WASHINGTON, March 4, 2018: We have all heard the horror stories of ridiculously high medical bills. Despite insurance, the stories of hospital and doctor charging patients excessivelu are many. 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. The bill has fees for checking opioids ($4,675), for anxiety ($2,975) and for illegal drugs ($1,275), none of which were part of the doctor’s orders.
Moreno’s health insurance portion is $100.92. Moreno’s father paid $5,000 to settle his daughter’s medical bills.
John Fugazzie got bills totaling $171,569.44 from a hospital following a heart attack and six-day stay hospital stay. It is easy to see that 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.”
The growing problem of high and higher medical bills
Medical bills comprise about fifteen percent (15%) of the average American’s yearly expenses. Often, these bills are high. Even when they are not, there are ways to reduce those medical bills and to pay less.
The number one method for getting reductions of your medical bills is simply, almost unbelievably, to ask for that reduction.
Before getting to other useful information about reducing 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 do a little research can be a huge factor in reducing your medical bills.
First, and always, you must ask why your medical bill is so high
We have no problems negotiating the price of a car or of a home. Why would dealing with an inexplicably high medical bill be any different? Similar to the typical lottery game advertisement proclaiming “if you don’t play you can’t win,” when it comes to your medical bills if you don’t ask you will never get a discount.
Understanding that medical bills ARE NOT based on actual costs, and that profits for hospitals and insurance companies are a huge component of the total bill provides an important basis for initiating negotiations. This key understanding allows you to skip feeling bad for the doctor or hospital as you attempt to negotiate your bill.
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 toward getting reductions in your medical bills from a hospital or doctor’s office.
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 often negotiate and they are willing to do so.
Check out estimated medical bill charges in advance of treatment
Before getting medical care, you should ask about the charges in advance, and begin the “reduction” conversation at the very start. Otherwise, when you get a bill you believe excessive, or worse, simply cannot afford to pay, 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 has asked to pay less. We scrutinize many bills we get. The utility bill is one that is 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.”
Tell insurers and providers about your financial circumstances
When asking for reductions in your 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 if you are over the plan’s maximum coverage, share that. Tell these things to the doctor or billing personnel. Make it clear 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 than what a patient with insurance pay. This is because the insurers negotiate lower rates for people they cover.
Find out in advance the schedule of what Medicare of Medicaid would pay. These rates are always lower than the bill you receive.
What if you are uninsured or underinsured?
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 individuals 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 can make a difference
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. Note that there is no requirement for-profit hospitals to offer assistance programs, but many do.
Your willingness to research your situation is important
Before a medical visit, check pricing for “fair market” as discussed above. After the visit, review the bill thoroughly. Know what your insurance covers, and know what is not. Check for mistakes on medical bills as they are common.
“Balance-billing” is a medical billing practice that requires you to pay the difference (or the balance) of your bill after your insurance pays some part of it. In today’s automated billing regime, it is not uncommon 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.
Although it should never happen, duplicate billing happens more often than we might think. Check your bill to see if you were double-charged for the same procedure.
Coding and unbundling issues
Every medical procedure has a “code” that is universal. Mismatched coding is a situation where the treatment code entered for the procedure does not match what occurred or the diagnosis. Without proper codes from the healthcare provider, insurers will deny claims, leaving the patient responsible for the full bill.
“Upcoding” is fraudulent medical billing that occurs when a provider bills a health insurer entering a code for a more expensive service than what was performed. An example is billing for name-brand medications when generics were provided.
“Unbundling” is an inappropriate process where a medical provider “unbundles” services that should have been grouped and billed together, billing them separately instead. This happens often when multiple medical tests are ordered that relate to a single medical diagnosis. If these procedures are sent to the insurer unbundled, the patient ends up paying significantly more.
Knowledge is power
By learning fair-market costs, insurance contract requirements and coding, healthcare consumers can save thousands of dollars, and even tens of thousands of dollars.
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 if you have issues with medical bills you do not want to take on yourself, investigate working with medical billing advocates. There are many good organizations that can help negotiate your bills for you.
About the author:
Paul A. Samakow is an attorney licensed in Maryland and Virginia, and has been practicing since 1980. He represents injury victims and routinely battles insurance companies and big businesses that will not accept full responsibility for the harms and losses they cause. He can be reached at any time by calling 703-761-4343, via email, or through his website.
His book “The 8 Critical Things Your Auto Accident Attorney Won’t Tell You” can be instantly downloaded, for free, on his website: http://www.samakowlaw.com/book.
Samakow has now also started a small business consulting firm. The website for this business is brand new and Mr. Samakow will be most appreciative of any and all comments. www.thebusinessanswer.com.