How to fight an outrageous medical bill, best practices explained

I’ve come across some astounding charges investigating how emergency rooms bill patients. A woman in California fell off her bike and now faces a $20,243 bill. A patient in New Jersey never got past the ER waiting room and ended up with a $5,751 bill. A dad in Connecticut got a bill for $629 for the Band-Aid put on his 1-year-old daughter’s finger.

Most patients can’t afford these kinds of bills. But they often don’t know that it’s possible to negotiate them down.

I recently interviewed a dozen patients who successfully got their bills reduced, some who were unsuccessful, and even one whose bill went up after he attempted to get it lowered (more on that later).

I learned that people can indeed shrink their bills, but only if they’re willing to put in significant time and, in some cases, money. Here’s what patients say worked — and didn’t.

Best Practices

• Challenge what’s in your bill and how it was coded​ - Find any documentation about how your medical visit was coded and what services were provided. Once you get an itemized bill, you can analyze it for mistakes. You might see a charge for something that never happened, duplicate fees, or things being billed at exceptionally high prices. In the emergency bills I’ve read, I’ve seen a decent number of success stories from patients who challenge the coding of their facility fee — the charge for walking into an emergency room and seeking care. Emergency rooms typically charge higher facility fees to cases they deem especially complex, using a 1 to 5 scale.
• Ask for a prompt-pay discount​ - Patients I’ve spoken with said they often found hospitals pretty willing to offer a discount to those who are ready to pay their bill right then and there.  From the hospital’s vantage point, this often makes sense: It can be easier to take a smaller payment rather than chasing down a bill you might never pay.
•  Call. Then call again. And again. And again.​ - This is something I heard from nearly every patient I interviewed: Negotiating a medical bill almost always involves time on the phone. This is all about getting to the person who has the power to change your bill.
• Consider hiring a professional​ - If you're a patient facing especially big bills, consider working with a professional patient advocate who knows the ins and outs of medical coding.
• Go public​ - When all else fails, shining a spotlight on your bill can often do wonders. Find out who covers the health care industry for your local paper and send an email. It’s important that you have your billing documents and are willing to share those with the reporter. If you’re not having luck with a reporter, social media can be helpful. Tweeting or posting on Facebook (and tagging the involved parties) is a pretty low-effort way to get some attention to your case.
• Be aware that sometimes negotiating won’t work — and can even backfire​ - At the end of the day, it’s really up to the hospital whether to say yes or no. And in some cases, attempts to lower a medical bill can backfire.

The full Vox article can be viewed at this link.