Medical bills are soaring and increasingly difficult to decipher. Whether you don’t have the money to pay the bill or just find it outrageous, there are some steps you can take to negotiate your medical bills. But first, you need to understand what’s on your bill.
Review Your Bill
You will usually receive your bill in the mail (likely weeks or sometimes months after the service). The natural reaction is to pay the bill, but before you pull out your credit card and charge the outstanding balance, look at the charges. Healthcare providers and hospitals can make mistakes. It’s up to you to ensure the charges on your bill are for services you received. If they aren’t you will need to negotiate your medical bills.
Potential errors may include the following:
- Wrong hospital codes. If there are codes on your bill for services you didn’t receive, your insurance won’t necessarily pay the claim.
- Duplicate billing. Sometimes you may receive a bill twice for the same service.
- Separate service billing. Sometimes the bill covers different treatments for one diagnosis instead of bundled under an umbrella category. The charge is typically more.
Do the Research
Do some research to determine whether the chargers are a fair amount for your services. If you have insurance, call your insurance provider to understand how they arrived at your payment portion. Make certain the amount gels with your chosen plan and that your deductible amount is applied correctly.
If you’re uninsured, you can consult with the Healthcare Bluebook, which calculates the fair market value of medical services. Compare this amount to what the hospital or medical office charged you.
Federal Protections for Surprise Medical Bills
If, in the course of your research, you discover something on your bill that you didn’t expect, it may qualify as a surprise bill related to services your health plan didn’t cover or out-of-network charges. In December 2020, Congress passed The No Surprises Act, which went into effect on January 1, 2022. Under this act, patients who receive care unintentionally or inadvertently from out-of-network providers are offered certain federal protections. The areas typically covered under the act involve emergency services, post-emergency stabilization services, and non-emergency services at in-network facilities.
Providers are required to work with the health insurance company to come to a solution regarding these charges. The provider is prohibited from sending a balance bill to the patient for charges that a health insurance company refuses to cover. The process for resolving the charges often happens between the provider, health insurance company, and sometimes, an independent arbitrator.
Here are three options you can pursue if you suspect a surprise medical charge:
- Contact your health insurance company. Confirm with your health insurance company if it is a surprise medical charge. The health insurance company can determine if the charge was processed incorrectly and arrange to cancel the balance bill with the provider.
- Contact the federal government. The federal government has a No Surprises help desk to address issues regarding a surprise medical charge. The phone number is 1-800-985-3059.
- Submit an online complaint. You can file an online complaint with the federal government via the following portal. Once the complaint is received, you may be asked to provide further documentation, and the agency will let you know of the next steps.
Pick Up the Phone
Once you’ve studied the bill and identified any discrepancies or charges you don’t understand, it’s a good idea to call or talk to a hospital billing representative. Ask specific questions about the bill, insurance reimbursements, and any discrepancies you might have noticed. If the representative is unable to help, ask for a supervisor. Remember that those on the phone may not have the authority to negotiate the bill. Often, you will have to talk to several people before you get your questions answered. Be patient with the process and always be polite. Take detailed notes about the explanations they are offering. Also, document the names of people you spoke with and the time and date.
Once you establish you’re talking with someone with authority to negotiate your bill, it’s a good opportunity to ask the following questions:
- Do you have any discounts for financial hardships?
- If I pay in cash, can you reduce the payment amount?
- Are there any junk fees they can take off?
- Can I work out a payment plan?
- Are there any charities that can help me with my payment?
Ask About All Options
If you told the administrator or office manager that you could not pay the bill in full by the deadline, ask if there is a way to make the payment that will work for your financial situation and satisfy the billing department. Here are some potential approaches:
- Timeliness Discounts. If you suggest that you could pay faster by eliminating fees, would the administrator be willing to consider this option?
- Payment Plans. Ask for a payment plan and make a request no interest. Many hospitals will offer this option since the bill is more likely to be paid.
- Medicare-approved amount. Is there a chance you can pay the Medicare-approved amount? Those charges are typically lower than what is billed to the patient.
Seek Outside Help
If the administrator refuses to negotiate, you may need outside help to resolve your billing issue to move the conversation forward. Professional medical bill negotiators like Goodbill can negotiate on your behalf. Goodbill will charge you only if they are successful in reducing your bill. This charge is usually 15% of the amount the save you on the bill.
The Healthwell Foundation helps low-income individuals with bills of up to $5,000. Eligibility for this organization requires that you are low-income, have limited insurance, and have an unexpected health emergency. For those without insurance, the Patient Access Network (PAN) can help. Bills must be between $200 and $3,000. In addition to having no insurance, you must be low-income and have faced an unexpected medical emergency.
Don’t Ignore Your Medical Bills
The last thing you want to do is to ignore your medical bills. These bills won’t disappear, and over time will only get larger and become more of an issue for you. If you cannot pay the bills, call the appropriate people to determine what can prevent delinquency. The process may take several months to resolve, but having a conversation with the administrators will at least prevent the bill from going to collections. If you don’t address the charges, the medical bill will be sent to collection agencies, and eventually, the delinquency will live on your credit report and impact your score.
Our medical system is difficult to navigate, and to a consumer can feel overwhelming. However, taking the time to look deeper into your bills and talk to the right people, can help you avoid paying for billing errors, make payment plans, and even perhaps get your bill lowered.
This article is intended for general informational and educational purposes only, and should not be construed as financial or tax advice. For more information about whether a reverse mortgage may be right for you, you should consult an independent financial advisor. For tax advice, please consult a tax professional.