Beware Of A Predatory Or Surprise Medical Bill
When patients are responsible and careful to pick in-network hospitals and in-network doctors but still receive care and bills from other out-of-network doctors that they did not choose… that’s predatory billing!
This is also known as “surprise” out-of-network billing. Insurance company’s routinely refuse to pay these out-of-network doctor’s fees, which are typically over-priced and un-regulated. In many such cases, the doctor then “balance bills” the patient for the difference.
Does Your State Have Laws To Protect You From Surprise Medical Bills?
Review the Balance-Billing Protections By State to see if your government officials are protecting you.
Here Are 18 Things You Can Do If You Are A Victim Of Surprise Medical Billing:
1. If you are a client of Revolt Healthcare Alliance: Contact your Concierge specialist to negotiate a fair bill. Every medical bill is disputable. Due to the lack of billing transparency, Americans are often being charged outrageous prices for common medical services, such as $600 for a Band-Aid or $9,000 for a CT Scan.
2. Find the fair market price: You can find out the average price for a medical service by looking up what Medicare would pay and what a commercial insurance company would pay for the same service. Another tool that can enable you to find average prices is healthcare bluebook. Even better, you can show the hospital what other centers charge for the same service by researching prices on our Affordable Surgery Center list.
3. Ask for an itemized bill: 80% of medical bills contain mistakes. Review the services and let the hospital know if there were services not rendered or if there are duplicate charges. Hospitals will often delete items when patients report inaccuracies. Use this tool to translate medical procedure codes and medical diagnosis codes into plain language so you can understand your bill.
4. Call your insurance company: If you have insurance, check your explanation of benefits (EOB) to see if the services you are being charged for should be covered. If you believe that the bill should be covered according to your EOB, but the insurance company is refusing to pay, contact your state. Here is an example of how to file an appeal.
If this seems needlessly complicated – you’re right! But it’s complicated for a reason: there are of course stake holders who benefit from the complexity of our healthcare system.
5. Contact the hospital’s financial aid office: All hospitals are required by law to have a financial aid program. Some hospitals forgive or reduce bills of patients who are below 200% of the federal poverty line. Most hospitals offer payment plans, however, beware of payment plans that offer a small discount on the total bill. Your payment plan should be based on fair market prices and not on an inflated price.
6. Contact your doctor: Explain to your doctor how much you were charged and request that they help to negotiate a fair price on your behalf. For bills from private practice physicians, you can explain your financial hardships and ask for help.
7. Address out-of-network services: If you received an out-of-network charge at an in-network hospital for non-urgent care, you should have legally been warned that you may receive a surprise bill. 57% of Americans have received a surprise bill.
8. Get Help: The Patient Advocate Foundation is a free service that can help.
9. Know your rights: When going to the hospital, you are absolutely not required to provide a credit card or other financial information, including insurance status. Hospitals are legally required to take care of all patients who go to an emergency department regardless of their ability to pay. If the hospital pressures you for payment information cite the EMTALA law.
10. Call your hospital’s executives: If you believe you’ve been unfairly charged for services not rendered or massively overcharged for services received, then contact the hospital’s CEO’s office through the hospital’s operator as well as the CFO’s office. If they don’t help, and the bill is truly egregious, contact the hospital’s board members through their offsite office. Many hospital executives are reasonable, but are unaware of how extreme their billing systems can be.
When fighting a surprise medical bill, be sure to inform your agent that you are taking these actions:
11. Post a review: Draft a review to post on social media sites. But prior to posting, share it with the hospital and billing department to see if they think your review is fair. If publishing a review, post it to multiple sites. Be sure to be factually accurate and civil to protect yourself from legal recourse. Sites you can post to include: Yelp, Rate MDs, Healthgrades.com, Real Patient Ratings, Vitals.com, Doctor.com, and Google.com
12. Engage with your hospital on their social media sites: Lookup your hospital on social media. Tag them within your posts or directly message them to share your situation. Hospital administrators typically respond to patient feedback if it’s public.
13. Call your local news stations: Lookup your local news outlets on the internet. Find their contact information and share your story with their investigative or consumer protection journalists.
14. Submit your bill to national media outlets: There are plenty of national news sources that are willing and happy to tell your story of injustice. Here are a few news companies and how to contact them: NPR, VOX, KHN (Kaiser Health News)
Be patient when taking these steps. It does take time to fight a predatory bill!
15. Contact your state’s attorney general: Reach out to them explaining your situation. With this explanation, ‘cc both the hospital that billed you and a news source who may help hold them accountable for a response.
16. Demand to see a legal contract: If collectors are harassing you for an unfair bill, insist they provide you with a contract requiring you to pay. Collectors are generally unable to provide documentation and without a written agreement that you owe money, you have no legal obligation to pay. If someone mows your lawn without a contract and bills you a $1000, you wouldn’t have to pay for it. It’s no different with medical bills. Even if you signed payment agreements and a consent to treat form when you were under duress, they are not legally invalid.
17. Don’t pay for care you didn’t need: If you received inappropriate care or had an avoidable complication, you’re not responsible for these services. In a study regarding patients in the state of Washington, over 600,000 patients underwent unnecessary medical care at a cost of $282 million.
18. Cash is King: Offer to pay the hospital cash if they will accept the Medicare allowable amount. Hospitals don’t like to, but they will offer larger discounts for an instant cash payment.