On Your Side: Strategies to overcome high medical bills

BIRMINGHAM, Ala. (WBRC) - The cost of healthcare in the U.S. is staggering. While 90% of American adults have some form of insurance, 23 million people - or nearly one in ten adults - have significant medical debt, according to a 2022 Kaiser Family study.

We’ve all opened an astronomical medical bill that takes the wind right out of you. We’re On Your Side with actionable ways to navigate steep health care costs and avoid overpaying.

Caitlin Donovan, Senior Director of the Patient Advocate Foundation, says it’s important to know the total bill isn’t a final number and there’s a chance it could be wrong.

“I think the biggest thing people don’t realize is that most medical bills have a mistake in them,” Donovan explained. “I’ve been in this for ten years and I’ve never seen a mistake in favor of the patient.”

Don’t pay the bill immediately

“I absolutely think that business models rely on most people just paying the bill and you should never just do that,” Donovan stressed. “It’s worth your time and effort to challenge anything that looks fishy to you.”

Request an itemized bill from the provider

“I usually see hospitals sending patients a bill with just a number and nothing else and we’re looking at it saying what is this even for,” she asked. “How do we know if that’s correct? We just know it’s a big number and that doesn’t feel right and that’s a good sign for you to follow up with that billing office and ask for an itemized bill. They’ll give it to you if you ask for it.”

Keep an eye out for an explanation of benefits, or EOB, from your insurer to show what they paid.

“Otherwise, you might end up with this $30,000 medical bill and think that that’s what you actually owe when you really only owe $200.

Compare notes

When you receive the statements from both parties, make sure the numbers from your insurer and provider are the same. If not, there’s an error.

If everything checks out, call your insurer to ask why the bill is so high.

If the provider submitted a wrong code for a service, ask for the correct code. Contact your provider with that information and ask them to resubmit the claim.

“When I had my daughter, I received a high bill and I knew it was incorrect; it was for a lactation consultant which should have been free by law,” Donovan explained. “So I finally said to the insurance company, ‘what do I need to have them bill this as, what code should it be’? They told me the code, I called the billing office back and said the insurance company is saying it should be this code and they resubmitted it, and I had a free service.”

Donovan urges all patients to be direct and ask the tough questions.

“We try to tiptoe around asking ‘do you have financial assistance for me’ or ‘can you tell me if this is correct’, when you should just say what’s bothering you because it will save you some time and you’ll get the answer that you actually need.

Pursue relief

If the bill is correct, contact the provider’s billing office to see if they offer financial assistance. If you don’t qualify, discuss settling the bill for a lower price. You aren’t required to accept the settlement amount offered at the time of the call. After a final number is reached, most billing offices offer payment plans to spread out the cost.

Another option is to request the cash price, or what it would cost if it wasn’t filed with insurance, which is generally lower.

“But there’s one trick about it,” Donovan warned. “Check to make sure that you’re not going to hit your deductible that year. If you’re going to hit your deductible, it’s worth having it go through your insurance so that the rest of the plan year you’re fully covered and only paying those copays.”

If you need additional assistance, there’s help available to cover other costs while you pay down that bill, starting with the Patient Advocate Foundation’s financial resource directory.

“You can search for whatever you need, if you need something to help you with rental assistance, transportation assistance, childcare, even pet food,” Donovan added. “You can find it on there. Just remember that you don’t have to solve a medical bill by looking for medical billing assistance all the time.”

If you’re diagnosed with a condition that has an advocacy organization, those groups often offer financial relief for patients as well.

Negotiating medical bills is a long game. Know going in it could take weeks or even months to get to the bottom of questionable costs.

“We have professional case managers who will chase down some of these bills and sometimes it takes them 22 phone calls on average to resolve the case, and they’re professionals,” Donovan said of the Patient Advocacy Foundation.

No Surprises Act

Donovan calls the No Surprises Act one of the most consequential pieces of legislation for patients in recent memory. It protects the consumer from surprise medical bills for both the insured and uninsured and adds protections for good faith estimates for health care costs.

You can read the guidelines and your rights here.

Medicaid

For the first time in years, Alabamians are being disenrolled from Medicaid. Donovan urges parents who may no longer qualify to check with Medicaid to see if their children qualify individually.

“You can actually qualify as a child with twice as high of an income and as an adult in a lot of places,” she explained. “If you’re worried that you’re no longer insured or if you need assistance, please look for it because there’s a good chance that someone somewhere will be able to find you insurance coverage or find new financial assistance so that you can get the health care you need and focus on getting better.”

Click here for more information on All Kids Insurance for Children, offered by the State of Alabama. For example, a family of four making less than $90,000 a year can qualify for All Kids.

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