As if dealing with an illness or injury isn’t stressful enough, handling medical bills and insurance paperwork can add an additional layer of stress to your life. Maybe the doctor’s office or hospital sent you a bill with a mistake. Or maybe your insurance company unexpectedly denied your claim. No matter your situation, it’s important to stay on top of your bills or you may find yourself at the mercy of a bill collector. Fortunately, if you cannot handle all of this yourself, there are professionals who can help you. Our tips for handling medical bills will hopefully make your life a little easier!
It’s all in the details.
There is so much room for errors when it comes to medical bills. A code can be entered incorrectly. You can be confused with another patient. It’s entirely possible to get bills for services you never received. Therefore, it’s important to read over your medical bills with attention to detail.
The same attention to detail applies to your explanation of benefits from your insurer. Perhaps they rejected a service that is normally covered due to a clerical error or a change in policy. But you won’t know unless you read these statements carefully and compare them to the appropriate medical bills.
Yes, it’s all boring. And sometimes frustrating. But it’s necessary if you don’t want to overpay.
Before you make an appointment…
It’s best to avoid unexpected bills by taking the following steps before you schedule an appointment.
For starters, check in with your insurance company to:
- Learn if the services you expect/need are covered.
- Find out if you have met your deductible.
Additionally, call your doctor and/or hospital to confirm they accept your insurance plan, to learn if you need pre-authorization, and to ask about co-pays.
Importantly, ask for a “good faith estimate” for all expected costs, including a detailed breakdown of prices. Since the enactment of the January 2022 No Surprises Act, all medical providers must provide a good faith estimate when uninsured or self-pay patients request an estimate, discuss costs, or schedule a procedure.
If you schedule a procedure or appointment at least 10 days beforehand, the provider must give you a good faith estimate within 3 days of your request. However, if you schedule a procedure closer to the date of a procedure (at least 3 days in advance), the provider must provide an estimate the day after scheduling.
Unfortunately, there are currently no clear requirements regarding procedures for which you have less than 3 days’ notice. However, it can’t hurt to ask the doctor or hospital!
You can use these good faith estimates to compare prices across providers.
Most importantly, the law states that the final bill may not exceed the estimate by more than $400 per provider.
Before you pay a bill…
Don’t pay a bill until you are certain that it is correct AND that the total due matches the amount stated on your insurer’s explanation of benefits.
First and foremost, make sure the bill doesn’t contain errors, including duplicate charges. If you didn’t get an itemized bill, you can request one (the law requires providers to give patients itemized bills).
Although you can get refunds for overpayments from hospitals and doctors office, it’s a hassle you should avoid when possible.
If you have a billing question or issue with your doctor or hospital, or with your insurer, call them. But do yourself a big favor and keep track of all phone conversations; write down the name of the person you speak with, the details discussed, and the next steps.
If your insurance company denies a claim, don’t give up too quickly. Send a written letter describing why you think your policy should cover the service in question. Get a detailed letter from your doctor to include. If necessary, ask someone from your doctor’s office to call your insurance company for you.
What about “surprise bills”?
“Surprise bills” occur when patients receive unexpectedly high bills from out-of-network providers when they receive care in an in-network facility. How does this happen?
Unfortunately, you can receive care from a doctor who doesn’t not have a contract with your insurer, even when your care takes place at an in-network facility. These surprise bills are more common with bills from anesthesia, pathology, emergency rooms, internal medicine, and ambulance services.
According to a recent study, out-of-network bills are increasing among inpatient admissions and emergency department visits to in-network hospitals. In fact, studies show that about 20% of emergency room visits have resulted in surprise bills.
Fortunately, there is some very good news. As of January 2022, the new No Surprises Act bans surprise medical bills by instituting a cap on the pay doctors, hospitals, and air ambulances can collect for out-of-network care. Simply put, if you receive care at an in-network hospital, they cannot bill you more than a negotiated, in-network rate for any out-of-network services you receive while there. Instead, the insurance company and the healthcare provider must work out how the bill gets paid.
Importantly, if you don’t know about this new law, you might end up paying more than you should. Unfortunately, it might be up to you to make sure your hospital or other healthcare provider follows the law.
The law does not apply to all providers.
Importantly, the law protects us when we receive care in a hospital, but it doesn’t apply to many other places we receive care, including doctors’ offices, labs, birthing centers, or most urgent care clinics. Additionally, air ambulances, which often come with huge out-of-network bills, are covered by the law, but ground ambulances are not.
Watch out for “Surprise Billing Protection Forms”.
According to a Kaiser Health News article, out-of-network providers may present you with a form addressing their protections from unexpected bills, labeled “Surprise Billing Protection Form.”
This is critically important to understand – if you sign this form, it waives any protections and instead acts as a consent to treat you at out-of-network rates. These forms protect the provider, not the patients.
Furthermore, providers can catch you off-guard by giving you an iPad to sign without showing you what you are signing. Instead of blindly signing, insist on seeing the form before you sign!
If your provider asks you to sign this form, make sure it includes a “good faith estimate” of what they will charge you for your care. For nonemergency care, the form should include the names of in-network providers you could see instead.
Additionally, the form should explain that the provider can refuse to treat you if you refuse to sign the waiver.
Importantly, it is against the law for some (but not all) providers to even give you this form at all. This includes emergency room doctors, anesthesiologists, radiologists, assistant surgeons, and hospitalists.
What if you have no choice?
Don’t sign if you notice a problem.
However, you might not have a choice if you urgently need care. In that case, consider these important suggestions from Kaiser Health News:
- Write on the form that you are “signing under duress” and note the problem (e.g., “Emergency medicine facilities are not allowed to present this form”).
- Take a picture of the form with your notes on it. Also, consider shooting a video of yourself with the form, describing how it violates federal law.
- Report it! There is a federal hotline (1-800-985-3059) and a website for reporting all violations of the new law barring surprise bills. Both the hotline and website help patients figure out what to do, as well as collect complaints.
Help for low-income patients.
Certainly, if you don’t have insurance, a medical bill can devastate your finances.
Did you know that in order to keep nonprofit status, the government requires nonprofit hospitals to have Charity Care programs that can cover some or all of your hospital bill if you qualify?
If you or your loved one received care at a nonprofit hospital, find information on their charity care program by searching online with the hospital name and the phrase “patient financial assistance”.
To take advantage of these programs, you must complete a potentially difficult and confusing application process. Additionally, you may have to persist to get an application since some hospitals deter applicants.
However, it can be worth your time and efforts, even if you already paid a bill – you might get a refund.
Hospitals often bill low-income patients.
Disturbingly, a 2019 Kaiser Health News analysis of reports submitted to the IRS found that 45% of nonprofit hospital organizations routinely send medical bills to patients whose incomes are low enough to qualify for charity care. This accounts billions of dollars of medical bills sent to patients who likely would have qualified for hospital charity care programs.
What are the requirements of these programs?
Each hospital can decide the qualifying criteria. For example, a generous hospital may give free care to people earning less than twice the federal poverty level, and may provide discounts for people earning up to double the federal poverty level. But other hospitals may have less generous cut-offs.
Additionally, hospitals’ charity care programs can include exceptions, such as not covering bills for doctors who are not on their payrolls.
Not all medical providers offer charity care programs.
Importantly, the law only applies to nonprofit hospitals. And only about 56% of community hospitals have nonprofit status – the rest are for-profit. Additionally, realize that doctors and other medical providers are not hospitals and therefore don’t fall under this rule.
Handling medical bills yourself?
If you are handling medical bills and insurance yourself, take the time to set up an organizational system. It’s critical to stay organized! Keep records of bills you pay and the associated insurance statements of coverage.
Need professional help with inaccurate bills or denied coverage?
If handling medical bills is too overwhelming, or you’re struggling with a claim or bill that you think is wrong, you may want to hire a medical-billing advocate (for a fee). However, not all advocates are equal, so do your homework before you hire someone.
Firstly, ask your friends and family if they know of a reputable advocate. If no one has a lead for you, try Medical Billing Advocates of America, a professional organization for those who help with billing and insurance issues. You can use their website to find a professional in your area.
Before hiring help, be sure to speak with past/present customers; and get a written contract detailing the billing rate, services provided, and if they require payment if they cannot reduce or eliminate the medical bill in question.
More tips for handling medical bills.
Read these blog posts to learn more about money related matters:
- How to Save Money on Prescription Medications.
- Can You Comparison Shop for Healthcare Prices? Yes, and You Should!
- How to Shop Around for Healthcare Pricing.
- Reduce Your Healthcare Expenses.
- The Impact of the High Cost of Healthcare
NOTE: I updated this post on 4-11-22.