The Art Of Negotiating Medical Bills: Understanding Your Rights After Insurance

Medical bills can be daunting, but they are often negotiable. In fact, negotiating medical bills can lower your annual healthcare costs by thousands of dollars. The first step is to understand what your bill includes by requesting an itemized bill, which breaks down all the charges, including the cost of each procedure, medication, and service. You can then identify any errors or discrepancies, such as duplicate charges or incorrect patient information. It's also important to verify your insurance coverage and understand your medical codes, which can be looked up on the American Medical Association (AMA) website. Once you've identified any issues, you can contact the billing department to have them corrected. If you can't afford to pay your bill, you can ask the billing office about a reduced fee or a payment plan. It's also worth checking if you're eligible for Medicaid or other financial assistance programs. Remember to stay calm, polite, and persistent during the negotiation process.

Ask for an itemized bill to review all charges and identify errors

Asking for an itemized bill is a crucial step in negotiating hospital bills. Itemized bills contain a detailed breakdown of all charges, including the cost of each procedure, medication, and service. They are essential for identifying errors and discrepancies in billing. Here are some key points to keep in mind regarding itemized bills:

• Requesting an Itemized Bill: You may need to proactively ask for an itemized bill, as hospitals typically won't send one unless requested. Contact the billing department and politely request an itemized bill, specifying that you want a detailed breakdown of all services, procedures, and associated costs.
• Understanding the Itemized Bill: Itemized bills contain various codes, such as CPT (Current Procedural Terminology) codes and HCPCS (Healthcare Common Procedure Coding System) codes. These codes are used to identify specific procedures and services. You can look up these codes online to understand what they represent and ensure you were billed correctly.
• Identifying Errors: Carefully review your itemized bill for any errors or discrepancies. Look for duplicate charges, incorrect patient information, incorrect codes, or unbundling of charges. If you find any mistakes, document them and contact the provider's billing department to have them corrected.
• Comparing Charges: Research the typical costs for the services you received to determine if the charges on your bill are reasonable. Compare the prices of procedures and services with average costs in your area using resources like Healthcare Bluebook or Fair Health Consumer.
• Negotiating Charges: If you find errors or discrepancies, contact the billing department to discuss the issues and negotiate the charges. Remain polite and patient during the negotiation process. You can also offer to pay upfront or set up a payment plan, which may encourage providers to offer discounted rates.

Understand medical billing codes to ensure you were billed correctly

Understanding medical billing codes is essential to ensure you are billed correctly. Medical codes are used to describe diagnoses, treatments, and procedures, and they play a crucial role in determining costs and reimbursements. Here are some tips to help you understand medical billing codes and ensure the accuracy of your medical bills:

• Obtain an Itemized Bill: When you receive a medical bill, request an itemized bill or invoice from the doctor's or hospital's billing office. This detailed list of charges will allow you to verify that you are being charged only for the services you received.
• Understand the Coding Systems: Familiarize yourself with the different medical coding systems, such as CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System). CPT codes are five-digit numeric codes assigned to each task and service provided by a healthcare provider. They are used for billing and tracking medical procedures. HCPCS codes, on the other hand, are used by Medicare and are based on CPT codes. They include codes for non-physician services like ambulance rides and medical equipment.
• Decode the Codes: Each code in your medical bill corresponds to a specific procedure or diagnosis. Look up the codes online or on the American Medical Association (AMA) website to understand what each code represents. CPT codes can be searched on the AMA website, while ICD codes can be searched on the Centers for Disease Control and Prevention (CDC) website.
• Compare with Explanation of Benefits (EOB): Cross-reference the codes on your medical bill with the EOB statement from your insurance company. The EOB will show how much of the cost of each service was covered and what you owe. Ensure that the dates, codes, and amounts match between the bill and the EOB.
• Check for Common Errors: Be vigilant for common billing mistakes, such as incorrect quantities, duplicate charges, charges for services not received, inflated surgery times, or charges for basic supplies. For example, check that you were charged for the correct type and duration of a hospital room stay.
• Seek Assistance: Medical billing can be complex. If you need help interpreting the codes or identifying errors, consider reaching out to a patient advocate or a Consumer Assistance Program in your state. They can provide guidance and support in resolving billing issues.

Compare your bill to average costs in your area to identify overcharging

It is important to compare your hospital bill to the average costs in your area to identify overcharging. Hospital bills can be complex and confusing, and it is not uncommon for them to contain errors. Up to 80% of hospital bills may contain errors, and surprise charges are more common than most people think.

To compare your bill to the average costs in your area, you can use online resources such as Healthcare Bluebook or Fair Health Consumer. These websites provide fair price estimates for medical procedures and services based on your location. By entering your zip code and the name of the procedure, you can find the average or estimated price in your area. This information can be powerful in negotiating lower fees.

Additionally, you can refer to the Medicare price lookup tool to get a benchmark for the cost of procedures. Publicly available data on health claims in certain states can also help you identify if you are being overcharged.

It is also worth noting that hospitals are required by federal law to list pricing information online for services provided during inpatient admission and outpatient visits. While hospitals may not always comply with this requirement, you can contact the billing department to request this information if it is not readily available on their website.

By comparing your bill to the average costs in your area, you can identify discrepancies and potentially save a significant amount of money. This step is crucial in ensuring that you are not being overcharged for medical services.

Appeal your insurance claim if you believe the required payment is incorrect

If you believe the required payment on your insurance claim is incorrect, you have the right to appeal the decision. Here is a step-by-step guide on how to appeal an insurance claim:

Step 1: Review Your Policy and Paperwork

Before appealing, carefully review your insurance policy and paperwork, including the summary of benefits and the letter or form sent by your insurance plan explaining the denial of your claim. Understand the reasons for the denial and the limitations or exclusions outlined in your insurance documents.

Step 2: Know Who to Call for Answers

Contact your insurance company to clarify any uncertainties and ask if the denial was due to a billing error or missing information. Keep detailed records of your conversations, including the names of the representatives, dates, and decisions made. If the issue involves coding errors or missing information from your doctor's office, reach out to them to rectify the error and resubmit the paperwork to your insurance company.

Step 3: Learn About the Appeal Process

Familiarize yourself with the appeal process by checking your insurance plan's website or calling customer service. Understand the specific forms and deadlines required for filing an appeal. Inform your doctor or hospital about your intention to appeal to ensure they hold off on sending you bills or turning your account over to a collection agency.

Step 4: File Your Appeal

If your claim was denied for a treatment you've already received or one that your doctor deems necessary, ask your doctor's office to send a letter to your insurance company explaining the medical necessity of the treatment. Make sure to send this letter to the address specified in your plan's appeals process and retain a copy for your records.

Step 5: Follow Up and Persist

Follow up with your insurance company within 7-10 days of submitting your appeal to confirm its receipt. If your initial appeal is denied, don't be discouraged. You have the right to request an external review by an independent third party, which will provide an impartial assessment of your case.

Remember to stay calm and polite throughout the process, and don't hesitate to seek help from patient advocates or professionals if needed.

Seek financial assistance or a payment plan if you cannot afford the bill

If you're unable to afford your hospital bill, even after insurance, there are several options available to you. Firstly, you can seek financial assistance or charity care. These are financial assistance programs that provide free or discounted healthcare to people struggling to pay their medical bills. These programs are often offered by medical care providers, states, non-profit organisations, or advocacy groups. The Affordable Care Act (ACA) mandates that hospitals have a written Financial Assistance Policy (FAP), which outlines eligibility criteria and whether the care is free or discounted. You can ask your hospital for a copy of their FAP and an application form. You may also be eligible for Medicaid, a program that provides free or low-cost medical coverage to people with low incomes, older adults, pregnant people, and those with disabilities.

If you're not eligible for financial assistance, you can ask your healthcare provider about setting up a payment plan. Hospitals and medical providers usually prefer to work with patients to find a payment plan rather than selling the debt to a collection agency. Payment plans are often interest-free, which is advantageous compared to using a credit card to pay off the bill.

Frequently asked questions