Another Law School For You – Challenge Your Medical Bills

We have all heard the horror stories of ridiculously high medical bills.

In 2015, Elizabeth Moreno had a surgical procedure. Her doctor later wanted a urine sample. Sunset Labs of Houston analyzed the urine and provided results. Their bill was $17,850. Included were fees for checking opioids ($4,675), for anxiety ($2,975) and for illegal drugs ($1,275), none of which were ordered. Moreno’s health insurer would have paid $100.92.

Moreno’s father paid $5,000 to settle his daughter’s medical bill.

John Fugazzie got a bill of $171,569.44 from a hospital after his six-day stay there, following a heart attack.

If one wants to get sick to the stomach (pardon the pun), one need only go to the Internet and search “high medical bills stories.”

Medical bills comprise about fifteen percent (15%) of the average American’s yearly expense. Often, these bills are high, and even when they are not, there are ways to have them reduced and to pay less.

The number one method to have medical bills reduced, is simply, almost unbelievably, to ask for that reduction.

Before getting to other useful information to reduce medical bills, it is important to understand some variables that will impact both the initial amount of the bill and your ability to get that bill reduced.

First, your financial situation and whether or not you have health insurance is an important variable. Next, where you live and where you are getting medical care are both very important. Finally, your ability and willingness to research can be a huge factor in getting medical bills cut.

First, always, you must ask

We have no problems negotiating the price of a car or of a home.

Similar to the expression of various lottery games across the countries that advertise “if you don’t play you can’t win,” here, if you don’t ask you will never get a discount.

Understanding that medical bills ARE NOT based on actual costs, and that profits are a huge part of the total bill is an important understanding for this process. It allows you to skip feeling bad for the doctor or hospital. Medical bills charges, for exactly the same services vary, often significantly, from location to location, from city to city, and from state to state. You must know this before you begin your journey to getting your medical bills reduced.

Many doctors and hospitals can and will negotiate, if you ask. Sometimes they will reduce fees, particularly if you pay the entire reduced amount up front. Doctors and hospital billing office personnel are used to negotiating.

Before getting medical care you should ask about the charges, and you should begin the “reduction” conversation. Otherwise, if you get medical bills and believe they are excessive, or, simply, you cannot afford them, you should ask about paying less.

The “doctor is g-d” mentality sometimes makes people reluctant to ask a doctor for a reduction. Trust that no doctor is going to provide less care because a patient asked to pay less. We scrutinize many bills we get – the utility bill is one commonly reviewed for errors and is frequently challenged. Scrutiny should also be the case for medical bills.

Tell your doctor: “I trust you as my doctor, but I have financial concerns.”

Who You Are

When asking for reductions of medical bills, share your financial circumstances. It will make a difference.

Tell the doctor or hospital billing office you do not have health insurance if that is the case. If you do have insurance, but you have not yet met your deductible, or you are over the plan’s maximum coverage, share that. Tell the doctor or billing personnel these things. Express you will have a very difficult, or impossible time paying the higher bill.

Find out in advance what insurance would pay. Doctors often automatically charge people who do not have insurance more that what their insured patients pay, because the insurers negotiate lower rates for people they cover.

Find out in advance what Medicare of Medicaid would pay. These scheduled rates are always lower than the bill being charged.

Ask to pay the insurance or government-schedule rate.

Ask about payment-assistance programs. Even if your income is above a certain level, do not assume you will not qualify for financial aid for medical bills. Many programs – public, private and non-profit – help pay medical bills for consumers regardless of income, particularly those facing higher medical bills in a given year.

Ask if you qualify for discounts. Some providers offer discounts if you pay over the phone. Ask about Charity programs.
Where You Live and Where You Get Care

You must investigate. Medical bills can vary widely by location, zip code, county or city. They can vary from non-profit to for-profit facilities.

You should investigate what the “fair market” price is for a procedure using location and type of facility variables.

For-profit hospitals are not required to offer assistance programs, but many do.

Your Willingness to Research

Before a medical visit, check pricing for “fair market” as discussed above. After the visit, review the bill thoroughly. Know what is covered by insurance, and know what is not. Check for mistakes on medical bills as they are common.

Balance-billing is the concept in medical billing that requires you to pay the difference, or the balance, after your insurance pays some part of the bill. It is not uncommon with automated billing that you are charged the balance, when in fact you should not be charged at all. Many insurers require the doctor or hospital to write-off any balance.

Duplicate billing happens more often (it should never happen) than we might think. Check your bill to see if you were double-charged for the same procedure.

Mismatched coding is a situation where the treatment code (every medical procedure has a “code” that is universal, meaning the code numbers translate to a specific procedure… example… a first extended visit with a doctor will have a different code than a “check-up” after that first visit) does not match what occurred or the diagnosis. Without proper codes, insurers will deny claims, leaving the patient responsible for the full bill.

Unbundling is an inappropriate process where a medical provider “unbundles” services that should have been grouped and billed together. This happens often when multiple medical tests are ordered but relate to a single medical diagnosis.
If unbundled, the patient ends up paying significantly more.

Upcoding is fraudulent medical billing that occurs when a provider bills a health insurer using a code for a more expensive service than was performed. Another example is billing for name-brand medication when generics were provided.

By learning fair-market costs, insurance contract requirements and coding, thousands of dollars, even tens of thousands of dollars, can be saved.

A story on the Internet:
Recently, I had to be taken to the emergency room twice. Unfortunately I have terrible insurance so my total bill was a whopping $10,400. Of course I did not have this kind of money laying around for such an expense. I called the billing department to explain that my insurance was not covering any of those bills. They immediately changed over my status to “self pay” which cut the bill by around 55%.

Wondering if I could reduce the bill even further through discounts, I asked if there was a discount to pay the bill in full versus a payment plan (it never hurts to ask). To my surprise, they reduced the bill by another 25% totaling $2,400. The two individuals I dealt with were extremely friendly, helpful and easy to deal with. It was simply about asking the right questions. With a simple phone call, I was able to reduce my original bill by almost 77% and it only took 5 minutes.

May you always be healthy. If not, and you have issues with medical bills you do not want to take on yourself, investigate “medical billing advocates.” There are many good organizations that can help negotiate your bills for you and get them reduced.