When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren’t thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges.
But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.
When, for instance, they asked a medical group they had never heard of why it was charging them $839.25, they said they got no clear answers, just threats if they failed to pay.
After 21/2 months of calls and a complaint to their state attorney general, the Yaskins finally learned that a pediatrician affiliated with the group had treated their son in the hospital. The medical group eventually cut the bill in half.
None of this surprises Pat Palmer, the founder of Medical Billing Advocates of America. “We get feedback from consumers saying that providers are telling them ‘We can’t give you an itemized statement’ or ‘You should have asked for it before you left the hospital.’”
The idea is to discourage patients from asking for the details behind the charges, she said.
Experts offer a range of suggestions for dealing with medical billing problems.
Know your rights. Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges.
“You can’t be billed if they can’t tell you what they are charging for,” Palmer says.
Contact the billing department at either the hospital or medical group where you received services, she said. Let them know that you want an itemized bill, and tell them you are aware of your legal right to have it.
Also, a few states have laws limiting how much hospitals can charge patients who pay for care on their own. In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service.
“Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates,” says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn.
Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.
If you meet with resistance, don’t waste time by calling back the customer service line or billing department. Go straight to the top.
Address a certified letter to the chief executive or chief financial officer of the hospital or medical group explaining that you have tried to resolve billing issues but have hit a brick wall. “The CEO and CFO will take it very seriously,” Palmer says.
Get help from your insurer. In the Yaskins’ case, both the hospital and the medical group were in their insurer’s network and had contracts to provide services at a negotiated discount.
“If you are in network — and this is one of the good reasons to stay in network — you can go to your insurer for help. It has a responsibility to some degree to what happens between you and a contracted physician,” says Susan Pisano, spokeswoman for the trade group America’s Health Insurance Plans.
Also, ask to make sure you’re getting the rate your insurer has negotiated with in-network providers, says Lynn Quincy, senior health policy analyst for Consumers Union, the policy arm of Consumer Reports. Insurers often pass claims through without processing them at the reduced rate. Ask your insurer to re-process the claim if the discount wasn’t applied.
Seek help and file complaints. If your bill is large or you’re having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America (www.billadvocates.com) and Health Proponent (www.healthproponent.com) can help you fight charges or lower your bill.
If you’re being stonewalled by your healthcare provider, and your insurer hasn’t helped, Quincy of Consumers Union suggests filing a complaint with your state’s department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting healthhelp.ca.gov. Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit https://www.insurance.ca.gov. If your provider isn’t contracted with your insurer, your state’s attorney general’s office is a place to turn for help.
The Yaskins ultimately enlisted the services of an advocate to help them sort through all their billing questions.
“We’re raising a family and running a business, and this is like a second job,” Keith Yaskin says. His conclusion: “Hospitals, medical groups and doctors’ offices have much to learn about communicating with real people.”
Zamosky writes about healthcare and health insurance.