Something that I get asked many, many times is “why did I get this large bill?”. Surprise bills do happen – and oftentimes people are not expecting them because they believe that they have done everything right, such as staying in-network. But due to deductibles and coinsurances, you can still end up with a large bill. I have recently come across a great book, called “Never Pay the First Bill”. It’s by Marshall Allen, and it’s interesting because he’s an investigative reporter. He was inspired to write the book based on a situation his parents were in, and he’s utilized some of the things he was finding out to help negotiate a basically, in their case, it was an error. It was an error in that they had put his father in assisted living, and even though his mom had power of attorney, there were things that were done that should not have been done without contacting her. Through reading this book, I am hoping to learn some additional things that I might not already be relating to my clients.
Whenever you get a big bill, the very first thing is to remember that the reason this book is called “Never Pay the First Bill” is that many, many times that bill is incorrect. It has been billed incorrectly because, even though it comes from the hospital, a lot of these big facilities outsource their billing. This means that it’s been done by someone who has really no contact with the facilities and may not even understand what’s involved in the different codes. They’re just going by what’s listed, the codes, the diagnosis, and often this is incorrect. I can speak firsthand, that billing gets done incorrectly, I have fought many bills, and I’ve helped clients fight many bills.
It is important to review your bill with your insurance company because sometimes the bill is more than what the insurance says you should owe. There are a couple of different ways reasons there could be a mistake One way is the exact charges – if you didn’t have three MRIs at the hospital and your bill says three MRIs, well, that’s a mistake. I had a client that was billed for an ER visit for an X-ray that the hospital couldn’t find. She said, “Well if you did an X-ray, I want I want to see the results”. Well, they couldn’t find it. If you can’t find it, it wasn’t done. And yes, you may have to find them. But you know, that’s fraudulent to bill for something you can’t prove was done. Generally, you want to review the first bill, compare it with your EOB to make sure that matches up to what the insurance owes.
If you feel that the bill is correct, now, what do you do? Okay, now I owe $4,000? Well, maybe not. The first step would be to call the facility and ask them if they have a financial assistance program, not a payment program, do not sign up for a payment program at this point. That’s what they’re trying to do. But you want to know if they have financial assistance – all big facilities have financial assistance. You need to learn where to find the forms, you apply, you fill out the form send it in, and that generally takes about three months. This is perfect timing, because if for some reason they deny your financial assistance, or don’t reduce the bill enough, then now we’re in a collection status. The bill is now 91 days old. And now where’s your bargaining time? Between 91 days and 179 days? Because at 180 days, yes, they can turn it into the credit bureau and affect your credit. But they cannot turn it into their collection department before that, so it’s not going to show up on your credit report yet, even if they use a collection agency. This window is your best negotiating time.
Generally, you can see what you know insurance has paid if you have insurance. And you can see what the balance of the bill is. Offer them a reasonable amount, what you think is fair. They generally, I’ve had this happen, accept it. A lot of the time, people just don’t know to ask that, all you have to do is ask, and a lot of times, it happens.
I’ll give you an example. I had a client that had to take an ambulance ride. The ambulance was out of network. The bill was not yet 91 days old, but I thought well, let me call and just see what’s going on. The client calls stating she noticed the insurance didn’t pay anything, because you’re out-of-network. And asked what to do if she had a financial problem. The billing department told her that they would still give her the PPO discount, even though they’re not in-network. So she just resent the bill.
The next step is for the client to ask if they have a financial assistance program. Stating she can’t afford that either. They told her they would bill her the Medicare pricing and adjusted the bill. And so now the balance was half of what it originally was. And the lady at the ambulance company said, you know, we don’t have set Assistance Program because there was an ambulance company, but what we can do is not charge you interest or late fees, and you can make a monthly payment, however much you want to make until it’s paid off. I thought that was a pretty good win in that situation. Instead of owing $1100, the client owed about $500.
There are other instances. I had another client that insurance paid, but her copay for her two-day hospital stay was $6,000. For a $95,000 bill, that’s not bad, but she didn’t have $6,000. So again, it’s one of the major hospitals – we looked it up, we got the financial forms, I had the client fill it out, we submitted those forms, and it took about three months. The client received a letter saying that they reduced the bill to a 30 days $30 copay. $30 from $6000. So even though her insurance said she owed $3,000 a day, which was what her copay was, the facility still reduced it more based on financial need and ability to pay. And her final amount was $30. What a deal.
Remember, if you are my client, please call and I will assist. I don’t call for you, I give you the tips and tricks to help you.
Finally, there’s the opposite way of trying to avoid a big bill. And that is beforehand. If you don’t have an emergency and didn’t need to seek care at an inopportune time, but you have something planned, whether it’s a colonoscopy, or it’s a planned procedure, you can shop all my resources that will help you determine the least out of pocket you’re going to pay. Because that’s the whole point – saving you money out of pocket.
Consider reading “Never Pay the Frist Bill”- my aim is to help people arm themselves with knowledge so that we can stop overpaying for health care (because that makes your premiums go up!).