The prospect of an outrageous medical bill is not what first comes to mind when you’re sick or hurt. Recovery is the top priority. Though many people think there’s nothing they can do about an exorbitant medical bill, that’s not the case.
It’s not simply a question of supply and demand, or fixed costs. Hospitals can and do charge whatever they want. Sure, they sometimes make deals with insurance companies to cut costs for policyholders, but even with insurance, prices vary widely between hospitals for the same service. The most expensive hospital for a particular service often charges 30 times more than the cheapest alternative.
Additionally, as many as 80 percent of large medical bills have errors that result in overcharges, and as many as 50 percent of medical exams are unnecessary. Those numbers may seem bleak, but they do mean one thing: the price on your initial bill doesn’t have to be the one you pay. It’s not fun to look over medical bills, but if you do, you’ll have a good chance of lowering it and saving money. Here’s how to do it right.
Ask For an Itemized Bill
Never pay a medical bill that comes as a statement of a lump sum. If you receive such a bill, ask the hospital to send you an itemized statement. Some insurance companies don’t require an itemized bill if the amount is less than about $10,000, but you should.
Verify Identifying Information
Common errors such as a misspelled name, wrong address or incorrect Social Security number or insurance policy number could result in your insurance company rejecting the entire claim. Depending on your coverage and the status of your deductible, the rejection of your claim could be the sole reason your bill is so high. If you get a bill that has the wrong identifying information, call the hospital or insurance company to correct the error and explain that you won’t pay until the information is correct on bills. Then, ask the insurance company to reprocess the claim.
Check for Common Errors
You don’t have to be a professional to spot many billing errors. First, look over the bill for outlandish charges and duplicate charges, two of the most common errors. Outlandish charges can constitute anything simple, like toothbrushes or Tylenol, for which the hospital has charged hundreds of dollars. Check price comparison tools on the Internet for average charges for services you have been billed.
Medications should be listed by name, along with a billing code. Drug orders are often cancelled or never filled and the patient record isn’t corrected to reflect it, which can result in charges for medications that patients didn’t take. Scan through any listed medications to ensure you took them all. Other common sources for error are room charges. Operating rooms are often billed by the minute, so if you’re not sure about how long you spent in that room, check your anesthesia charge, which should show start and end times under anesthesia. Also, if you stayed overnight and shared a room, make sure your bill doesn’t list a private room.
Compare Your Bill to Your Insurance Statement
Around the time you receive your hospital bill, your insurance company should send you an Explanation of Benefits (EOB) statement. Have your health insurance policy summary handy when you open your EOB so you can compare line by line. Certain errors listed above, like duplicates and overpriced toiletries, may have already been rejected entirely by your insurance company.
Depending on your coverage, your insurance company may also have rejected certain portions of the bill if they were coded the wrong way. If your insurance company didn’t cover something they should have based on your policy, make note of that. Once you’ve combed through your documents and have made notes of anything suspicious, you’re ready to negotiate.
Now is The Time to Negotiate
Contact the hospital first. Depending on the nature of the errors, the billing staff may be willing to adjust the charges and re-submit the claim to your insurance company. If they are not willing to discuss this over the phone, make an appointment to talk with them in person as soon as possible. Always ask the billing staff if there’s any way you can get a discount on your bill, if you pay cash for instance. In any case, you’ll need to contact your insurance company next.
If the hospital is unwilling to correct certain errors, raise your concerns with your insurance provider, since it may lower their payout amount to help you get the errors corrected. Depending on how willing the hospital and insurance company are to fix errors, you may be able to stop here. If not, you may want to write an appeal to your insurance company.
If all else fails, get professional help
If you have little or no luck lowering your bill through reasonable negotiation, get professional help by hiring a medical billing advocate who could negotiate lower costs. These advocates know the ins and outs of medical billing, and can make sense of all the codes and jargon on your documents. Usually they charge by a percentage of savings, so you’ll still get a rebate if they only find small savings.
Lacie Glover writes for NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and insurance.
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