Health-Care Savings Series—Day 4: Negotiate your medical bills and check for errors

The cost of medical care continues to rise, and the uninsured often have to pay a lot more for the same procedures than those who are covered. Insurance companies can negotiate group rates with hospitals and other health care providers, but when you don't have insurance, or your procedure isn't covered by your plan, there's nobody to negotiate on your behalf. As a result, the bill can be four or five times more than an insurance plan would pay. And even procedures that are covered can cost a lot more than you expect, especially as insurance covers less of rising health care costs. But you can negotiate on your own behalf.

If you have the means to pay, but the amount is too high, you may be able to get your bill reduced by more than fifty percent if you pay it at the time of service. Figure out how much you are willing to pay and ask to speak to the manager of patient accounts. Billing is an expensive and time-consuming process, so the hospital representative has an incentive to reduce the bill in order to get it off the books promptly.

If you can't pay up front, try to negotiate a reasonable payment plan that you can afford. Avoid putting your balance on your credit card, or on any special medical credit cards or loan programs, or you could end up paying high interest rates. See our full report on medical debt for more.

Also make sure you review the bills carefully. Billing errors are common at hospitals and other health care facilities, so ask for an itemized bill and check it for accuracy. If you have insurance, compare the bill to your plan's explanation of benefits or Medicare summary notice. Look for all the common errors, which include:

• Incorrect dates of service. Make sure you're not being charged for a room on the day you were discharged from the hospital, which most plans don't allow.
• Inflated room charges. Incidentals like sheets and towels should be included in the basic room charge.
• Duplicate fees for tests and procedures.
• Human errors. One mistaken keystroke could result in the wrong billing code.
• Inflated operating room time. Your hospital should have an exact record of when your surgery began and ended.

You may also find that you were charged out-of-network rates when you thought you were in-network. For example, you may have made an appointment with an in-network surgeon, but the anesthesiologist is out-of-network, leaving you with a hefty bill. In that case, ask if they'll accept your plan's in-network rate, or negotiate a lower rate. For more on hospital bills see our full coverage.

—Kevin McCarthy, associate editor

Tomorrow: Use Available Tax Deductions and Credits to Lower Your Health Care Spending

Comments

[Ali Belarbi]

the only ones making money in all this are the insurance companies AND the service providers.
After being hospitalized 3 times in a 7 months time,i was truly amazed and schoked at how many "billing mistakes" were made. My 3rd grader would have been more accurate.
I do not not believe that billing departments at hospitals,doctor's offices,labs,etc make innocent mistakes. They make these mistakes intentionally in hopes that nobody will call them on those mistakes. Why are the mistakes always in THEIR favors??? I have been over billed,billed twice for same services,etc... never UNDER-BILLED !!! No test have ever been forgotten from my bill. EVER.No charges have ever been "mistakenly forgotten" from my billing statements.EVER.

How convenient.
I have learned this the hard way. Fooled me once. Now i look at all my bills with a Columbo eye and i take pleasure on calling those rude and and mischievous people when a supposedly mistake is made and i dont let go til i get answers. I am a mad dog when it comes to this.And i let them hear my smile through the phone. They know they got busted and that just "shut-them up".
Shame on them.

That is my victory.

[Jo-Anne Sheehan, CPC]

*By law, physicians cannot adjust bills unless a patient requests this courtesy. A patient can always ask a doctor to accept what insurance would have paid for their visit- an amount that is substantially less than the orginal charge.
*Do not assume that your healthcare provider's invoice to you is correct. With the implementation of technology comes a myriad of problems linked to patient billing.
*Denials generate from an insurance company due to simple reasons like not having a correct date of birth on file or perhaps the doctor's office key punched in the wrong information.
*Missing suffixes and prefixes on an insurance id number can prompt a denied claim.
*Exact spelling of a patient's name is imperative. If the insurance company has your card printed out as Mary Kath instead of Mary Kathryn, a denial can be generated if billed as Mary Kathryn.
*Know your coverage. If your insurance does not pay for physical exams, know ahead of time that you will be invoiced. However, if you have a chief complaint, be sure to indicate this at the tine of service, even if you have not been seen in a year and may require an annual pap.
*Medical billing and coding of services has become very complex, making it difficult for doctors to code properly. Insurance rules vary so doctors not only must understand coding rules; they must know specific carrier rules in order to get paid. This is not easy.
*Many HMOs have time limits for billing and will deny a claim if it is sent in late. Patients are not liable unless they gave the insurance information to the doctor's office too late. Many patients make the mistake of ignoring bills because they feel they have coverage and when they do make an inquiry and provide updated information the file limit has passed.
*Be proactive. Insurance representatives are friendly and cooperative on both the doctor and the patient's side. Ask them anything.
*Ask your carrier ahead of time if you are having a procedure and see if it is covered or has a deductible.
*ALWAYS have your card read when you see a healthcare provider and make sure the office has your updated information.
*Keep a log of all visits, what happened at the front desk, reason for the visit and how much of a co-payment was made, if applicable. Any phone inquiries, written letters, etc. should be logged. A paper trail is vital if you have followed the rules but the doctor or insurance company have not done their job.
*Front desk personnel must know a lot more now than only a few years ago. Their job is not simply making appointments. There are not that many well trained front desk staff and you will be able to spot a doctor's office who may cause you problems in the future.
*Lastly, do not be embarrassed to state the true reason for your visit. Doctors and staff have heard it all. If you say you are coming in for an annual exam because you are too shy to say you are really having problems with vaginal itch or rectal bleeding, the reason for the visit is documented initially in the appointment scheduler.Sometimes doctors are so busy they end up focusing on the problem documented from your phone call than what transpired during the visit.
Healthcare is pretty complicated today so patients must take charge or get inundated with incorrect bills that they feel required to pay.