How to Deal With Confusing and Expensive Medical Bills
Shortly after visiting the emergency room or any major medical procedure, bills start popping up in the mail. Some look like duplicates, many are difficult to decipher, and some are not bills at all. Here’s how to decipher and identify all these confusing pieces of paper before someone comes in to look for money you didn’t know about.
Not every dollar sign document that comes in the mail is an invoice.
After a hospital visit or even a trip to your local doctor, the documents you receive in the mail can be divided into two categories: invoices and non-invoices. It seems obvious, but they look alike, so it’s easy to get confused.
Non-invoices (with the helpful tag “THIS IS NOT AN ACCOUNT”) come from your insurance company. This document represents your explanation of the benefits or EOB, and it is your record of what the insurance company actually paid and how much they paid. These are the ones that will probably scare you until your gaze stops somewhere on the “this is not a bill” page. Basic information includes:
- Who was your provider
- A brief description of each medical service provided and the code by which it is known.
- How much did the provider charge
- How much did the insurance company pay
- How much do you (ultimately) owe
- How close are you to paying the deductible, if you have one?
The exact details depend on your insurance company and you can visit your insurance company’s website for more information on how to understand your EOB.
If you see anything that looks like an error in this document, please report it to your insurance company. Believe me, they will want to know about it. For example, if you are billed for more time in the operating room than your transaction used, or if you are billed for services that do not match what you received, the insurance company will not want to spend them (and by proxy, your money.
Real bills come from people involved in your help
Meanwhile, the actual bills come directly from hospitals, doctors, laboratories, and other people and organizations that have provided some of your medical care. You can even get more than one invoice from the same provider. For example, if your treatment involved more than one procedure at one visit, you are likely to receive multiple bills. Don’t worry, just collect the notes, open them and assess the damage. This may not be as bad as you fear. I definitely dug through heaps of bills only to find that some of them were for annoyingly small amounts, like two dollars for my share of a minor procedure that was more than what insurance would pay.
These bills represent your debt after the insurance company negotiated a price cut and then paid its share. Compare bills with EOB to make sure you are not being charged for something that the insurance company has already paid for – this is a double bill and it happens more often than you think. Tell the provider about this and they will charge your account. They cannot legally charge you for something that has already been paid for.
Ask for more information if bills don’t make sense
Some accounts may not contain enough information to know if they are accurate and fair. If you have a consolidated invoice – just a few numbers without much useful information – call your service provider (not your insurance company) and ask for a detailed invoice.
If you receive one but it is still unclear, call back and ask what the individual charges mean, and don’t stop calling or asking until you find someone who can explain them to your satisfaction. After all, this is your money and you deserve to know where the costs are coming from.
Be aware that if you pay bills for someone else in your home other than your child — for example, your spouse — their provider may not be able to talk to you about that person’s health care unless they have explicitly given permission . So when you are a patient, make it a habit to ask and sign a release form (it may look like this ) whenever you seek treatment from a new provider. This way, you or your partner can discuss your bills.
Even with all the information a provider can provide you, you may still feel like you are over your head. If you get a workaround, or if you just don’t know where to start with a large account, consider getting a billing attorney to help you (more on this in a moment).
Beware of illegal billing and check for errors
Medical bills can reach astronomical dollar amounts even when things go up. What’s worse is getting stuck paying for someone else’s mistake or being trapped by illegal billing practices.
Some billing errors are difficult to spot unless you are familiar with the billing industry. For example, upcoding happens when you get paid for a more serious (and costly) procedure than what you actually got. Splitting means that you are charged for something that includes multiple components – for example, a room or operation fee – and then you also pay for some of the components separately (so you pay for the room fee hidden in a larger invoice, and then get another invoice for a room charge.) Read more about these common billing errors here .
Whether these errors are intentional or just plain honest, it is illegal to bill you for them. Medical Billing Advocates of America (MBAA) said medical expenses must be “truthful and accurate” and represent a “fair and reasonable” price.
Unfortunately, there are many unfair yet legitimate billing problems. For example, the infamous “unexpected medical bill,” where an out-of-network provider or service was involved in something that would otherwise be on-chain and you had no idea. Depending on the terms of your insurance company for out-of-network coverage, you may be hooked for a lot of money. To avoid this, the MBAA recommends that you check in advance if all providers who provide you with your health care, procedures, or hospital stays will be online and get a written statement to that effect. (This may not stop them from sending you the bill, but it will give you or the bill defender some support in challenging the charge.)
Balance sheet is another terrible idea associated with this. In this case, a provider who doesn’t like your insurer’s reimbursement rate will take the insurance company’s money and then send you an invoice for the remainder of the desired amount, also called the “balance.” In other words, it kills most of the insurance benefit from your point of view: even when the procedure is covered, you will still receive bills.
Balance billing is prohibited in many states. You can find a complete summary of state balance billing laws here . Some states protect people on some types of insurance but not others (for example, an HMO , not a PPO ), and some states protect you when you seek emergency care but not in other situations.
Negotiate or hire someone to negotiate for you
If you find errors or unfair payments, you can call your service provider or insurance company, or write a letter challenging the charges . Intercession can take a lot of time and energy, but if you think you have a chance to save a lot of money, it’s well worth it.
Even if the rates are correct, negotiations often pay off anyway. Don’t mistake a medical bill for just an apartment number. Providers are used to lowering their fees when negotiating with insurance companies, so if you get a bill that your insurance company did not participate in (perhaps for something not covered by your plan), the provider may be willing to give you a discount. …
Still too expensive? Many providers are willing to set up a payment plan. There are also charity programs to help pay your medical bills if you really have a hard time paying them. To do this, first talk to the hospital that treated you. Nerdwallet has a rundown of your options here . Depending on your situation, you may even be eligible for public assistance.
If this all sounds intimidating, there is good news. You can hire a professional to discuss bills or chase money that clearly owes you. Here are some organizations that can help you find a lawyer to help you with your bills:
- Claims Alliance
- Defenders of America’s medical bills
- Health restoration services
- National Association of Healthcare Consultants
Billing advocates sometimes charge a flat or hourly fee, but other times they deduct their salary from the money they save you. So if they take 25% of the money you save, you’re still better off than if you paid the full price without them.
Whether you’re handling medical bills on your own or with professional help, it’s good to understand these potentially confusing pieces of paper. The numbers on them shouldn’t be cryptic, and they certainly aren’t set in stone. So be careful and you can save yourself some money and headaches.
Illustration by Jim Cook.