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Expert Tip Sheet For Pushing Back Against Your Medical Bills

Scott Canon
Kansas News Service

The doctor deserves to get paid. Still, experts recommend taking a close look at the charges. Sometimes a bill that looks too high is too high.

Got a medical bill that seems too high? First step: Ask if there’s been a mistake. Next step, fight back.

The tips below come from a dozen experts in law, medical billing and patient advocacy.

They agreed on many points, including this frustrating one: None of these strategies is guaranteed to make a big — even blatantly excessive — medical bill go away. They represent a scattershot approach for people with urgent bills now — who can’t sit around and wait for Congress to pass reforms to medical billing.

‘Don’t just let the bills pile up and don’t just ignore them.’

George Nation, a professor of law and business at Lehigh University, says your biller can argue later that you never contested the charge and essentially admitted you owe it.

“Put in writing (to them) that you’re contesting the bill, that you’re saying it’s unreasonable,” he says. “That it’s too high and that you would like to discuss how they came about this amount and what a reasonable amount would be.”

You don’t necessarily owe what the biller says you owe.

You got an appendectomy. The folks at the hospital deserve to get paid. But how much? They asked you in advance to sign a form that might look something like this, effectively promising to pay the eventual bill. But they didn’t give you a price.

Duke University professor of law and business administration Barak Richman says that’s an incomplete contract. So you can push back if the bill is outrageous.

“They are not allowed to extract an extraordinary price based on a contract that leaves no price specified,” he says.

Investigate the market value of your care.

Under contract law, the justifiable price in this situation is market value, professors like Richman and Nation say.

So you want to know the market value for a treatment or procedure — what hospitals normally get paid for, say, an MRI in your area. What price do they agree to with insurers when they strike in-network deals?

Some websites help you explore the going rate near you. Check out the Health Care Cost Institute and its Guroo site. Try Healthcare Bluebook and FAIR Health. Check what Medicare would pay, too.

Then call your biller and negotiate.

“People should come armed with various data points,” says Elisabeth Rosenthal, a physician-turned-journalist and editor-in-chief of Kaiser Health News.

“I tend to like Medicare rates because that’s a rate that has been calculated as being fair and including a profit for the provider,” she says. “Say, ‘I got a bill for $30,000. I see Medicare would pay $6,000. I will give you that. Or I will set up a payment plan for that.’”

Many providers say Medicare underpays, she adds. So you might need to up your offer to 150% or 200% of Medicare. It may still be a lot less than your bill.

Discounts and charity.

Your hospital (especially if it’s a not-for-profit) may have financial aid options that apply to you, or discounts for paying cash.

But you may need to ask and ask again. As Kaiser Health News found, staff don’t always bring it up.

Did you ever get an itemized list of charges?

Ask for it. Hospitals and doctors deal with so many patients that people sometimes get charged for services they didn’t receive, or a wrong billing code slips in. (Check out Rosenthal’s own deep dive into her family’s medical bills.)

Don’t settle for a vague list of categories with subtotals next to each. Experts say you’ll want the itemized version to scour for errors or questionable prices. If the biller won’t give you that, one advocate recommended telling your state attorney general.

Complain, complain, complain...

...to your insurer, your doctor, your congressman, your senators. Don’t forget you have a state insurance commissioner. Federal laws limit their ability to help with some situations, but it’s worth asking.

File an appeal to your insurer. That could clear things up, for example, by getting your doctor to help show your care was necessary. Or, try your employer.

“Employers have a lot of sway with their health plans,” says Lynn Quincy, director of the Healthcare Value Hub at Altarum. “A lot of times the employer can weigh in on behalf of the employee and say, ‘We want this to be covered.’”

How about small claims court?

For smaller amounts, if you suspect you’re being overbilled, consider challenging it in small claims court. Rules vary by state. Here’s a few basics for Kansans.

Listen to this episode of An Arm and a Leg Show to hear how patients take their claims to court. The whole thing is a great listen, but if you’re in a hurry, fast-forward to 13:30.

Get someone on your side

If an outrageous bill still won’t go away, you may need a patient advocate or a lawyer. That can cost money, so small bills may not be worth it.

Kansans can call the Kansas Bar Association for lawyer referral or for $2-a-minute legal advice.

Patient advocates work independently or with nonprofit groups. Give this directory a try or head over to Google.

This story is part of our series, Bills of Health. Got a medical bill you want to share with a reporter? Email celia (at) kcur (dot) org.

Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @Celia_LJ or email her at celia (at) kcur (dot) org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

I'm the creator of the environmental podcast Up From Dust. I write about how the world is transforming around us, from topsoil loss and invasive species to climate change. My goal is to explain why these stories matter to Kansas, and to report on the farmers, ranchers, scientists and other engaged people working to make Kansas more resilient. Email me at celia@kcur.org.
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