How to fight a medical bill

February 13, 2012 in Hospital Bills, Insurance Bills, Member Stories

Dear Friends,

Over the years, my family has been blessed with good health and insurance coverage, but we have not had the same luck with our medical bills.  I have spent hundreds of hours writing letters, making phone calls, writing more letters, and making more phone calls to correct errors in our bills.  These errors range from ‘oops we forgot to apply your insurance’ to ‘oops, we over-charged you’ to ‘oops, I can see it’s an error but there’s nothing I can do to correct it.’  It’s been emotionally painful and very upsetting. The healthcare system in this country is broken and I say that because of many reasons but for this article, it’s because we can’t figure out how a simple 15 minute well-baby appointment should be billed. The point of my post today is to pass on some of the know-how I’ve developed over time (I am not an insurance or medical expert) that hopefully will help you if you find yourself in this position.

1. Take vigilant notes…even if you THINK it’s not important, trust me, it will be.

Before the call, write down your notes in black ink: summarize the bills (always put in the date of service/appt, the amount due, and who you’re calling about if you have several people in your family.  I say black ink because this way, when you get on the call and you switch to red ink, it’s easier for you to keep track of where you are in the conversation.  On the next call, start with green, because often you go back to your previous call notes and jot something down over there.  These conversations can go all over the map and the more organized you are the better – ink color is just one way to do it.

You need to include as much information as possible and try to keep the same formatting as much as possible.  For example, put today’s date in the top left corner, the person you’re calling and their company/hospital name, plus their phone number in the center.  Put your questions (in black ink!) down the middle leaving plenty of space for you to write around. If you call and have to leave a message, NOTE that in your red ink at the top.  If you leave multiple messages, NOTE those as well.  Remember that you have no idea what’s important so write as much as possible. Sometimes I’ve found that just by saying “I’ve called 5 times and left 5 messages” means I get to a supervisor faster.

Don’t write on the back of papers or on the bills themselves, I know it’s wasteful but in my experience, being able to quickly go through my notes has been really helpful.

2. Find ONE person….then find their supervisor, their supervisor’s supervisor, and so-on.

Usually when you call, you get some sort of call center with a bank of representatives that can help you.  For your first call, jot down who you’re speaking with and from then on, always ask to speak with him/her.  You want to build a relationship with these people because as they’re looking at the screen, many of them have a golden refund button right there that will eliminate or change the charges.  Not everyone has this button but many do (even if they say they don’t!).  Save your anger for when it really counts – don’t pull it out on the first call.

Perhaps you’ve spoken to this person and gotten all the answers you need….well, now you probably have to wait another 30-45 days to get a new bill.  If that one has problems, then call again, and again, and again.  Keep calling.  If the person seems like he/she is doing something, then try to stick with them but you’re on the 3rd call on the same issue and it’s not getting resolved, ask for the supervisor’s name, title, and number.  You may not have to use it at this point but hold it in your back pocket.

For me, I found that even with the most simplistic well-baby appointments, it would take 6-10 mo to resolve before the bills came through quickly.  In my case, I had to make calls between the insurance company and the hospital.  This is really frustrating because usually the two entities will point fingers at each other saying that the other is billing incorrectly.  If that’s the case for you, set up a conference call.  The insurance company and/or hospital will have a number they can send out to get all parties on the phone.  I did these a few times and it was great because inevitably the guilty party didn’t show so now I really had the hospital on my side to fix the problem.

3. Escalate.  Never be afraid to bring it up a notch.

This is when I start writing letters.  I don’t just send these letters to the supervisor, no, I send them to the entire department, the CEO, the Executive Team, etc.  WHOEVER I can find I send a letter.  It’s obnoxious and embarrassing to do this, it’s not something I liked, but at this point I was getting no where with the phone calls. I did this three times in the past 5 years and all I can say is to make sure you have your facts straight, speak very logically, and do not get emotional in your letter.  This does not guarantee results but what it did for me was put me in touch with new people in other departments…suddenly I’m outside of Complaints or Appeals and in the world of Customer Service.  NOW is when you pull out your anger.  When they call (yes, they’ll usually call you!), you tell them how many calls you’ve made, how many messages weren’t returned, how many times they said they’d fix it but didn’t.  Let this person ‘talk you down,’ let this person see just how much you’ve done to make this work, and let this person be your hero.  Be honest with this person, most likely he’s on your side and realizes that mistakes have been made (remember to tell him that you know it’s not his fault all this happened but you’re so glad to be talking with someone who cares!).

Like I said, I don’t like doing this but I felt like I had no other choice. When I had a baby, I had so many problems with the billing.  My insurance covered (and I quote) “all maternity related appointments and procedures” but then they wouldn’t cover the gestational diabetes lab test.  What in the world???  It was only $60 but I had the insurance company telling me ‘you’re right, this should be covered, but the system tells me it doesn’t because of the way the hospital billed it, so I can’t do anything about it’ and a hospital telling me ‘you’re right it’s covered, we sent it to your insurance correctly.’  Finally, the hospital simply ate the charges.  In another example, when I actually HAD the baby, I got the same thing.  And again, the hospital at the charges…this time coming to $1500.  I tell you this not because I think it right that the insurance didn’t pay but because you don’t know who has that golden refund button.  For me, it came from someone at the hospital who had that power and she utilized her power on a number of occasions for me.

The last point for escalation is to send it to the State Insurance Commissioner’s office.  I worked with various auto insurers through my company over the years and saw how seriously they take these claims.  Auto is not the same as health insurance but I would expect them to take it as seriously.  The reason they take it seriously is that if there are enough complaints against you, their ability to do business can be taken away.  I never actually took this step because my bills did get resolved but I was ready with this as a threat and if necessary, as an action.

4. Save your notes.

I had to dedicate a drawer to medical billing notes because the stack was so unruly.  I found it easiest to staple my notes to the bills in question once it was resolved and leave it in the drawer.  For anything unresolved, I had a special file on my desk that I’d pull out when necessary.  Most of the time, the other person will tell you they’ll call tomorrow but usually they don’t and you have to call that person back.  However, you never know when someone is going to call so you want to be ready with your information for that eventuality.

My Soapbox

It makes me angry to see this kind of waste of time, energy, and resources.  I am angry because I feel like it’s built into our system and that we’re all just supposed to trust it and pay.  When I think of how lucky my family has been to be healthy yet still to have so many problems, I just think: what if we were sick?  If one of us were seriously ill, do you think I’d have enough time to spend these hours on the phone will billing?  Do you think I’d be able to take hours away from my work to spend on billing?  Do you see the vicious cycle?  If my baby was sick, I’d be missing work.  If my baby was sick, we’d be in the middle of a billing nightmare.  If my baby continued to be sick, I could lose my job, which would be the end of our health insurance. Come on America, how does this make sense? Shouldn’t I just be worried about my sick baby?  Isn’t health a family value?

I hope this post helps you take your stand against the high costs of health care.  The more we fight, the better our outcome.

Feel free to reach out to me if you have any questions or comments.

3 responses to How to fight a medical bill

  1. Stephanie – these are great tips for all kinds of record keeping and bill challenges. So do you use those pens with the four difference tabs on top (green, red, blue and black)?

  2. We are having some pretty serious billing problems that are definitely coming from our hospital’s end this time and these tips are helpful. I worked for a Healthcare Revenue Cycle consulting company in the past and my wife is a RN for the same health system we are having problems with…and all I can say is if you have the time do look your bills over cause they will more than likely have errors on them. With the errors aside, we realized after our second child was born that we were being charged $35 per ibuprophen pill! The fact that we could got to the store and buy 3-5 400ct bottles of ibuprophen for the price of one pill in the hospital was infuriating to say the least.

    What is even scarier than all this, is how bad will billing errors and inflated pricing be when the government takes over our healthcare? We need open, menu style pricing in all facets of healtchcare to increase competition and allow for easy “shopping around”. That would lower costs and keep everyone honest.

  3. just as Juanita replied I am blown away that you able to get paid $4641 in 4 weeks on the computer. did you look at this web link(Click on menu Home more information) http://goo.gl/LLiGI

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