If you’re worried about financial ruin from big medical bills, you’re not alone. Consider these startling statistics: In a survey of 1,000 Americans, 64 percent said they delayed or neglected seeking medical care in the past year because of concern about high medical bills.
In another survey, one-in-four people had trouble paying a recent medical bill. And—because of high deductibles, co-pays, co-insurance rates, and surprise out-of-network charges—that includes many people with health insurance.
All told, one in three Americans has debt from medical expenses. Often that debt is delinquent. About 20 percent of consumer credit reports include one or more medical collections, which means the consumer has one or more medical bills that are unpaid and overdue, with creditors in pursuit.
The pandemic isn’t helping. So far, an estimated 5.4 million Americans have lost their health insurance since the virus struck in early 2020. Furthermore, a new study shows that the hospital treatment for COVID-19 patients without insurance (or receiving out-of-network care that isn’t covered by insurance) typically ranges from $35,000 to $46,000, with some bills as high as $93,000.
Even insured patients paying so-called “allowed amounts” are typically charged about $24,000, which translates into plenty of fiscal stress if you have a plan with a high deductible. (The number of people with high-deductible health insurance plans has doubled in the last decade.)
The first emergency coronavirus bill passed by Congress was supposed to provide money for hospitals and health-care providers to forgive all COVID-19 related medical bills—but lack of insurance, loopholes in funding for those who are insured, and the expiration of benefits will leave many people with a high tab. And possibly poorer health as a result.
A recent article published in the Journal of the American Medical Association, one of the leading medical journals in the United States, stated that financial harm from medical care is every bit as dangerous to health and well-being as harmful side effects from drugs or complications from surgery. The authors asserted that patients can and should demand “transparency and honesty in pricing and in billing for medical services.”
If you’re dealing with a medical bill that seems confusing, wrong, or unfair, or if you’re faced with a bill you can’t pay, here are ways to deal effectively with insurers, doctors, hospitals, and creditors to prevent or reduce your financial harm.
Know your coverage before you receive care. Before seeing any new doctor or specialist, check with your insurance company to make sure they are in your network. Call the insurance company to confirm: Online directories are not always updated and if a physician drops off the list, the extra cost is on you.
If your doctor or hospital orders tests and services, call your insurer’s customer service line and ask to review the Summary of Benefits and Coverage (SBC) section of your policy to make sure they’re covered. If the services aren’t covered, call the customer service department and find out why. Your doctor may be able to appeal the decision or request a “peer-to-peer” consultation with the insurance company’s medical director. Or your doctor may be able to order a different and generally comparable test or treatment that is covered.
Shop around for medical tests and procedures—and negotiate a fair price. Prices for the exact same service vary widely—if you can find out the price at all. For example, in a survey of 101 hospitals, prices for coronary artery bypass surgery ranged from $44,000 to $448,000, and only 53 of the 101 hospitals were willing to provide a price. Further, the varying prices reflected no difference in the quality of care, according to a quality score from the Society of Thoracic Surgeons.
Fortunately, there are ways to discover the fair prices of medical tests and procedures, which is particularly important if you don’t have insurance, or you have a policy that is not compliant with the Affordable Care Act (Obamacare).
Once you know the fair price, you can negotiate with your doctor, hospital, or insurance company. First, ask for the cash price. If your doctor or hospital accepts the Medicare “allowable amount,” offer to pay it in cash before your visit or procedure. In many cases, the doctor or institution will offer significantly discounted rates for upfront, cash payments—sometimes as much as 40 percent lower than the insurance-negotiated rate.
Don’t sign any paperwork in the emergency room. If you go to the emergency room and the hospital insists you sign a form for financial paperwork, refuse, or write “Did Not Read,” instead of your signature.
This is your legal right: The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital emergency rooms to stabilize anyone needing emergency care—and ensures public access to emergency services regardless of a patient’s ability to pay.
Watch out for balance bills. Many consumers with health insurance are blindsided by balance bills—charges from out-of-network providers (anesthesiologists, radiologists, and pathologists) who work at an in-network hospital. Up to 57 percent of all medical bills now include unexpected, out-of-network charges. (You don’t have to worry if you live in California or Florida—both states have outlawed balance billing.)
To help avoid this problem, make it clear to your doctor that you want to stay in-network and avoid all out-of-network charges. You can also contact your insurance company and ask them to help you find nearby in-network labs and facilities. (Quest and LabCorp are on most plans.)
Ask for an itemized bill from your doctor or hospital, and dispute inaccuracies. It’s your legal right to know what you’re being charged for, but you’ll likely need to ask for an itemized bill. Don’t expect it to be accurate. About 80 percent of medical bills contain an error, such as duplicate or incorrect charges.
If there are any discrepancies—for example, you’re being billed for a test you didn’t get, a medication you didn’t take, or an incorrect number of days in the hospital—dispute them without delay. Some insurance companies have a statute of limitations for appeals, such as 60 days.
Don’t pay for complications. You should never pay for treatment for complications that resulted from an adverse event, such as a hospital-acquired infection or surgery on the wrong part of the body. If you’re pressured to pay, tell the hospital that the price for the treatment was not disclosed and that you would like an itemized listing of the charges in discovery (or litigation). Hospitals are so averse to revealing their prices in court—where they would be revealed to the general public—that they often forgive the entire bill.
If your insurance company refuses to pay, complain. If the service should be covered by your insurance according to the Summary of Benefits of Coverage in your policy, but the company is refusing to pay—don’t give up. File an appeal. You can find ways to do that at https://advocacy.consumerreports.org/research/insurance-complaint-tool/.
If a debt collector calls, ask to see the contract. If a debt collector insists that you pay for an unfair bill, demand they provide you with the contractual agreement that obligates you to pay. If there’s no written agreement, you have no legal obligation.
Let your voice be heard. Lack of fair and transparent pricing is the key problem plaguing our health-care system. Health care should be regulated by the competitive, free market, where you know the price before the purchase and can shop accordingly. My organization is devoted to advocating for patients, families, and caregivers to receive real-time, free access to prices before undergoing medical services.
