Medical Bills - Tips and Advice

In this episode, I discuss how to handle your medical bills, how to dispute charges, and how to get a discount on your bill. ******* I've edited this post to provide a written transcript below as I think my written words do better with readers than an audio post/podcast type format: If you get a medical bill that you don’t have the money to pay, here are a few ways to handle it. First, I’ll talk about the accuracy of your bill, because that may not always be right. First, be sure to review the statement from the provider as well as the explanation of benefits from your insurance company (and if you don’t have insurance, keep listening). Make sure there are no charges unrelated to your service or that are incorrect. For example, I recently had an annual scope done – what you would call a sigmoidoscopy but since I don’t have a colon anymore we just call it a scope, to check my inflammation and to biopsy for cancer. This is something everyone should have done by the age of 50, or younger if you have family or personal history of colon cancer or other GI problems. Mine is because I have ulcerative colitis. MOST people get anesthesia for this procedure, but I don’t. It’s only a five to ten minute exam and while it can be very uncomfortable, it isn’t terribly painful, and whatever discomfort I have is over as soon as they start withdrawing the scope. Whereas if I get anesthesia I am wasted for the whole day, and have to find someone to drive me there and take me home. I also like to be alert for the scope to discuss the findings with the doctor as they go along. But anesthesia was scheduled to assist on my procedure since that’s what most people, and I had to them they weren’t needed, which they were fine about, and they left before we started. But the hospital billed me for anesthesia. I called and contested the charge and said they could confirm with the doctor that there was no anesthesia administered and that anesthesia didn’t do anything for my procedure, and they removed the charge. Never be afraid to dispute a charge that seems wrong. I once had to get a battery of STD tests because a former partner of mine slept with a stranger he met in a bar and then with me a few days later. Everything was covered but for some reason I was charged over $200 from the lab for the gonorrhea test. It should have been covered like the other charges. I called the lab and they said they would re-submit it to insurance. Now, once you contact them, they should note your account that charges are in dispute. This can be helpful in avoiding incurring collection fees – more on that in a bit. They rebilled my insurance and it was denied again and the lab said to contact insurance. The customer service person at my insurance didn’t know why it was denied, just that it wasn’t covered, and I said it didn’t make any sense because it’s a test like all the others and should have been covered. They asked if I wanted to dispute the charge and I said yes. I got notification a couple of weeks later that it was denied, again – this was the 2nd time. I called back and asked to talk to a supervisor to understand why the charge was getting denied, and they were able to research the coding and tell me that the test is only covered IF YOU TEST POSITIVE. This, of course, is ridiculous, because you can have all kinds of STDs and not have any symptoms, especially soon after exposure. And even if you did have symptoms, how would you know it’s gonorrhea vs. some other STD UNLESS YOU GET A TEST. I asked for an appeal, which means higher ups in insurance get together and look at the charge, and guess what – it was denied again. All this time, I kept updating the lab as to what was going on with the dispute. They continued to bill me but noted in their account that the charges were in dispute so that delays it going to collections. My final attempt to dispute the charge was to request an OUTSIDE appeal from my insurance company. This meant doctors outside of the insurance system would review my claim and decide whether or not they thought it should be covered. I asked to include a note in the appeal that I wrote, explaining that there might be no other way to diagnose gonorrhea than without getting a test, so like all the other STIs, the test itself should be covered, regardless of the result. It’s not logical or good medicine to only cover a test if it’s positive. Can you imagine getting a CAT scan on your brain to see if you have a tumor but if it turns out you only have clogged sinuses and not a tumor, they’re not going to cover it? I won my outside appeal. The bill was paid and the past due charges were lifted. This process took more than 6 months. You have to be willing to go as far as you need to in order to get charges removed that are wrong or unfair. Another time, I was charged an enormous amount for my annual scope, way more than usual. I called the facility’s billing office and they said the charge wasn’t covered by my insurance. I knew it should be covered and something was wrong. After several calls and finally talking twice to a supervisor, I was able to learn from the insurance company that the facility itself had not properly completed their annual paperwork to re-up with this provider. It was as simple as a missed check box on their renewal form. I went back to the billing department at the facility and talked to a supervisor there. My research uncovered that everyone for the first two months of the year who had my insurance and had gotten a procedure done at that facility had been incorrectly billed because of their error, and they were going to have to go back and re-bill all those charges and refund patients, all because they didn’t check a box. But sometimes, the charges are the charges and there’s nothing you can do about it. You get a whopper of a bill - $500, 700 dollars, whatever, and think, there is no way I can pay this all at once. Well, you don’t have to. You don’t have to pay your doctor’s office all at once either, nor charges for visiting an urgent care – always ask them to bill you when they ask for a co-pay. Unless you have an outstanding balance, they almost always agree to bill you instead of making you pay at the desk. By getting a bill, you can then pay it off in small chunks over time – usually with no interest at all. Figure out what you can afford to send them that will divide the bill up so it’s paid off in 6 or 8 months, and send that amount. As long as you are paying on the account and it doesn’t take more than a few months, they probably won’t turn you over to collections. Keep sending them money, ignore the late notices, and keep paying until it’s paid off. If it takes a super long time, they will send your bill to a collection agency, and then it’s important to get it paid as quickly as possible at that point so it doesn’t ruin your credit or so they don’t take it out of your wages. You can always call and try to negotiate with the collection agency to pay a lump sum that’s less than the total owed and see if they will accept it. They want the bill to be done as much as you do – collection agencies assume that debt and pay off the facility, so they want their money and they want as much as possible, but also as quickly as possible since they borrow on credit to pay off accounts. Some places will work with you to set up a monthly payment plan. If they ask how much you can afford, say the lowest amount possible, like $5 or $10. They’ll reply with well, we can’t take $10 a month, the lowest we can do is $17.50 a month, can you do that? And you say yes and then send them the money each month. They won’t turn you over to collections when you’re in an approved repayment plan, as long as you keep paying. IF YOU ARE A BROKE ASS MOTHERFUCKER and cannot pay on your bill at all, and your bill is from a hospital, apply for the hospital’s financial assistance plan. This is often hidden, and is administered by a different department than billing so you’ll have to google around to find information about it to be sure you’re contacting the right department. It is always worth applying for this plan even if you have a job because each hospital maintains different guidelines as to who is approved for a discounted bill and how much they will discount it. At my local county hospital for example, you can make up to 200% over the federal poverty limit and they will still discount your bill by 25% if you are in the financial assistance plan. And if you are low-income, these plans can wipe out your entire medical bill and cover you for 3-6 months at the same facility in case you incur any additional charges. You have to reapply for assistance each time the plan expires, but the paperwork is worth it because of the discounts you can get. Finally, some for-profit hospitals have what’s called a charitable fund or angel fund which is only available if you know to ask for it, and can help pay your bill if you don’t qualify for financial assistance. Always explore all your options in getting a medical bill paid because these insurance companies are making massive profit off of consumers and they don’t have to make it off of you.