Weeks after doctors removed her right ovary, Leann Carrozzo asked what she thought was a simple question: Why did a routine two-hour surgery cost $25,652.14?
Carrozzo, 43, requested an itemized bill from Good Samaritan Hospital in San Jose, Calif. That led to more questions: Why did equipment account for more than half of the charges? Couldn't some of the items be sterilized and reused? If so, why were they so pricey? What was that $2,190 ``endo-ta staple'' anyway?


Two years later, Carrozzo says she still has no answers. The billing department at the hospital and the insurance company told her they were merely punching in codes from billing documents. After negotiating certain discounts with the hospital, the insurance company paid $17,000 of the bill, and the hospital wanted Carrozzo to pony up another $2,148.


``Shame on them,'' Carrozzo said. ``Shame on the insurance company for paying a bill immediately, apparently without understanding what they were paying for... And how can the hospital be charging these insane amounts and giving lame excuses about codes?... Just fix it.''
Sounds simple enough, but it's not.


Just about everyone agrees that the medical billing process makes little sense from a consumer's perspective. Prices vary wildly on procedures as routine as a root canal, even within the same community. One surgical procedure will generate a bill from the hospital, another bill from the surgeon, and more from the radiologist, the anesthesiologist and maybe a pathologist. Then there are those pesky pricing codes, attached to everything from a latex glove to a cotton swab. One slip of a keystroke by a billing clerk can dramatically alter the tally.


``Then consider that a hospital might be dealing with 40 different insurance companies, and Medicare and Medicaid, each with a different billing system and format for payment,'' said Uwe Reinhardt, a health-care economist at Princeton University. ``Chaos reigns when it comes to billing because nothing is standardized -- not just in hospitals, but in doctors' offices and even pharmacies.''


Is it any wonder then that mistakes happen, as Carrozzo suspects was the case with her surgery?


No wonder at all, several consumer advocates say. Mistakes have become so prevalent that a niche industry has evolved to help patients decipher their bills. Pat Palmer, founder of Medical Billing Advocates of America, estimates that she finds multiple errors in eight out of every 10 hospital bills she reviews. Her organization, made up of 30 independent consultants nationwide, works for individuals, large self-insured companies and even state governments. For a fee, set by each consultant, the group roots out errors in medical billing and insurance reimbursements. It also hosts seminars to train consultants. Medical Billing Advocates says it has found as much as $400,000 in errors when it examined the bills submitted to self-insured companies.


It apparently doesn't take a consultant to spot errors, though. Five percent of the 11,000 people recently surveyed by Consumer Reports said they discovered major mistakes after examining their hospital bills. The patients with $2,000 or more in out-of-pocket expenses, meaning those costs not covered by their medical plans, were twice as likely to uncover errors.


Role in bankruptcies

The errors exacerbate consumer frustration with an already troubled health-care system. Those lucky enough to have insurance find themselves digging deeper into their pockets to pay premiums, deductibles and co-payments. Some dig so deep that they ruin their credit: Medical debt now ranks as the second-leading cause of personal bankruptcy in this country, after credit card debt. And it's not just because 43 million U.S. consumers are uninsured: About 80 percent of families in bankruptcy due in part or in whole to medical bills were insured, a recent New York Law Review study found.


The future looks even more bleak if health-care costs keep climbing 10 percent to 14 percent each year while wages continue to grow by an annual 2 percent to 3 percent.


``Consumers will feel more squeezed than ever before,'' said Helen Darling, president of the National Business Group on Health, which represents the views of large employers. ``They will need to pay much more attention to the details of cost-sharing because the money is even more precious and because there will be a larger variety of (insurance) plans, which means more confusion and errors.''


Even if insurers pick up the tab for those errors, consumers could ultimately pay the price, said Tom Brennan, director of special investigations with Highmark Inc., a Blue Cross Blue Shield plan based in Pittsburgh.


Every mistake eats into the lifetime cap per patient set by many benefits plans, Brennan said. Yet patients often ignore expenses if insurers reimburse doctors, hospitals or labs without a hassle, he said.


``God forbid you get hit by a catastrophic illness or an extended hospital stay and then find out your benefits have been exhausted,'' Brennan said.


Not to mention your savings.


Family overwhelmed

Consider the Goodale family in Long Beach, Calif. Last year, Darryl Goodale had a sore throat that went from bad to worse. The diagnosis: throat cancer. The treatment: daily radiation, weekly chemotherapy and a host of drugs to deal with the side effects.


His wife, Ann, initially did not fret about medical costs. ``My main concern was his welfare,'' she said.


But the bills trickled in.


From the oncologists: $37,000. So far, the insurance company has picked up $13,000, she said.


For a biopsy: $7,000. The Goodales paid about $4,000 of that out of pocket.


Then came the whopper: $72,000 from Long Beach Memorial Medical Center for five days of intense inpatient radiation sessions. Insurance paid $16,500 and negotiated a $14,000 discount, she said. That left the Goodales with a $41,500 tab.


That's when Ann Goodale turned to Joyce Zilai, owner and operator of Medical Claims Recovery in Portland, Ore. Zilai spotted what she describes as nearly $12,000 in billing errors.


Among them: Darryl Goodale received six heavy-duty radiation treatments at $4,000 a pop, but he was charged for seven, Zilai said. The itemized bill lists two ``initial'' visits, each more than $100. And certain costs that should have been included in the price of the operating room -- such as the $48 drape that covered his body -- were charged separately as well. ``It's called the nickel-and-dime concept,'' Zilai said.