Jill finally had a smile on her face. Not only because the scars from her cardiac surgery 3 months back had all but disappeared and her skin color was almost indistinguishable, but also because of her recent victory in the law suit against her health care provider. 2 months after having returned home from hospital to recover from her major surgery, Jill almost had a second heart attack on finding that her insurer had disputed several of the charges mentioned in her long form medical bill. She suddenly found herself in a position where she would have to foot thousands of dollars from her own pocket.
Luckily, Jill, an educated woman who also ran her own brokerage firm, had researched extensively on her laptop about her medical predicament, as she lay in the hospital bed for weeks before being finally discharged.
A quick review of her itemized bill showed glaring discrepancies in the services she had received and the charges levied. The icing on the cake – the hospital had affected a bogus augmentation charge to a woman who had only received emergency cardiac surgery following a sudden attack at the age of 57.
A quick letter from her lawyer ensued to the hospital within a fortnight. When the health care provider did not respond satisfactorily, she sued. Cue one month later and one of the biggest hospitals in Los Angeles had settled the case with a very handsome compensation in favor of Mrs. Jill Hathaway.
Negotiating a Payment Plan, Rebates, Financial Assistance and Crowd Sourcing
If you’ve planned for hospitalization in advance (surgery, pregnancy etc.); it pays to research online to find out how much it could potentially cost you. Information is power, so compare the costs at your hospital with other health care providers to make the best choice. Contrary to popular belief, hospitals do negotiate charges in the face of overwhelming evidence against phantom fees. This is because no reasonable business wants to draw itself out in protracted lawsuits which would cost thousands of dollars additionally in legal fees. Not to mention the damage to reputation.
If the charges are reasonable but outside your budget, try and negotiate a systematic payment plan with your hospital. You’ll be surprised at how many hospitals are opting for the same these days. Some tips that will help:
- If you are making payment upfront or all at once, ensure that you get a rebate out of it.
- If you are eligible for hospital financial assistance, don’t forget to avail the same.
- Financially challenged patients can turn to crowd funding websites such as GoFundMe.com to support their medical bills.
The A, B, Cs of Prudent Medical Financial Management
Always, always insist on an itemized bill without fail. Routine items such as gloves, blankets, lights etc. cannot be charged separately. They are part of the facility fee. Ensure that double billing does not happen. Unless a second opinion was garnered, doctor’s readings should only be billed once. The same goes for anesthesiologists etc.
The In-Network Doctor and Hospital
When you’re inside a hospital for yourself or a relative, ensure that the doctor looking after you participates in your insurance plan along with the hospital. This is one of the most common reasons behind phantom charges in medical bills as most patients automatically assume that in-network hospitals also provide in-network doctors. Nothing could be farther away from the truth. If your physician does not participate in your insurance plan, your chances of getting phantom charges on your bill will be higher.
If however you had already mentioned in writing your preference for an in-network doctor but your hospital could not provide you one, you can later on negotiate the charges levied by the doctor. The same rule applies when your hospital outsources tests to external labs. Always ensure that all tests are done by participants in your insurance plan and document the same to your hospital in advance.
The ER Services
If you availed ER services, please note that hospitals charge the same by levels. Level 1 signifies minor injuries such as nosebleeds etc. and level 5 represents major trauma such as heart attacks etc. Always ensure you were charged a level appropriate to the services you availed. Ask for a written explanation if you have to.
ER doctors also charge by levels ranging from 1 to 5. Ensure that your doctor charges you for the appropriate level. Hospitals can never charge you for a level higher than that of the doctor so flag the same if it happens.
Medical Billing Advocates and Legal Recourse
Even after taking every precaution, if you are unlucky enough to find yourself at the receiving end of exorbitant charges on your medical bill, don’t lose heart just yet. You still have a few tricks up your sleeve.
These days, many aggrieved patients are actively seeking the services of medical billing advocates – professionals who will negotiate your bills on your behalf with the health care providers and charge you a percentage on your eventual savings.
Of course, when all else fails, consider hiring an attorney to alleviate your situation in a court of law.