8 Things You Should Know About Challenging A Medical Bill

8 Things You Should Know About Challenging A Medical Bill
August 15 01:00 2014

8 Things You Should Know About Challenging A Medical Bill

Imagine you’ve been denied employment because of something in your medical history. You and your doctor can’t figure it out, until you do a little digging into your paperwork. Turns out, someone in your doctor’s office transposed some digits on a billing code and accidentally billed you for leprosy.

Then there was the physician who wasn’t happy with the reimbursement he was receiving from Medicare, so he was billing for three visits per week even though he was only seeing the patient every Monday.

Another patient drove to the nearest hospital after being stung by a scorpion. There, she received two injections. Her bill: $58,000.

“It is absurd, and there are all kinds of crazy stories like that,” says Sharon Hollander, author of Medical Billing Horror Stories. “Sometimes a patient is charged $45 for one aspirin.”

Billing errors or overcharges that leave patients in the lurch could become a bigger problem in the future, as high-deductible plans make consumers responsible for more of their up-front medical costs. As healthcare costs increase, more than half of companies are introducing or expanding their high-deductible plan offerings, and nearly a third plan to offer only high-deductible health insurance options to employees in 2015, according to a recent survey from the National Business Group on Health.

“Before, patients weren’t paying too much attention because they knew they had insurance,” Hollander says. Now, with high-deductible health plans, patients are often responsible for thousands of dollars in medical costs before insurance kicks in. The average HDHP deductible in 2013 was more than $2,000, according to the Kaiser Family Foundation, and the average individual on an Obamacare bronze plan was responsible for a deductible of $5,081, according to a study by HealthPocket. So it’s worth your while to pay attention.

“All medical bills are negotiable,” Hollander says. At the very least, you may be able to work out a payment plan or land a lower fee if you can pay on the spot.

If you’re thinking of disputing a medical charge, here are some pointers:

Keep good notes. From the very first phone call, write down the date, time and the name of the person to whom you speak. “Often, with insurance companies especially, you can’t ever get back to the same person,” says Victoria Caras, founder of Aspen Medical Billing Advocates. “So you have to be able to say, ‘On August 12 I spoke to Debbie, who said XYZ.’”

Request the right bill. If you’re questioning hospital charges, you will want to ask for a bill that details every single charge individually. That may be called a line-item or detailed bill. “That would show every single thing you ever received, from every bottle of IV fluid to every procedure, large and small,” Caras says.

Start with a phone call. If you’re questioning a bill from a physician’s office, you may be able to ask the doctor herself about the charge, or you may have to start with someone in charge of billing who can work on it for you. Whatever you do, keep calling until you get the right person on the line. “Be both patient and persistent, because you’re going to have to go through several levels of challenging it,” Caras says. “The person who first picks up the phone doesn’t have the authority to adjust that bill.”

Follow up in writing. After your initial call, put your request in writing and mail it. Then fax it as well. “I think it garners more attention if you do it both ways,” Caras says.

Do your research. You can’t refuse to pay a charge just because it feels excessive to you. “When you make a challenge like that, you need some basis on which you think the amount is outrageous,” Caras says. In other words, you need some idea of what that procedure might cost elsewhere, or in general. Start with a site such as HealthcareBluebook.com, which can help you estimate prices for a procedure in your area. Alternatively, some insurers offer a way to price healthcare services, such as UnitedHealthcare’s myHealthcare Cost Estimator. If you know someone who’s had the same thing done and you know how much they were charged, that’s also a valid comparison.

Don’t worry about your doctor. Many people are afraid to question a charge because they feel they won’t get good treatment from the doctor or hospital afterward. “But in fact, most of the time a doctor doesn’t even know what the cost of their services are—they have outside billing agencies,” Caras says. “You shouldn’t be concerned that your doctor is going to compromise your quality of care if you challenge a bill. I have never seen that happen.”

…or your creditworthiness. The good news is that if you have medical debt on the books, it will no longer crater your credit. In a new FICO scoring system, medical collections debt will have less impact on your credit score—a welcome change for consumers struggling to pay bills from a serious illness or who aren’t even aware that they have a medical bill in collections.

Get help if you need it. If you’re really overwhelmed or facing an enormous amount of medical debt, consider talking to a medical billing advocate, who can help you locate errors in your bills and haggle with healthcare providers on your behalf. Billing advocates sometimes charge an hourly fee of $50 to $200 or take a percentage of whatever they save you, up to 35 percent. Look for someone who will offer an initial consult free of charge, and who has a proven track record and tough negotiation skills. “I had a patient the other day whose bill was $160,000 with no insurance,” Caras says. “He ended up getting a 50 percent discount on that bill. That’s a negotiated result that a patient, in all honesty, probably cannot get for themselves.”

Read full story at Forbes
write a comment


No Comments Yet!

You can be the one to start a conversation.

Add a Comment