Kelley Long, consumer financial education advocate for the AICPA and founder of the newsletter Financial Bliss, was shocked recently when she received a surprise medical bill after a routine primary care visit.
Her regular doctor had a substitute doctor filling in for her while she was on maternity leave. During the appointment, "I asked if I should start getting mammograms because I was 10 years younger than my mother had been when she was diagnosed with breast cancer," Long says.
Because Long asked about the possibility of a mammogram, the doctor coded the visit as a follow-up visit, rather than the free annual preventative care visit Long was expecting, and she received a bill in the mail for $130.
She disputed the bill in writing, included a deadline for response and cc'd her insurance company. Ultimately, it was resolved when her physician's office manager called Long and the bill was canceled.
If you've had a similar experience to Long's, you know that the stakes can be a lot higher, too.
More than 1 in 3, or 35%, of Americans polled in the February 2020 KFF Health Tracking poll reported feeling "very worried" about being able to afford a surprise medical bill. In February, the Journal of the American Medical Association published a survey of 350,000 people, and the researchers found that 1 in 5 Americans who have planned elective surgery are hit with surprise bills that can be as high as $2,000 over what their insurance would typically cover.
That's a tough pill to swallow, especially when, according to a January Bankrate survey, only 41% of Americans have $1,000 in the bank to cover an emergency.
Here are five steps you can take to handle, and even negotiate down, surprise medical bills.
Each procedure, test, or wellness visit has a medical code attached. "If a code is one digit off, your insurance company may not pay it," says Alan Schoenberger, owner of Endeavor Financial Planning. There are whole companies dedicated to disputing codes, he says. You don't need them. Call your insurance company and go over the bill with them.
Make sure the codes were the right ones for the services and procedures you received. If you don't know what the right code should be, describe the procedure. Your insurance company may code it slightly differently than another insurance company, he says.
Video by David Fang
"My surprise medical bill was an out-of-network 'balance bill' for anesthesia I received for a covered procedure at an in-network office," says Long. "I called the provider and learned I was kind of out of luck. So I asked for a discount, and they gave me 20% off."
If you find out that the bill is actually legitimate, always ask for a discount. If you have a higher deductible or out-of-pocket cost, you can also ask what the service price would be if paying on your own without insurance. You may pay less than what you'd pay with insurance, says Schoenberger.
Many employers may offer free or discounted services such as a gym membership or mental health visits, but Long noted that it's an increasing trend for employers to offer help with medical bills as part of a benefits package.
"Many large employers have some type of employee assistance fund that you can apply to for help with emergencies like overwhelming medical bills," says Long. "These programs are typically funded by a combination of company money and fellow employee contributions."
Employers may also offer free access to a medical bill advocate company such as CoPatient, or a financial wellness coach, that can help with understanding medical bills and the process of disputing them, she says.
Both experts agree: Ask for a supervisor at the hospital, doctor's office, or insurance company phone line.
Getting the official person in charge can often give you a little more negotiating power as they have the authority to change your bill. There will also be a chance that they are more familiar with the specific medical codes than other staff members who don't deal with them on a daily basis.
Video by Stephen Parkhurst
Hospitals may have a hardship program if you are unable to afford payments, says Schoenberger. This option may help you get part or all of your bill forgiven.
If your bill is accurate and you've done everything possible to get it reduced, the next best option is to ask for a payment plan ASAP, says Long. "I've yet to be declined for this and most medical providers are happy to get consistent payments."
"Whatever you do, don't just put medical bills on your card or take out a loan before asking for a payment plan," says Long. Payment plans often have zero percent interest. However, don't wait until the bill is late. Asking early increases your chance of getting a monthly payment plan and not having the bill reported to credit bureaus as a collection.
Reyna Gobel, M.B.A. and M.J., is a financial and physical fitness journalist, author, and professional speaker who's been quoted by Money Magazine, Real Simple, and The Washington Post. She's been published on reuters.com, weightwatchers.com, and theatlantic.com.
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