy Rights Foundation in Austin, Texas.

If you want to access your medical records, you don't have to steal them like Elaine did on "Seinfeld" after she learned a doctor had marked her as a difficult patient. You are legally entitled to see, copy and ask for corrections to your medical records.

This article was reported and written by Reshma Kapadia for SmartMoney.

Updated Sept. 5, 2008

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