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Demystifying Healthcare Costs – Part 2 of 3: Double Check and Negotiate Your Medical Bills

Navigating America’s healthcare system can sometimes be a time consuming and frustrating task. However, putting in the time and effort to review and interpret your bill can save you hundreds, and even thousands of dollars. Recent reports note that nearly 80% of all medical bills contain an error, meaning you are most likely getting mischarged for things that didn’t even happen. Even if there isn’t a billing error, most patients are unaware that medical bills are often negotiable. In the event of emergency medical attention, bills can get out of hand, with only 23% of Americans reporting they can pay off a medical bill greater than $100 without going into debt! But who do you talk to about incorrect charges or negotiating your bill? Your doctor? Your insurance company?

Today’s article is part two of our three-part Demystifying Healthcare Costs series. We’ll examine some of the ways that physicians and hospitals might try to collect more money than you should owe, who to talk to, and how you can fight back against unfair or incorrect charges. If you haven’t had the time, be sure to check out the first part in this three-part Demystifying Healthcare Costs series. In part 1, you’ll learn about how medical organizations actually generate the fees seen on your bill.


Deciphering The Code

Your medical bill can sometimes seem thicker than the Holy Book itself, as healthcare providers have to itemize every single detail of your visit. Routine physicals may be a little more straightforward, but additional items like bloodwork or x-rays and especially surgery can incur dozens and dozens of individual charges. The codes used by your provider are termed ICD, and in its most current 10th revision, there are more than 70,000 individual codes that represent doctor services and diagnoses. 

With so much data to interpret, it’s no wonder that mistakes can happen. While one would think that absolute trust could be placed in our doctors and their billing departments to generate a bill that’s accurate, unfortunately that’s not always the case. Recent reports note that nearly 80% of all medical bills contain an error. Accidentally omitting a charge can sometimes occur, but more likely than not codes are being used that have no place on your statement. In extreme cases, you may even receive a bill for another patient entirely, as medical charts have been known to be mixed up in error.


Understanding Your Bill

One of the best ways to make sure you are being charged accurately for a medical visit is to have the skills to read your statement. After your appointment, it’s common to receive a few items in the mail, including an explanation of benefits from your insurance provider and a bill from your physician. Some organizations fail to send out itemized statements, so if you receive a bill with only a few services listed, call the billing department and request a fully itemized document.

In some cases, you may receive a packet in the mail that’s rather thick and, at first glance, can be overwhelming. Yet when the potential of paying thousands of dollars in incorrect charges is at stake, you’ll be thankful that you invested the time in deciphering your balance due. In some instances, you may want to seek additional help from a friend or family member. In fact some areas in the United States offer professionals who are skilled at reviewing your bill for a nominal fee.

There are a handful of different codes that you might see, some of which are the ICD-10 codes mentioned above. Some include references for services or products while others are practice-specific revenue codes. Take some time to review each one and look up any terminology that doesn’t make sense. If you are being charged for medication that you didn’t receive, make a mental note. If you’re being asked to pay for a procedure that didn’t happen, keep that in mind. Every code that’s incorrect could add up to a huge difference in your bottom line.


Handling Grievances

Now that you’ve thoroughly reviewed your medical bill with a fine-toothed comb, it’s time to resolve the errors and make sure you’re only responsible for the appropriate codes. But who do you talk to? Your physician, insurance company, and the billing department at the hospital or office all seem like logical choices, but some will be able to help more than others. 

The first step to take is to contact your insurance provider to see if they are open to negotiation. While most coverage plans include deductibles, coinsurance, and out of pocket specifications, it never hurts to see if they are willing to pay more on a specific service. In many instances, the figures that your plan covers are negotiated based off of arbitrary prices set forth by the healthcare facility you visited, so there’s often more than enough wiggle room to see if the price can go down.

An important to document to request from your insurance carrier is a summary of benefits and coverage. This information lays out exactly what your plan will and will not pay, and in some instances can be an important piece of ground for you to stand on if your provider is pushing back on some charges. Once you’ve been able to successfully lower your bill by offsetting costs onto your insurance plan, there’s still another place to turn.


The Billing Department 

It would make sense that speaking with your doctor would help in your quest to lower your balance due, but shockingly enough, most physician’s don’t know the cost of the procedures they complete. Because hospitals are largely responsible for setting their own prices, it’s not up to the doctors themselves to account for each nickel and dime on your bill. 

Your best bet is to reach out to the billing department of the hospital or office you visited. Depending on the specifics of your visit, you may get the bulk or even all of your bill resolved. Let’s say you scheduled an appointment at your local hospital for a mammogram only to find out that your primary care physician was out sick for the day. Thankfully another doctor was there to perform the procedure, and you were in and out in no time.

But what if that fill-in physician isn’t part of your insurance network? It would hardly be fair to pay higher rates when you had no idea about these details and it certainly wasn’t your fault that your normal doctor wasn’t there. Instances like these are far too common, and it’s these types of billing situations that can often result in decreased charges if you play your cards right.


Affording Your Care

While the process to get your bills lowered can be time-consuming, it can result in hundreds of dollars in savings. However, what if you contact your insurance provider, speak with multiple people in the billing department, and even plead with your doctor only to find that everything was coded correctly and your enormously high balance remains the same? 

Hospitals tend to realize that most people don’t have $100,000 in their bank account at all times to handle a medical bill, and many are flexible enough to set up payment plan options. Some providers will break up your balance due into manageable chunks, often without charging you interest. Those who qualify for low income assistance can also reach out to Medicaid, your local Social Security office, and state social services agencies for help. Individuals who are on a fixed income can’t adequately plan for unforeseen medical expenses, and when the care they received was essential, asking them to pay large bills is often too much of a challenge.

Others also resort to crowdfunding, a popular option that you may have seen on social media. The basic idea is that individuals with overwhelming health expenses can set up a request for financial assistance. Anyone around the globe can donate any dollar amount of their choosing, and even if your campaign only generates a fraction of your total amount due, it’s still a helpful avenue to offset some of your costs.

Last but certainly not least, organizations like the National Patient Advocate Foundation can be a great resource to contact if you’re experiencing ongoing medical bills that are too much to handle. NPAF works to provide affordable healthcare to those with chronic or life-threatening conditions and can help you to connect with local resources that can assist in managing your expenses.


Being Proactive

When it’s all said and done, wouldn’t life be so much easier if you could avoid receiving a surprise medical bill altogether or at least be able to plan accordingly? For many individuals, these scenarios sound like a dream come true, and while instances of emergency treatment may not allow you to be proactive all of the time, there are other ways you can work to manage your care.

Make sure to check in with our third and final part of this series that uncovers tips and tricks for reducing the element of a surprise healthcare bill once and for all. Until patients receive greater healthcare pricing transparency, investing the time to research and plan upfront can make a world of a difference.