What You Need to Do to Fight Outrageous Medical Bills

As you might know, my wife and I have had serious medical problems for years and years. Over the last ten years, our medical costs have exceeded 30% of our gross income. That’s about four times what the average person has to deal with based on numbers from 2017. So we’ve seen our share of outrageous medical bills.

Outrageous medical bills are all too common. Here's what you need to do in order to fight for your rights so they don't take advantage of you.

Unfortunately, it’s something we have to live with and it is one of the main reasons why we are so careful when it comes to saving money. You see, without being so aware of how to save, we would have even more difficulty managing to get through life and the cost of medical care would simply overwhelm us. We aren’t alone and I am not going to whine about it here anymore that I have to do it in order to make my important point:

There are things you can do to fight your outrageous medical bills.

Do You Think the Cost of Medical Care Is Scary?

Most of your life, unless you have some sort of life-long illness, you never really think about medical costs and if you do follow a good healthy regimen in life, medical care is reasonably affordable. It may mean an annual physical or treating some minor illness or injury occasionally, but for the vast majority of people it’s not a real problem.

If you are fortunate enough to have medical insurance, then the cost is even less for you. Throw in the fact that when you are young you are basically immortal (or at least you think you are) and you can easily think that medical costs today are low and work well for you. The problem is that being young and healthy is just one stage of life and when you get into other stages, you may be in serious trouble.

The Cost of Medical Insurance

I just wanted to mention the elephant in the room here: medical insurance cost. You hear about it in the news almost every day and it’s a major concern because so many don’t have medical insurance, can’t afford it, or can’t qualify for it for a host of reasons. And the sad part is this, even if you can get it, it is often super expensive. That alone is scary, but it isn’t the focus of this post.

Years ago, you always got insurance through your job and it usually was very low in cost or even free. Those days are gone.

The Emergency Room – When You Seek Help in the ER, What Then?

The emergency room is a place you never want to be. I have on occasion found myself in one and I can tell you every second of the experience I have endured has been hell. I have waited for attention for hours on occasion or after treatment spent hours waiting to be admitted to the hospital by sitting or lying on a gurney waiting endlessly for something, anything to get into a room. Why?

Mainly, ERs are overwhelmed these days. Many people use the ER as their doctor’s office and go there simply for routine care. If you have no other way to treat even a simple thing like a cold or a cut, then you go to the ER and get treated and worry about the cost later on it seems. Unlike a doctor’s office, if you don’t have your medical insurance handy when you check in, it seems when you are actually bleeding they will still treat you…thank goodness.

ER Medical Bills Can Be a Nightmare

With an illness or injury, you cannot know how serious it may be and when you go to the ER to be examined, you hope for the best and do as you’re told for the most part. You go in and hopefully out with medications or you are admitted.

Eventually—usually long after the fact—you get some sort of a bill which in many cases can only be described as obscene. Often you have a hard time figuring out the details and have no idea just how it was all figured out and how shocking it actually would be.

You may even feel seriously that something is amiss. An amount billed to you may be hundreds of dollars and that is even after insurance if you actually have it. Before insurance is taken into account, your bill might be thousands, or tens of thousands, of dollars.

Could the bill really be that huge for a 30-minute visit? Often the bill isn’t even itemized, so you should always request one to try to prevent further horror. But here’s the thing, an itemized bill almost always contains errors, which is why you should never just pay a medical or ER bill before carefully looking over all the charges.

Are There Any Errors?

There are always some honest errors with anything and ER bills are no exceptions. Small errors such as an overpriced $14 aspirin that hikes up a bill are fairly common. Go through every line and question anything that looks weird and call the hospital billing department. Entry levels charge codes are used to determine the severity of cases entering the ER and that will dictate what reimbursements the hospital should receive—and guess what? They are entered in by the doctor and mistakes in these charge entry levels aren’t uncommon.

These issues are often unintentional, but are simply the result of a doctor trying to quickly code and move on. However, this process can be deliberate at worst or accidental at best. Doctors and nurses can check boxes for procedures as simple as reviewing medical history or spending extra time with the patient which have the potential to kick up the charges on any bill with coding levels.

How Can You Fight for Your Rights?

In the fight to reconcile an error, keep a careful paper trail, noting each date you receive a bill, who you speak to on the phone about it, and what next steps are suggested and agreed to and taken.

By the way, you have no recourse with something like the Better Business Bureau because medical providers have terrible ratings anyway and they don’t really have competition so they don’t care when you complain. However, if you have insurance, the insurance company cares about their money, so they may provide help in fighting with the provider. Another possible ally is your benefits department at work who may provide patient advocacy help.

Eventually, if necessary, you can even record the calls and make it known to the person on the phone about the act of “upcoding” over and over and when it drags on eventually the hospital may just decide to write off the charges. Never agree to pay until you get a true explanation of charges and are sure there are no errors.

In my experience, often they will accept the most ridiculous compromises like long extended payment plans with no interest or reduced payments by huge percentages (90% if you pay now rather than waiting until insurance covers some of the bill) or they may never get a penny at all if you don’t pay.

Learn as Quickly as You Can When It Comes to Medical Bills

I wish I had known from the start how to handle erroneous charges on high medical bills. The word “upcoding” was not really part of my vocabulary back twelve years ago when I had my heart attack. If it had been, I might have saved many hours spent on the phone.

Unfortunately I spent a year of my life fighting them when they were so clearly harassing me and in the wrong. Part of it was the insurance company itself which was threatening not to cover any of my costs because it claimed I had a “pre-existing condition”. They wanted to deny coverage and saddle me with almost $100,000 of medical bills had they prevailed. All the time, the hospital and doctors kept on billing me left and right and the bills just kept on coming.

At some point, you almost can’t even be sure the bills belong to you as the names of the providers and services include some that were incidental and done by people you have no recollection of at all. It doesn’t matter though, they will bill you anyway.

What You Need to Do to Fight Outrageous Medical Bills

Here are the steps I recommend to fight off crazy healthcare costs.

Know your insurance plan and your network

Find out in advance if what you’re having done is covered by your plan, what copay or co-insurance is required, and whether your provider is in your network. Advance planning is key to make sure you don’t get saddled with ridiculous bills later.

Keep track of the bills and make sure they’ve been processed by insurance

Many providers will send you bills even before they’ve been processed by your insurance company. This leads to uninformed patients paying high costs that they aren’t responsible for. Make sure you get your Explanation of Benefits (EOB) from your insurance and that the patient responsibility matches the amount on the bill. You may also get duplicate bills, or be billed for something you’ve already paid for. Stay organized and when in doubt, call the provider or insurance company to check.

Ask for the detailed bill and check it for errors

Check the detailed bill against your memories and notes, and if you need help, seek out a patient advocate from a place like the Patient Advocate Foundation or check pricing databases such as Fair Health Consumer or Healthcare Bluebook. Don’t be afraid to question billing items and prices that don’t make sense to you.

Act quickly and communicate

If you don’t pay your bill within a certain amount of time, it may be sent to collections. Likewise, there are typically time limits on insurance appeals. Act as soon as possible and try to resolve issues with a phone call when you can.

If all else fails, negotiate

There was a point after my heart attack when I didn’t think the insurance was going to pay. I made small payments to the hospital to keep my account in good standing, and they were willing to negotiate with me on the total. Thankfully, my insurance appeal went through. But if your situation isn’t working out or you don’t have insurance, speak to a supervisor and negotiate.

Final Thoughts

The vast majority of health care providers are honest and they do what they need to do for their patients, but it only takes a small number to really impact the entire system. And yes, mistakes happen, frequently.

A month ago I had a serious surgical procedure done and I am just now getting the first bills for it, so far totaling over $18,000 from the hospital alone. I expect these bills will be coming for months.

If and when you find yourself in this situation, try to remain aware of these small details or at least have your loved ones do exactly that for you. That way your hospital and doctor bills won’t make you sicker when you already are dealing with illness.

Have you had issues with medical bills, and if so, how did you resolve them? What can you do now to prevent problems? Can you say that your health insurance covers you well if you have to go to the doctor, hospital or have an ER experience?

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