Medical billing errors are common, and pricing is all over the place. You may feel you have no other option but there is! You can negotiate — seriously! Here’s simple ways to make sure you’re not overpaying.
We may think we’re used to sticker shock upon learning what that new car will cost, but nothing compares to the jolt a medical bill can deliver. Even the dreaded “what’s it going to cost me?” drives some to skip seeing a doctor in the first place, even when they probably should.
And wouldn’t you guess, one way hospitals are dealing with exploding health care costs? By suing patients over their delinquent bills.
No wonder patients are more incentivized than ever to cut their medical costs.
We’ve worked out a step-by-step list to help you make sure you aren’t over-paying. Not all steps will apply to everyone, so feel free to skip ahead.
1. Check for errors. It may not shock you to hear that in medical billing, mistakes happen. A lot. To truly understand your bill, you’ll need to learn some medical lingo. Most insurers have an “explanation of your bill” section on their website. That is a good place to start.
2. Find out what’s a fair price. Think you paid too much? You can figure out online if you’re paying too much.
3. Negotiate your bill. Even if your bill seems fair and free of errors, negotiating a better price does happen — and more often than you might think.
Oh, and before we dive in, there is some upbeat news to share on a related front; There’s real progress reigning-in “surprise medical billing.” These are the potentially ruinous bills people face when using out-of-network providers during an emergency room visit. At least 25 states have now passed legislation to protect patients from surprise medical bills. The problem is far from being solved, but if you’re dealing with a surprise medical bill here’s where to read up further.
Here is a deep dive into each of the steps to help get that medical bill reduced:
1. Check for errors
If you’ve got a hunch that “this bill just doesn’t seem right” you’re right to act on it. It’s estimated that 49 percent of clams contain a billing error, according to a 2014 NerdWallet study. Did the doctor bill for the wrong thing? Were you charged for services you didn’t receive? Should your insurance have covered it? And what do all these codes mean??
First get the right type of bill. Make sure you have an itemized bill that details your visit, and not a summary of services that may be short on the information you need. If you didn’t get an itemized bill, ask that they send one to you.
Crack the provider’s codes. Even with an itemized bill, it may take considerable guesswork to know what exactly you’re being billed for. The info is likely there but buried under a lot of codes.
Medical bills use five-character codes to specify what procedures they performed. These are Current Procedural Terminology (CPT) codes used in healthcare. And for example, should you not know that a 0510T is “removal of sinus tarsi implant”? You can look up your CPT codes online at The American Academy of Professional Coders website. Looking up CPT codes can seem more complicated than it should be, but now you know the language they’re speaking.
Crack the insurer’s codes. If you have insurance, at this point you’ll want to check it against your explanation of benefits (EOB) that your insurer will send to you detailing what was covered during your visit. EOBs are statements that often have “not a bill” written prominently on them to prevent confusion with your actual bill.
You’ll need to check this for errors as well. And critically, you need to confirm that they applied your coverage per the terms of your plan. It’s not uncommon to suspect a billing error only to learn a particular insurance plan “doesn’t cover that.”
Forewarning: you may have to play code breaker again. Insurers use up to four types of medical coding to detail medical procedures. Explaining all of them is a little beyond this post, but if you’re stuck here’s a primer understanding EOBs and the codes they use.
Bring in reinforcements. Nobody relishes playing the mediator between provider or insurer. And it is possible they won’t be eager to talk to you either.
If you hit a wall, the Patient Advocate Foundation offers advice on how to get answers and how to make a formal complaint should it come to that.
And if you feel it necessary to escalate things — and pay for it — consider getting the help of medical billing advocate to assist with your appeal and untangle any red tape. Some medical billing advocates may be cost-free, or they may only collect a fee if they get results.
And we’ll mention for future reference; They can also assist you prior to your treatment to help head off billing snafus before they ever start. More insight into medical billing advocates is available at the Alliance of Claims Assistance Professionals (ACAP).
2. Find out what’s a fair price
If you’ve confirmed your bill’s correct, but are wondering if you got a fair deal, it’s time for a check-up on their pricing. The cost of any specific procedure can vary by a dizzying amount. Thankfully, in the same way you can look up what to pay for a used car, you can get a baseline estimate of what to pay for a specific procedure. The online sources include:
3. How to negotiate your bill
OK, you checked for errors and found none, you’re satisfied you’re paying what’s typical for services received. And yet…if it still feels like you’re paying too much. You’re far from alone; plenty of patients have figured out they can get a better price — and succeeded.
To be clear; Individual results will vary, and some providers will budge more than others. Nonetheless, it may surprise you how much wiggle room there actually is. In 2016, The Journal of the American Medical Association (JAMA) looked into how often people leveraged a deal on out-of-network bills:
“We found patients negotiated 19% of [out-of-network] bills, were successful in lowering their costs 56% of the time and were more likely to be successful negotiating with providers compared with insurers.”
So how did they do it? There’s no secret sauce, except to say this is a case where honey works better than vinegar. Polite, patient, and sincere will get better results than losing your cool. We scoured online forums for instances where people talked their way into a discount, and here’s what works:
- Ask for a discount for paying in cash. Of all the ways people report scoring a discount, this may be the most successful. If you can pay your bill in full, in cash, users report getting their bills reduced by 25% or even more.
- Make your case for hardship. If you can explain in direct terms that your medical bill contributes to real financial hardship, they may offer to reduce it. “You’ve got nothing to lose by asking” is the thinking here.
- Explain an honest mistake. Medical billing is notoriously convoluted, as even medical professionals will testify. If you feel a service and the resulting cost were not adequately explained to you during your visit, let them know. They just may see it your way cut you a break.
- Ask for a zero-interest payment plan. Select hospitals may offer financing options to patients at no interest. You’re not negotiating in the strictest sense, but if you’re only option is putting the bill on your credit card, then at least you saved paying a bunch of interest.
Check for financial assistance
But don’t overlook financial assistance available directly from participating hospitals. They may or may not include this information on your bill but call or search online to be sure. They can be in the form of outright assistance to those that qualify, or they may take the form of zero-interest loan. Finally, there may be financial assistance available for specific disabilities or medical conditions. A starting point to see what’s available is medlineplus.gov.
If only we could update you on all the ways medical costs are dropping across the board, or even leveling off. While we wait on that kind of rosy news to report, hopefully you’ve got some new tools to unravel the inscrutable world of medical billing. And just maybe use that “final bill” as more of a starting point.
One final option—Let Vantage Acceptance do the negotiating for you!
If all of this seems overwhelming, we understand! Vantage Acceptance has a long history of negotiating substantial decreases in medical bills on behalf of our clients and we encourage you to give us a call for a no-obligation review of your situation.
Good luck in getting your bills settled fairly and affordably!