Before you start, please ensure that you have your health plan to hand and that you understand the benefits and the limits. In case you would like to know more about some of the confusing terminology contained in your health insurance plan, check out our other blog post on Health Insurance Basics Explained.
Now that you know your plan, let's follow these steps together to work out how to reduce your medical bill.
Step 0. First, check if you have not already received and paid that medical bill. You will be surprised by the number of duplicate bills that are sent out by healthcare providers. If it is a duplicate bill, call your doctor’s office or your health care provider and inform them about this error immediately. Let us assume this is not the scenario- what next?
Step 1. Do not pay your medical bill immediately. Wait for an "Explanation of Benefits" document to be sent by your insurance company. If a collections staff of the health care provider calls you up and asks for payment, inform them that you have not received the explanation of benefits from your insurance company. The Explanation of Benefits (EOB) provides a great deal of detail about the healthcare service availed by you and lists out how much you owe. The EOB is generated typically after the insurance company has negotiated with and agreed to pay a final amount to the healthcare provider (and hence what remains to be paid by you). In some cases, the health care provider sends out their bill before this is done and many times customers pay it without giving it a second thought! You should never pay a medical bill unless you receive the EOB.
Step 2. You have got the explanation of benefits from your insurer- now what? Check if the medical bill lists all the services availed by you in detail. If it does not, then you have the right to ask for an itemized bill that lists every procedure and service that was performed by the health care provider and its charge. Wait to get this before you pay anything. Check if you have met your deductible payment till now. If not, then you will have to pay that part of the bill before your insurer begins to pay for your health care costs. Also, check that the co-payment indicated in your EOB is correctly calculated and that you have not paid it already. If you find any issues with the co-payment calculation, contact your insurer and tell them to fix it. If you think you have paid the co-payment already (as you may have paid this amount at the time of appointment), contact the health care provider to correct the bill and resubmit to the insurer.
Step 3. Do you fully understand all the charges in the medical bill and do they match the EOB? If you do not understand all the charges on the bill, then contact your health care provider for an explanation. This is your legal right! The provider’s staff may raise objections against giving you this information, but you should hold your ground and get this information. Also, check if the cost indicated on the health care provider’s bill matches the charges shown on the explanation of benefits statement sent by your insurer. If there is a mismatch, then you should call the insurer or the healthcare provider to correct it.
Step 4. Check if the EOB states that all or part of the medical bill is for an ‘uncovered procedure’. Also, check if a provider who was ‘out-of-network’ delivered any of the services. Confirm this with the terms and conditions of your health insurance plan, preferably on the website of the insurance provider and with their customer service. If you have misplaced the terms and conditions, then ask your employer to provide a copy or get it from the website of your insurer.
Step 5. What if you found some (high!) charges caused by ‘uncovered procedures’ or procedures delivered by ‘out of network’ providers? Usually, this leads to high-cost items on the medical bill. Why are the charges high? Only because these are rates that have not been negotiated with your insurer and the provider has used their discretion in (over)charging you! At this stage, your course of action is to negotiate the high charge with the provider. Many providers will accept a discounted payment if you ask for it and if you can pay the discounted amount immediately. They accept a lower payment because from their experience, uncovered procedures and out-of-network result in high costs and collection issues that they prefer to settle quickly. So here's what you do: refer to the CMS website and other sites such as healthcare blue book to research details on the usual pricing of your procedures. Then call your health care provider and explain to them that the charge for the procedure is usually quite low (use your research data from the above websites). Make sure you connect with someone senior in the billing department of your health care provider. Be firm and assertive.
Step 6. What are the other steps to take if the situation is taking time to be rectified? The author Elisabeth Rosenthal writes in her book on this subject, “An American Sickness”, that another step to take is to protest high bills in writing. Send a copy of your letter to the local newspapers, the state insurance commissioner, the consumer protection bureau and the national specialty association of the doctor who examined you. For the list of the medical associations, refer to this list of medical associations.
The associations are usually not very happy to have one of their members overcharging the public, resulting in negative publicity for them and they can typically exert pressure to rectify the situation. Hopefully with some time, a few phone calls and some patience, you would have managed to remedy the situation and reduced your high-cost medical bill.
We sincerely hope this guide is useful to you. We will be periodically adding more informational posts that help you save money!
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