Demystifying Emergency Room Bills: Strategies For The Uninsured

Medical bills can be daunting, especially when patients do not have insurance to cover the costs. However, it is important to remember that medical bills are often negotiable, and there are several steps you can take to lower your bill. Firstly, request an itemized bill, which breaks down the charges for each procedure, medication, and service. This allows you to identify any errors or discrepancies, such as duplicate charges or incorrect patient information. You can also compare the itemized bill to the explanation of benefits (EOB) provided by your insurance company to look for discrepancies. If you find any errors, contact the provider's billing department to have them corrected. Additionally, you can ask the billing department about possible waivers, discounts, or financial assistance programs. Nonprofit hospitals are required by law to offer financial assistance programs, and many hospitals offer interest-free payment plans. You can also reach out to a patient advocacy group or a professional negotiator for help. Remember to stay calm and polite during negotiations, and don't be afraid to ask for a reduced fee.

Request an itemized bill to check for errors

Requesting an itemized bill is an important step in negotiating your emergency room bill. It allows you to identify any errors or discrepancies in the charges and ensures transparency in the billing process. Here are some key points to keep in mind when requesting an itemized bill:

• Know Your Rights: You have the right to request an itemized bill, and hospitals are legally required to provide it to you. This document will contain a detailed breakdown of all the charges, including the cost of each procedure, medication, and service you received.
• Understand the Contents: Itemized bills contain various codes, such as CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, which are used to identify specific procedures and services. These codes are usually 5-characters long and start with numbers or letters. The bill will also include service dates, revenue codes, quantities, and charges for each procedure.
• Identify Potential Errors: Carefully review the itemized bill to spot any errors or discrepancies. Look for duplicate charges, incorrect patient information, incorrect codes, or unbundling of charges. Compare the itemized bill with your explanation of benefits (EOB) to ensure that the charges match and that your insurance coverage has been applied correctly.
• Verify Charges: Compare the charges on the itemized bill with standard prices for similar procedures and services in your area. You can use online tools like Healthcare Bluebook or FAIR Health Consumer to research average costs. This will help you identify if you are being overcharged or if there are inconsistencies in the billing.
• Contact the Billing Department: If you find any errors or have questions about the itemized bill, don't hesitate to contact the hospital's billing department. They can provide clarification and make any necessary corrections. Remember to be polite and patient during your interactions.
• Keep Detailed Records: Document all your interactions with the hospital and the billing department. Take notes on who you speak to, the date and time of the conversation, and the details discussed. This will be helpful if you need to refer back to these discussions or escalate the issue.
• Consider Seeking Assistance: If you feel overwhelmed or unsure about the billing process, consider seeking assistance from a patient advocate or a medical billing advocate. They can help you navigate the complex world of medical billing and insurance and may be able to negotiate on your behalf.

Ask for a reduced fee

Negotiating a lower fee for your emergency room bill is possible, and you can take several steps to achieve this. Firstly, it is important to start the process early. Contact the billing department as soon as you receive your bill or explanation of benefits (EOB). You will have more time to negotiate before the due date, and bills are usually not sent to collections agencies immediately.

Next, review your bill for any errors. Ask for an itemized bill, which breaks down all charges, including the cost of each procedure, medication, and service. This will allow you to identify any mistakes, such as duplicate charges, incorrect patient information, or incorrect codes.

Once you have reviewed your bill and identified any errors, you can begin negotiating a reduced fee. Reach out to the billing office, usually via a phone call, and ask for a reduction. Be persistent and ask to speak with a supervisor or the director of the department if necessary. Remember to be polite and courteous throughout the negotiation process.

You can also offer to pay a discounted bill upfront. Many hospitals will be open to negotiating a lower cost if you can pay immediately. If you cannot afford to pay the entire bill at once, consider asking about a payment plan. Many providers are willing to work with you to find a plan that fits your budget.

Additionally, research comparable rates for the procedures and services you received. If you find that your bill is significantly higher than average rates in your area, use this information to negotiate a lower price. Letting providers know that you are aware of the typical costs can strengthen your case for a reduction.

Finally, if you are uninsured, ask to pay the same rate as insured patients or the Medicare rate. Uninsured patients are often charged a higher master rate, but you can negotiate a lower fee by highlighting the typical insured rates for the same procedures.

Appeal your insurance claim

If you believe what you’re being asked to pay for a medical procedure is incorrect, you have the right to submit an appeal. There are two types of appeals: internal and external.

Internal Appeal

If your insurance company denies your claim, you have the right to submit an internal appeal. You can request that your insurance provider does a fair and complete review of its decision. Your state’s Consumer Assistance Program can help you through this process. If your insurance company still denies your internal appeal, then you can file an external review.

External Appeal

Within four months of receiving a denial from your insurance company, you can file an external review with either the state or federal government. While some states have their own external review process, others don’t, and in these cases, the Department of Health and Human Services will process the review. Typically, an external review takes less than 45 days.

What to do if you don't have insurance

If you don't have insurance, you can ask the hospital about financial assistance programs for low-income or uninsured patients. You can also check if you qualify for Medicaid or, at least, ask to pay the same amount as insurance companies.

Seek financial assistance programs

If you're facing a large emergency room bill and don't have insurance, you may be able to get financial assistance. Financial assistance programs, sometimes called "charity care", provide free or discounted healthcare to people who need help paying their medical bills. These programs are offered by medical care providers, states, non-profit organisations, and advocacy groups.

• Ask for a copy of the hospital's financial assistance policy: By law, hospitals must provide this policy for free and tell you how to apply for help. Ask whether the policy is available in your preferred language.
• Fill out an application form: Complete the application with information about your income, such as last year's tax forms or a current pay stub, and your expenses, including rent or mortgage payments, utilities, credit card bills, and other expenses.
• Ask questions about the process: Find out how long it will take to process your application, how to get answers to any questions, and what happens with your bill in the meantime.
• Notify debt collectors, if applicable: If debt collectors are trying to collect on the hospital bill, let them know that you're seeking financial assistance and ask them to pause collections in the meantime.
• Follow up as needed: Stay in contact with the service provider and its billing department about the status of your application.

In addition to the above steps, keep in mind that:

• Non-profit hospitals are required to offer financial assistance programs: Under the Affordable Care Act, non-profit hospitals must have a written Financial Assistance Policy (FAP) and widely publicise it. This policy should include eligibility criteria, the basis for calculating charges, and the method for applying for assistance.
• Some states have specific charity care laws: For example, California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Rhode Island, and Washington have protections that apply to all hospitals.
• You may be able to get help from advocacy groups: Patient advocacy groups often have financial assistance resources and programs that can help people facing large medical bills.
• You can also explore other options for financial assistance: For instance, government programs, financial aid from charities, support from hospital billing offices, or free charity care.

Prepare for your medical visit

If you have health insurance, check with your provider to see if they will cover your visit and, if so, by how much. Push for coverage if a similar expense was covered by insurance in the past. Whether your medical provider is in- or out-of-network can play a role in whether your insurance will cover your health care. Not all insurance companies will help pay for out-of-network bills, and if that's the case, you may need to find an in-network medical professional to work with you.

You may also need to get a procedure preauthorised by your insurance provider to ensure it's covered. Even if a medical professional tells you it's already been preauthorised, independently verify with your insurance company and get it in writing.

The No Surprises Act protects consumers who have health insurance from getting unexpected bills for most medical care procedures from in- and out-of-network providers. This legislation allows insurance companies and medical providers to independently dispute with one another and come to an agreement.

Under the No Surprises Act, consumers who don't have health insurance or who choose not to use insurance have the right to receive a good faith estimate outlining the expected expenses of their visit. You can then dispute your medical bill if it's $400 or more than the "good faith estimate" you originally received.

Understand your medical bill

The first step in negotiating your medical bill is understanding what it includes. Medical bills can be complicated, with various line items and codes that might not make immediate sense to the average person. Request an itemized bill, which breaks down all the charges, including the cost of each procedure, medication, and service. This will allow you to see exactly what you are being billed for and identify any errors or discrepancies.

Verify your insurance coverage

Before you start negotiating your medical bill, it's essential to understand your insurance coverage. Log in to your insurer's website and check your Plan Details to see what your insurance covers and what you are responsible for paying. You can also check your Explanation of Benefits (EOB) to see what your insurer has covered in the past. If you notice any discrepancies or have questions about your coverage, contact your insurer for clarification.

Identify billing errors

Billing errors are more common than you might think, and identifying these errors can significantly reduce your medical bill. Here are some common billing errors to look out for:

• Duplicate charges: Make sure you are not being billed twice for the same procedure, medication, or service.
• Incorrect patient information: Double-check your personal information, including your name, address, and insurance details, to ensure there are no mistakes.
• Incorrect codes: Check the CPT codes on your bill to ensure that the correct procedures and services are listed.
• Unbundling of charges: Some procedures are billed as a package but are sometimes billed separately, leading to higher costs. Verify that you are not being overcharged due to unbundling.

If you find any errors, document them and contact your provider's billing department to have them corrected. If you are trying to negotiate hospital bills after insurance has already been involved, it's not too late. Call your insurer or write a letter of appeal to get the charge reduced or removed.

Frequently asked questions