Ever opened a medical bill and felt like you were trying to decipher ancient Egyptian cave drawings? You’re not alone. Medical bills are intentionally confusing and hardly anyone really knows what they mean.
In this article, I’ll give you 5 tips that can help you save money on your medications, including:
- The importance of getting an itemized statement
- How to negotiate lower prices
- How to dispute charges
- How to fight back against surprise bills
- How to submit your medical bills to the media
Profits Over Patients
When I worked in a major medical center in New York City, I took care of a young woman who had been in the hospital for months. She was suffering from an unexpected illness that almost took her life. To make matters worse, she had an infant son at home that she couldn’t see.
How’s that for stressful?
I thought she had gone through quite enough having almost died and all. Not to mention being separated from her new baby for so long.
Apparently, the hospital didn’t think so.
The billing department started calling her hospital room to harass her about medical bills. They even threatened to send her bills to collections. In the midst of this woman’s crisis and grief, all the hospital could focus on was getting their money.
Of course, she had not taken any time to go through her bills to try to decipher them-or pay them- because SHE WAS REALLY, REALLY SICK and STILL IN THE HOSPITAL! Even if she did get a break from trying to stay alive, the bills would have been so confusing, so inflated and so ridiculous that she wouldn’t have understood them anyway.
Which begs the question…
Why Are Medical Bills So Confusing?
The sad truth is that many healthcare institutions don’t want you to understand your medical bills. They’re hoping you won’t catch the errors that occur in 90% of bills. They’re crossing their fingers that you won’t dispute the $12,000 obscure charge for “ER Services.” They’re praying you won’t figure out that someone ‘upcoded’ your bill to make more money.
To make matters worse, the information your insurance company gives you to explain what portion of your bill they paid (this is called the explanation of benefits) is equally, if not more, perplexing than medical bills.
Most people throw their hands up and pay their bills (if they can afford to) just to avoid getting sent to collections. Others are not so lucky and end up facing financial ruin from their medical debt. Some hospitals are even suing patients that can’t afford to pay their medical bills.
Prices slapped on medical services are completely unregulated by the U.S. government which leaves hospitals, and other providers, free to price gouge ’til their pockets’ content. And boy do they stick it to us. This ‘wild west’ way of operating means that one facility may charge $5,000 for an MRI while another one bills for the same test at $200.
And if you’re uninsured, the prices you are demanded to pay will far exceed those paid by insurance companies.
Here are a few tips to get you started.
1. Always Request an Itemized Medical Bill
When you receive a medical bill, chances are it won’t be itemized. Most billing departments send out ‘summary statements’ that have no explanations of the charges. The reason for this? They don’t want you to see their truly ridiculous, overinflated prices ($60 for a band-aid or $90 for a Tylenol) lest you start to question their price gouging.
If your bill isn’t itemized, call the billing department (usually listed on the bill) and ask for one. Tell them your new statement should also include diagnosis (ICD 10) and service codes (CPT or HCPCS).
Be prepared for a tremendous amount of push back, defensiveness and all-around ridiculousness.
Here are just a few of the lies I’ve been told when requesting detailed statements:
- We aren’t allowed to send itemized statements. (Yes, they are. It’s your legal right).
- Only your insurance company can see the diagnostic and service codes. (Nope. Wrong again. You certainly can see codes).
- If you want an itemized bill, you have to pick it up in person. (Umm, negative. Pretend like you’re living in the 1990s and tell them to mail it to you).
I’ll say this again. You will likely have to put up a big fight to get a copy of your itemized bill. And it will be infuriating. Don’t give up.
2. You Can Usually Negotiate Lower Prices
First, let me preface this section by saying that even if you do get a discount on your medical bills, you are likely still grossly overpaying for the services and products on your bill. Remember, prices are usually marked up beyond reason and there’s no government regulation on charges for medical services.
That being said, many hospitals and providers are willing to negotiate when it comes to your medical bills. I mean, why wouldn’t they? They’re still getting paid more than what’s fair for most services-even if they “discount” your bill.
Here are a few suggestions when you call to work out a “deal”:
- First, arm yourself with knowledge. You can look up typical prices for healthcare services at Healthcare Bluebook or Fair Health. Use the prices on these websites when negotiating.
- If there are charges on your bill that seem especially outrageous, ask for them to be reduced to the amount listed on Healthcare Bluebook or Fair Health.
- Ask for a ‘prompt-payment’ discount if you pay your bill within a certain amount of time.
- Ask if you can set up a no-interest payment plan.
- Find out what your options are for financial assistance. Federal law requires nonprofit hospitals to provide financial aid to qualified patients. Keep in mind that some hospitals’ definition of assistance is to simply to knock a small percentage off your bill.
- If you don’t have insurance or received a service that wasn’t covered by your health plan, ask if you can pay the insurance or Medicare rate. These rates are almost always lower than what the hospital charges private-pay patients. Again, you can find these rates on Healthcare Bluebook or Fair Health.
3. Dispute Any Charges That Seem Suspicious or Outrageous
Yes, I know. Most charges are outrageous. But some more so than others. As mentioned in tip #2, research to find out the rates insurance companies typically pay for medical services in your area.
It’s your right to dispute any charges on your bill that don’t seem right or are obviously wrong. Do this in writing as soon as possible.
Your bill cannot be sent to collections while it’s being disputed. Remind the billing department of this.
4. Fight Surprise Bills
Even if you go to a hospital that is in-network with your insurance, there will probably be providers involved in your care who are out-of-network. When this happens, you may get a hefty ‘surprise bill’ for any services provided by out-of-network clinicians.
Some states have enacted laws to protect patients from surprise billing. The National Academy for State Health Policy put together this excellent chart highlighting the specifics for each state involved.
If you do end up in the hospital, be aware of the language on your admission forms. You’ll be asked to sign a ‘financial responsibility’ contract stating you will pay any charges your insurance doesn’t cover. CROSS THIS SENTENCE OR SECTION OUT and write in: “I do not consent to out-of-network providers being involved in my care. I will not accept financial responsibility if out-of-network providers render care or consultation without my consent.”
If you do get a surprise bill, don’t hesitate to dispute it with the hospital, provider and your insurance company.
5. Expose the Corruption
Fortunately, the corruption in our healthcare industry is finally being exposed. Medical professionals, like Dr. Marty Makary, and Dr. Eric Bricker, are working diligently to demand transparency, accountability, equality, and fairness when it comes to healthcare.
The media has also been instrumental lately in bringing to light what really goes on in the underbelly of the healthcare industry.
News organizations such as NPR, Kaiser Health News, and Vox have been gathering real bills from real patients, analyzing them and then reporting on the outright corruption in our healthcare system. They have even helped some patients get their debt reduced or erased.
Have a bill you think is outrageous or fraudulent? Send it in and see what happens!
You can also help expose corruption and demand change by doing these things:
- Contact your local, state and federal lawmakers. Let them know you are fed up and demand action.
- Get on social media. Share articles, generate conversations, engage in meaningful discussions and call out the bad eggs!
- Contact the media if you believe you’ve been victimized by the healthcare industry.
- Start a petition to bring awareness to issues you feel strongly about. Change.org is a great platform to do this.
Don’t think that you can’t make a difference. You can.
We all need to be the change we want to see!
- Never pay a bill until you see an itemized list of the charges.
- Look up the prices insurance companies pay for medical services in your area using Healthcare Bluebook or Fair Health.
- Dispute any bills you believe are incorrect or outrageously overpriced.
- Most bills can be negotiated. Call the billing department to see what you can work out.
- Always dispute surprise bills. Check if your state has protections against surprise bills.
- Make your voice heard. It’s the only way we’ll ever see change.
I hope these facts about medical bills help you become a savvier patient.
Have a question for me? Or just want to share your experiences with the healthcare system? Email me at firstname.lastname@example.org
I’d love to hear from you!