MEDICAL BILLS
MANAGE COSTS
Financial Tools
How to Negotiate Medical Bills
En Español | Many Americans avoid getting medical assistance due to the high cost of medical care, which is sometimes impossible to pay. This is why it is important for a patients to know which steps to take in order to help reduce the financial burden of medical bills.
BILL AND COSTs review
1. Request an itemized hospital bill with all Current Procedural Terminology, best know as CPT billing codes. CPT codes are five-digit codes that describe medical services.
2. Create a medical record of all the services and supplies you received along with their corresponding charges.
3. Review the bill for any errors like number of days in hospital, surgical procedure, use of private room, and check that the correct service code was applied.
Some common errors can be:
Upcoding: When the provider has reported a higher-cost diagnosis in order to make more profit.
Unbundling: When multiple tests are separately billed instead of bundling them together for the one medical diagnosis.
Duplicate Billing: When they duplicate a charge.
Mismatched Coding: When the code does not match the diagnosis.
Name and identification number: Check if they are correct.
4. Ask your insurance company to check the bill for errors or overcharges. Ask if the procedure is covered by the plan and try to obtain an estimate of how much you would need to pay.
5. Take look at the following websites to check the average cost amount the hospital would be receiving from the insurance company for service at an in-network facility.
These figures can serve as starting points for your negotiation if you were balanced billed (when an out-of-network provider took part in your treatment without your knowledge and charged you the difference between their fee and what your insurance covered).
negotiate payment
1. Figure out how much you can pay.
2. Try to agree for a prompt payment. Sometimes medical provides will accept far less money if you agree to pay them immediately.
3. Ask for an installment plan. Let the hospital know how much you can afford to pay. Generally, you will have up to two years from the original bill to pay it off.
4. If unable to pay ask if you can be eligible for the hospital’s “financial assistance policy” or “charity care”. If your income qualifies, the hospital might cut the bill in half or forgive it. Non-profit hospitals are required by law to have this assistance policies. If you don’t qualify, ask if they know of any organization that can help you cover the cost.
The Affordable care Act (ACA) requires hospitals to have financial assistance policies and parameters for what the hospital can do. Hospitals are not allowed to charge patients who qualify for financial assistance aid more than they would charge an insured patient.
5. Don’t pay your medical debt with a credit card, you might pay higher interest rates and lose protections that come with medical debt. Instead use a Medical Credit Card which provides the option to purchase interest free periods of 6-12-18-24 months.
6. If there is no progress in your negotiations, work your way up to speak with a supervisor like the Director of Revenue Cycle for the hospital.
7. If you had filled out the consent for treatment and have crossed out the clause that says “you agree to pay whatever the cost is”, you have no contractual obligation to pay, and the law prohibits collection agencies from hurting your credit. More information can be found here.
8. Keep track of calls in writing, dates, time and name of person with who you spoke.
9. Document your concerns and requests in writing, mail a copy to the hospital and keep a copy for your records.
1o. If the hospital threatens you to send you to collections tell the company you are waiting for an itemized bill (in case you still haven’t received it), this way you can delay the process and protect your credit record.
11. You can always consider suing them in a small claims court, the cost to file the claim can be $30 and their claim limits can be up to $8,000.
12. If the bill is sent to collection ask for the written statement that one agreed to the price (hopefully this statement was crossed off).
For additional assistance:
National Foundation for Credit Counseling
The Payment Advocate Foundation
Phone: 1.800.532.5274
Professional Billing Advocates, they offer free consultation.
Medical Credit Cards:
search for CPT codes:
Centers for Disease Control and Prevention (CDC)
To search ICD-10 Diagnostic codes.
How to Deal with Debt Collectors
Hospital Collectors:
Tell the hospital collections department that they did not provide you with known pricing before the time of service in accordance with the federal law of Section 2718 of the ACA.
If they continue to pursue you, say that you will turn them to The Center for Medicare Services (CMS) for breaking a federal law.
Collections Agencies:
The Florida medical debt statute of limitations is five years, and four years for oral contracts. This means that after five years (or four for oral contracts) creditors will not be able to file a lawsuit against you for an outstanding debt. However, it does not absolve you from your obligation, and it will not stop collection agencies from calling you, or change the negative payment history on your credit report.
You can have them stop calling you by sending a “No-Contact letter” but keep in mind that you are still responsible for the debt, they might sue you and file a lawsuit.
How to Contest a Code Error
1. Contact the billing department of the facility: Try to solve the error with them. Always take notes of the representative name, date, and time of call. If unsatisfied with progress appeal in writing to the hospital administrator or patient ombudsman.
2. Call insurer to dispute the error: They can work with the client to file a formal appeal to dispute a charge. They can also examine the bill for red flags that can indicate fraudulent activity committed by the provider.
3. Contact a credit-reporting agency if your credit score has been affected. Credit agencies should be able to address credit score issues if the charges are still in dispute.
4. Submit complaint/grievance.
File a Claim to
US Department of Health and Human Services (HHS)
TO FILE A COMPLIANT contact
Agency for Health Care Administration
Phone: (888) 419.3456
How to Negotiate Surprise Medical Bills
Florida Health Bill, prohibits an out-of-network medical provider from balance billing members of a Preferred Provider Organization (PPO) or an Exclusive Provider Organization (EPO) for covered emergency services or covered nonemergency services.
Medical Surprise bills are bills that charge you for a service given by an out-of-network provider in your in-network facility. They might be the ones looking at your X-Rays, the pathologists, anesthesiologists, cardio EKG, ER physicians, or the blood work facility where they sent your tests. Insurance companies will reject them claiming you should have known better. It is tedious but important to ask every single person you work with, from the staff to the labs to the imaging center if they are also covered by your insurance.
Before a planned procedure
1. Ask what the doctor charges, and call the insurer and medical office to verify that the facility, the treatment, the doctor, the tests, and anyone involved in the procedure are covered in your health plan’s network.
2. Find out if the local in-network hospital uses their own physicians or rely on outside contractors.
3. Ask your insurer in advance which labs they cover, and ask the hospital that all your lab works go there, as this is a common huge out-of-network bill.
4. Ask for the Current Procedural Terminology (CPT) code for your procedure. This is a five-digit code used for billing and insurance claims.
5. Call the insurance company and get the exact procedure name for this CPT code, they will be able to look for the payment amount specified by their contract with a provider or hospital.
6. The insurer can help you compare rates it has negotiated for the same procedure at different hospitals in your area.
7. Look if emergency transport is part of your plan.
The following steps will help you negotiate a surprise medical bill:
1. Try to negotiate with the hospital, the broker who sold the insurance policy, or the company handling the claim.
2. You can argue that you went to an in-network facility, and were not informed that out-of-network providers would be taking part in you care, and you did not consent them participating in your care. Tell them that you will pay only the co-pay you would have had to pay for an in-network provider.
3. Reach out to the insurance regulator and Attorney’s General’s Office in your state, or the Consumer Services at the Florida’s Chief Financial Officer as they provide advocate services.
Some hospitals and providers may offer discounts for pre-payments, but you need to ask for them. Common examples are CT scans, which can alleviate the high medical costs. Before proceeding with any payments, ask your insurance company how reimbursements are handled if you pay in advance, and how your health plan handles its part of the bill.
RESOURCES:
Protecting American Consumers
Health Bill Summary