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In the United States, there are many opinions about the current state of our health care system. Currently, 79 million Americans have some sort of problem with their medical bills.
The American healthcare system is a endless cycle that goes between the physicians, hospitals, insurance companies, pharmaceuticals and stockholders. Almost always, the patient is the one left out of the conversation.
The United States spends about nine thousand dollars on healthcare for each citizen, yet the U.S. is only ranked 12th in life expectancy.
The simple fact is for many years medical debt among working and non working citizens has been growing at a alarming rate. Medical debt is rapidly becoming the number one reason American citizens are filing for bankruptcy with a total of seven percent doing so each year.
Currently, one in five Americans are experiencing crippling medical debt. How can you manage to get out of the debt, or even start to negotiate with the correct parties to get some relief? Is it even possible?
Yes, it is possible to negotiate your medical bills if you take the time to educate yourself and put forth the effort.
Read on for advice to help you not only save as a consumer and as a patient, but also stand your ground against the medical billing agencies.
1. Spotting Common Billing Errors
As an average American citizen who did not go to medical school, understanding that basically every single procedure the doctor performs on you has a specific code can be a little confusing. These medical codes allow your provider to bill your insurance company.
Think of the coding as a secret language of sorts. The main concern with coding is the average patient does not understand what any of the codes mean or represent.
Below are some of the most common coding errors that you, as a patient, can keep an eye open for when reviewing your bills.
Upcoding is a medical bill that has been inappropriately charged. Most of the time this looks like a charge or amount that has been written down as a different treatment or prescription drug from the one you had originally received.
A good example of upcoding is when a name-brand medication like Glucophage is used instead of its cheaper generic form Metaformin.
Unbundling occurs when procedures such blood tests are performed together but on the invoice are split and billed separate from each other. Again, this a common error that usually involves numerous tests being ordered, all relating to the same medical diagnosis.
A common example of this is when a woman will go for her annual mammogram. A provider may accidentally bill for two seperate mammograms instead of billing for the one connected screening.
Who doesn’t enjoy getting not one but two bills for the same doctor’s visit? Nineteen percent of Americans would not be able to pay if an unexpected medical bill where given to them right now. Duplicate billing is much more common than you would like to think.
For many who have experienced duplicate billing, the patient will have gone in for a particular procedure and then be billed multiple times for that exact same procedure they already had.
In other cases, some are billed for services that have never been performed and on other occasions a procedure has been canceled but not removed from the patient’s profile.
In very rare cases, fraud is the cause. This is when a person is willingly filing false medical claims. As a patient, you have the right to perform your own chart audits and to check if items are being billed correctly.
Mismatched coding happens when the treatment codes do not match the diagnosis. When mismatched coding occurs the claim is denied by your insurance company and the bill is either sent back to your doctor’s office to adjust and fix or the claim can be sent directly to you.
So now that you are aware of some of the most common billing errors in the medical field and what to watch out for, how do you confront the realization that you may need or want to negotiate the bill?
Tips for Negotiating a Medical Bill
1. Work Out What Your Medical Debt Is
It can be very overwhelming to open bill upon bill and just stare at the numbers growing higher and higher. But before you can start negotiating your medical debt, you have to have a very clear and realistic number of what you currently owe.
You do not want to ignore the medical bills as this will affect your credit score for many years.
Your medical bills are just as important as any other of your monthly bills and need to be worked into your monthly budget. At least while you are negotiating, the minimal amount should be paid.
Also, if you can afford to pay a little bit more than your minimum due each month, this will go towards your balance and not just paying down the interest.
A rudimentary understanding of how your doctors operate with your insurance provider, how your insurance company calculates what they will be charging you and how your insurance company calculates what you will be charged will help you spot errors on your bills much more quickly.
Knowing all of this will help put you in a better stance to negotiate.
Breakdown of Your Bill
You will receive a statement after you have visited with your doctor. If the statement is a bill, it will say invoice, and it will have a non-in-depth breakdown with what you owe after the insurance company pays their share.
If it is not a bill, the statement will make you aware of the charges with a little break down on what your insurance should cover and an estimated amount of what your total will be.
This form is sent from your doctors or hospital that you used to your insurance provider. It will have all procedures in coded format, so it can be processed.
Explanation of Benefits
Two to four weeks after visiting with your doctor this should be mailed out to you. This is not a bill; your explanation of benefits comes directly from your insurance company.
The explanation of benefits will explain to you how much you have been charged for the care you received. More importantly, it will state why you were charged for this care. The explanation of benefits will lay out what your insurance company will pay and what you will be responsible for.
Do Your Research
It helps to understand your insurance benefits and what they cover. If you are in an emergency situation, you do not want to have to think about whether or not your emergency room visit or urgent care choice is covered under your insurance plan.
It is a good idea to become familiar with the coding terms as stated above. Using Google to explain some of the coding definitions can really help make it a bit easier to understand.
Your insurance company should send through reading booklets quarterly. Even though they look a bit boring to read, read them.
These booklets will go in-depth to outline every single item you are covered for under their plan. You do not want to be a patient in a situation who is weighing cost versus care.
Call to Define
If while reviewing, you spot a problem or concern with your bill, do not hesitate to call and inquire about it.
If you are not sure if a particular procedure is covered, or you think you have noticed a billing error, most doctor offices will be happy to help answer those question as they deal with insurance companies day in and day out. They also have a bit more of a background when it comes to those types of questions.
It is recommended to call rather than send a letter or email. By picking up the phone and calling directly, you can then document the time you called, who you spoke with, and also, most companies record their calls.
If you do decide to call, remember what your grandmother always said and treat others the way you would want to be treated. Try to be kind and understand that customer service representative on the other end of the phone has not put your bill together.
Ask for the manager and speak with them every time you call. By being kind, respectful and maybe even a little funny, this could warm them up to connecting you to the right people who can properly handle your situation. You may even end up with a few extra dollars.
Feeling empowered is a great tool when finally knowing the facts that are leading you to the negotiation table. With the above information, you are now ready for battle. So when should you start negotiating?
2. The Art of the Negotiation
It is not widely known that it is possible to start negotiating your medical bills before you even have seen your doctor.
As a patient, you can also start this negotiating process after the appointment, after the insurance company has paid their share and even after the insurance company has sent you the bill.
Ruth Linded, PH.D and president of Tree of Life Health Advocates says “It almost always makes sense to try to negotiate. It doesn’t mean you’ll always be successful but it’s always a good idea to ask.”
3. Make the Best Choice in Providers
Currently, one in five working Americans who has insurance are struggling with paying their bills.
When researching health insurance plans, make sure they include your preferred general practitioner and hospitals as in-network providers.
After choosing your plan, make sure you really try and only see those in- network doctors, as your insurance company is more likely to cover more of the cost for in-network providers.
If you chose not to use an in-network provider, it can end up costing you more money.
An example of how not using an in-network provider could cost you more money is if you have a scheduled surgery with your in-network doctor and in-network hospital, but you used an out of network anesthesiologist.
There are laws that some states are enforcing that will prevent out-of-network providers from charging out-of-network prices. Unfortunately, these laws do not apply to every state, so if you are not careful, you can wind up with an unexpected bill.
Always make sure you call your insurance provider and confirm that your hospital will only be using in-network providers.
4. Negotiate before treatment
The idea behind negotiating before the treatment is that it will give you an idea of what you are willing to pay for a procedure. In simple terms, negotiating beforehand lets you shop around.
When buying a car, you wouldn’t just buy the first car you see on the lot; you would price compare and visit other dealers, so why not do the same with your medical treatments or medicine?
There are plenty of sites that offer savings as well. Healthcarebluebook.com can help you figure out an average cost for a medical service in your area.
Once you do receive a quote, always get it in writing. You will want to obtain their signature, name, title and the procedure you are going to have done.
You will want to do this for every single doctor that will be in the room as well. Make sure when receiving a quote that you cover all costs that will be connected with your procedure.
5. Negotiate after treatment
Even though you have already received care, you can still try and negotiate a better outcome.
Being diligent and reading each bill sent to you from your provider and insurance company and comparing them with your own records is how you will spot if there are any errors, human or otherwise.
You may find that there are no errors, but you can still try to negotiate a reduced bill. If you are in a financial situation that would make paying the bill difficult, there are also options for having a bill forgiven.
6. Payment Plans
Sometimes all the negotiating in the world cannot achieve a discount. When or if this happens, ask about an interest free repayment plan. This sort of payment plan will let you pay your bill in smaller amounts over a longer period of time.
Do not underestimate how money talks. Most doctors end up paying thousands of dollars every year when trying to get patients to pay their bills. The physicians are forced into hiring lawyers or collection agencies to go after unpaid invoices, and these services comes with a fee.
Even though doctors’ offices accept credit cards, it doesn’t mean they like them. Some credit cards come with high processing fees. If you can pay cash up front and within 30 days, you can almost always get a discount, sometimes up to forty percent.
Hospitals often have standard payment programs and can offer up to 40 percent off a bill at times. There are also bank accounts that are just for medical situations with the most common being a health savings account (HSA) or a flexible spending account (FSA).
- Using a health savings account or HSA lets you contribute money which is tax-free and spend it on medical expenses. By sending this tax-free money on qualified medical expenses, you get a discount equal to your tax rate.
- A flexible spending account or FSA is very similar to a health savings account which offers tax-free deposits and tax -free withdrawals. But the FSA is only offered through employers.
7. Some Great Tactics for Negotiating Medical Bills
There are no stupid questions.
If you feel that a certain procedure may not be necessary, do not be afraid to voice these concerns to your doctor. If you are curious as to how much a blood test may cost, ask.
The bottom line is that you, as a patient, have every right to ask whatever question is on your mind.
Time is your friend
The quicker you react to any sort of situation regarding your medical bills, the better. By responding swiftly, you will decrease any chances of your bills being sent to collection agencies. This will make the billing companies more willing to negotiate if you chose to.
Always ask for an itemized bill of services. This will give you a complete break down of all services rendered. When you go to the grocery store, most people will stop and look at their receipt, making sure their coupons were used correctly and all sales where applied.
Do the same with your medical billing.
Finally, when negotiating your medical bills, you will want to get everyone on the same page; this includes your doctors, insurance companies and bill collectors. This step only happens once you are well versed in your explanation of benefits.
As the patient, you will want to tell everyone that you are actively researching payment plans. Even if you are in the middle of negotiations, you still want to contact your billing agency because being proactive will always help you in the long run.
8. Looking Outside the Box for Help
Foundations Who Help
Never underestimate the power in seeking assistance from outside resources such as government foundations or patient advocate foundations.
When working with these particular resource options, it is safe to expect that a hefty amount of your bills will be taken care of. Most of these foundations’ main goal is to get the patient a full write off.
If you qualify for federally sponsored Medicaid, which is there to help low income families, they can have all of your medical bills paid for. The Medicaid policies last for one year so if you may not have qualified previously, the next year you may be able to.
At the very least, try to always remember the negotiated rate. The negotiated rate is a discounted price for medical services that is most always offered to insurance companies.
If for some reason your insurance company does not cover you or you do not have insurance, the hospital should be able to offer you the same negotiated rate insurers would pay.
It is safe to order drugs online if done via the correct websites. Many of these websites are based internationally through foreign pharmacies. These websites legally ship American drugs into the United States at a fraction of what they once cost.
If you are online, you can also research and look for commercial co-pay cards. These cards come directly from the drug manufacturers. These cards can potentially cover some, if not all, of your out of pockets costs.
Just like you would search for discounted prescription drugs, don’t cast out the idea of searching for lower cost treatments.
In a study done by the Center for Health System Change and the University of Chicago, only 51% of doctors told their patients about lower cost diagnostic testing, and that it was available to the patient as an option.
More shockingly, just 40% of these doctors recommended outpatient treatment instead of hospitalization.
The lesson to be taken from this is always do as much research as possible and always ask your doctor if there are other options available to you.
When it comes to negotiating your medical bills, you are not alone. It may seem stressful and overwhelming, but there is a light at the end of the medical tunnel.
With the newly found power to negotiate, you will hopefully come out with a better payment plan, or if you’re lucky enough, maybe even your entire medical bill being written off. Good luck and happy negotiating!