Another Look at Bills, Bills, Bills

There was a report in the Associated Press the other day that made some great points about managing medical bills.  It’s familiar territory, but let’s revisit the wonderful world of health care billing before our savings are used up and bankruptcy looms.  Okay, that’s a bit extreme, maybe.  But medical bills remain an anguishing, stressful and nearly unavoidable challenge to everyone’s financial health – vaguely ironic, but true.

Everything starts out fine – you’ve got good medical insurance – but then you get sick.  You need some testing, a few consults, maybe an outpatient procedure and a different prescription regimen.  You aren’t worried.  You’ve got that health plan.  Besides, it’s 2012 and it’s all reformed…isn’t it?

Then the invoices start flooding in.  The language, the codes, the jargon, the bewildering details that tell you absolutely nothing, they all overwhelm and embarrass you.  What on earth am I looking at, you ask yourself?  Who did what test, and when, and where?  And it cost…how much?  I pay this portion, that portion, the whole thing…how much?  Where’s the deductible?  Again, who pays what here?

You start to have some serious doubts about your reasoning skills at this point.  How could sorting through a few bills be so hard?  Then you find out that even in-network doctors have rates that vary and change – all perfectly legal, by the way.  And further, that four or five independent groups were involved in your care.  And further still, didn’t anyone tell you that it has been reported, on impeccable authority, that there’s an average difference of 300 percent to 600 percent between the lowest price and the highest price for any one medical procedure in any US city?  Really!  Dr. Neel Shah, executive director of a nonprofit that helps patients manage their bills, observed that

You can get an MRI on one side of the street that will cost you $2,000, and the exact same MRI on the other side of the street will cost $4,000.

Obviously, it pays to comparison shop.  Who knew?  Let your doctor know you are budgeting your health dollars carefully.  No matter who your health insurance carrier may be, there will still be a portion of the bill that you will have to pay out-of-pocket.  You’ve got to ask about the costs before deciding to go ahead with the care (in a non-emergency situation, obviously).  Call around, asking doctors and hospitals you may be using about their charges.  If you are uninsured, know that most doctors charge lower rates for patients who have to pay out-of-pocket.  You have to ask, though – practices rarely announce these policies.

As far as the health insurance side of the equation goes, you already know what we’re going to say.  You absolutely must follow the procedures of your particular insurance company to the letter.  Check your policy.  Call your agent. Call the insurance company.  If you’ve got several health plans, a primary and a secondary, be sure you understand who covers what, and how to organize it.  Do you need to file a claim with the primary insurer in order to have that claim denied, so the secondary can take care of it?  Then do it exactly that way.

Of course the paperwork rules are absurd.  Of course they are insulting and invasive.  Follow them anyway.  Do you  need pre-authorization to see a specialist?  Does this involve another form, or a phone call from your doctor?  The only person who really cares about this is you.  Do not expect anyone else to follow up on these details.  If they do, that’s fantastic.  But, ultimately, it’s up to you.  And save your records and copies of anything you submit.

Finally, ask for line-item billing from the hospital or your doctor.  Go over everything carefully.  Match dates for lab work (were you really there on the 10th?) and make sure the drugs listed are the ones you received, that the visits are correctly noted.  Human beings record this stuff, and human beings make mistakes.  Coding errors and typos and transpositions happen – it’s not a vast conspiracy, it’s just part of clerical life.  So check for accuracy.

Should you find something wrong, if you believe you’ve been billed for a covered service or procedure or you don’t understand any aspect of an invoice, call your health insurance company.   If your claim is denied and you are still uncertain about it, ask for a review of that claim – you have this right under the new health care reform laws.  Go to for more info.


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