How to reduce the bill for treatment in an American hospital

Having received a bill from the hospital, the main thing is not to panic, otherwise you may end up in the hospital again, this time with a nervous breakdown. If you approach the issue wisely, you can try to reduce the bill that you were sent after treatment. ForumDaily learned how to do this in theory and what happens in practice.

The main thing is not to ignore

Rimma Gonchar from childhood stands on skis, conquered the steepest mountains in Europe. Having moved 10 years ago from Vilnius to Denver, she did not give up her hobby. Injuries over the years, of course, have been. But, as a rule, bruises healed themselves. But an unsuccessful hip landing two years ago had serious consequences. Rimma recalls that even at that moment she was thinking not about how the femoral neck would grow, but about what expense she would get for the treatment.

“As expected, the bill was almost $95,” Rimma sighs. “I didn’t have insurance, I couldn’t afford it, so what can we say about such a sum for treatment. I cried for several days, imagining that now I was in debt.”

Friends gave the right advice - never ignore the bill and find a lawyer who solves such issues, helping to reduce the bill. Rimma was then very surprised by this opportunity: “I remember I asked, “Are some of the medications going to be pumped out of me?” How can I reduce the expenses that have already been made?

According to the national survey Consumer Reports, 57% of Americans do not even know that they can dispute a bill from a medical institution. At the same time 93% of those who fought to reduce the bill, were able to achieve this. Therefore, the advice Rimma got right.

Having received the bill from the hospital, Rimma Gonchar cried for several days, imagining that she was waiting for a debt pit. But the lawyer found errors in the bill, and the amount was reduced. Photos from the personal archive

There is no point in ignoring your hospital bill in the hope that they will give up on you. Yes, the hospital will give up, but the collection company, to which information about debtors is transferred, will ask you for everything. The first result will be the reaction of banks: credit card limits will be cut. In addition, an unpaid medical bill will immediately affect your credit history and credit score. The debtor receives a mark of financial unreliability, which is called a derogatory public record. It is attached to your Social Security number and can be branded for up to 10 years. Such a mark may cause refusal by the employer or company renting out housing. Of course, with any purchase on credit there will be difficulties - you will simply be denied loans. To avoid getting into such a situation, Rimma Gonchar turned to a medical lawyer (Medical-Bill Advocacy or billing specialist).

These specialists work differently: some ask to pay for their services immediately, others only invoice after a successful resolution of the issue. Online Medical Billing Advocates of America You can find a lawyer in your city.

Check seven times

First of all, Rimma, together with a lawyer, asked for an account statement from the hospital called an itemized bill. With its help, you can figure out what services the clinic has rendered and for which it was billed. After a thorough check, it turned out that a submission was made to Rimma’s account. That is, she was offered to pay for services that she did not receive. It turns out that this is not uncommon.

As Rimma's lawyer Alison McGuire explained to ForumDaily, checking the bill that came from the hospital is a normal and correct tactic, because errors creep into a third of medical bills. And this is not always an attempt to deceive the patient; sometimes the error can be technical, and sometimes the reason is a banal “human factor”.

Attorney MacGuier is currently working with a client who received a huge bill for childbirth: “The woman had multiple surgeries, a difficult birth, and the bill came in at over $100. Her family cannot afford to pay such a bill, but we started not by looking for a way to reduce it, but by carefully checking for errors and deception.”

As explained by the lawyer, the details in the invoice include the date of treatment, a description of all services for which fees are charged, and CPT codes these same procedures. In the CPT codes, the description and cost of the procedure is encrypted.

Here are some tips on how to detect errors even without the help of a specialist:

1. Check the dates on which the treatment was carried out. If they do not coincide with reality, this is the first sign of addition to the account.
2. Make sure your insurance details are recorded correctly. Despite the fact that you have filled out all the forms and submitted the correct information, it will be useful to make sure that all the data about your insurance is recorded correctly.
3. If you have insurance, ask the insurance company for a full payment explanation (Explanation of Benefits) and compare the amount of expenses that you have to pay with the services that your insurance policy covers.
4. Check for duplication of procedure. Make sure you don’t have the same procedure recorded twice.
5. Find the procedures you canceled. If the doctor has prescribed, and then canceled some type of treatment, make sure that it is not included in your bill.

Other errors that may be hidden behind CPT codes are difficult for a non-specialist to see. But if you have a bill that you cannot pay, and the amounts for the procedures seem clearly inflated, this is a reason to start an investigation.

According to medical attorney Alison MacGuier, a payment plan is the first thing to do once you know the final amount of your medical bill. Photo from personal archive

How to appeal a bill with an error

If an error is found in the invoice that you received, you must appeal it immediately. This does not always need the help of a lawyer. When errors are obvious, it is enough to contact your doctor or hospital.

For Lana Gorbunenko from New York, the error in the bill was related specifically to the insurance: “After shoulder surgery, I received a refusal of insurance compensation and a bill for $29. I didn’t understand why the insurance company rejected the application to pay the bill, so I first came to the clinic with this question. At work I was advised to do just that, because the clinic is no less interested in getting my bill paid than I am.”

Lana found on Online Hospital information about where to go to those who are not ready to pay the bill in the form in which it was exposed. Ibid found outthat it is possible to get a Russian-speaking assistant.

“The hospital took care of the entire appeal process; all I had to do was get a denial letter from the insurance company and give it to the doctor,” says Lana. As a result, she received a new bill for $760. The woman came to the hospital again and said that she would pay the amount, but in installments. A payment schedule was immediately drawn up, and within a week she received a new bill and the opportunity to pay off the debt with minimal disruption to the family budget.

If you can't pay, bargain

Coming to the hospital and negotiating sounds almost the same as going to the market and negotiating a better price. In fact, it is true! A resident of Portland, who asked not to be named, shared his experience with ForumDaily: “My wife had a simple gynecological operation, but we received a bill for more than $20. At that moment, money was very tight in the family. I came to the financial department of the hospital and said as if in spirit, they say, there is exactly half of the amount, and then I can pay in installments. Usually they hire a lawyer for such negotiations, but I didn’t have the money for one either. I expected that they would throw me out the door, but at the hospital they met me halfway. Not right away, really.”

The whole process took about three months: “I proved our low income, wrote letters explaining the plight. As a result, they reduced my bill by a third and advised portal, where money can be raised using so-called “popular financing” - crowdfunding. There we collected $3500, added the same amount of our savings and paid the bill.”

At least 10 dollars, but pay

If you cannot get a discount from the hospital, or after the discount the amount is still too large, you need to move on to the next stage of negotiations - draw up a favorable payment plan.

According to medical attorney Alison MacGuier, a payment plan is the first thing to do once you know the final amount of your medical bill. “If you have checked the invoice for inaccuracies and errors, if you have tried to get a discount, and you already have the final invoice in hand, and you still can’t afford it, you should not immediately take out the family savings and sell them,” the lawyer advises.

If you make a payment plan, then, most likely, the payment of debt does not hit hard on the wallet. Counsel's advice: at least 10 dollars per month, but pay. In order to draw up a payment plan with the hospital financiers, you need to show the income and expenses of your family and justify the amount you are willing to pay every month.

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