How To Dispute and Pay For Large Medical Bills

How to Dispute and Pay for Large Medical Bills

If you’re looking at astronomical medical bills thanks to the coronavirus pandemic or another health emergency, you might think there’s no choice but to pay thousands of dollars for your treatment. Lucky for you, though, there is hope.

Here’s some advice on how to bring down the numbers on your medical bills and tips on how to cover the remaining costs in five easy steps.

Step 1: Review your bills.

Typically, you’ll receive an Explanation of Benefits (EOB) from your insurance company along with the actual bill, which tells you how much you’re responsible for paying.  It’s important to hold onto both of these documents and to review them carefully.
The EOB is a document provided by your insurance company explaining your insurance benefits as it pertains to a bill. It will usually include the following information:

 

  • Amount Billed by Provider (this refers to the amount the doctor or hospital charged)

  • Plan Discounts (this refers to a discount negotiated by your insurance company)

  • Amount paid by insurance company

  • Amount you owe the provider

 
Most explanations of benefits will also include information about your deductible, co-pay and coinsurance. If a procedure or treatment is not covered, the EOB should include a short explanation about why it’s not covered. If your statement includes charges for COVID-19 testing or related expenses, like copayments and deductibles, your insurance should be covering the entire amount, as per the Families First Coronavirus Response Act.

Review your bills carefully and make sure the EOB and the medical bill correspond with each other. If there is a discrepancy between the two documents, it may be a billing error.

If you suspect an error, it is a good idea to ask for itemized bills. These will provide you with a detailed breakdown of all costs charged to you for services and/or hospitalization.

If you’re being billed for a hospital stay, review the charges carefully to be sure you’re not getting billed for a treatment you haven’t actually received. According to a report by the U.S. Government Accountability Office, an overwhelming 9 in 10 hospital bills contain errors.

Step 2: Review your insurance coverage

It’s a good idea to familiarize yourself with your health insurance policy before disputing any charges. Most health insurance providers will present all members with a detailed manual (now usually provided online) that outlines exactly which treatments and charges are covered and which are not. Using this, you can refer back to the EOB to see if the insurance paid for all procedures it claims to cover.

Step 3: Dispute all errors

If your insurance billed you incorrectly or did not cover a procedure or treatment that is covered under your plan, call a company representative to ask about the charge. Be sure to have your insurance card and bill in front of you when you make the call, and to note the time of your call, the contents of the conversation and the name of the representative(s) you speak to in case you need it for future reference.

If the error is with your doctor’s office, ask to speak to a representative of the billing office and calmly explain your position. Here, too, keep a careful record of the conversation for future reference.

In both cases, you should be prepared that you may have to make multiple phone calls until you reach a party who can actually effect change.  It’s also a good idea to follow up with a written request to challenge a charge.

Step 4: Negotiate the remaining bill

If the bill is unmanageably high after all errors were corrected, you still have options. Consider negotiating a discount on your bill in exchange for up-front payment with the billing office.  If it is a hospital and they are local to you, consider doing this in person.  Most hospitals and outpatient facilities will allow you to schedule an appointment with a representative of the billing office. Bring all your bills and other supporting documents, such as payment receipts, your insurance card and a copy of your benefit plan from your insurance provider.  If you believe a charge for a procedure has been unreasonably inflated, it’s a good idea to research the going rate of coverage through sites like HealthcareBluebook.com and myHealthcare Cost Estimator.

At the meeting, explain that you are having difficulty with your bill and that you’re looking for a way to lower the costs. Here are some open-ended questions to guide your negotiations:

 

  • What discounts do you offer for financial hardship?

  • Which of these fees can be waived?

  • I know many hospitals have charity relief plans for patients having difficulty meeting their payments; can you tell me about yours?

  • Can you tell me what Medicare would pay for this service?  Is this the same as your cash price?

  • Can you offer some relief if I set up an auto-draft payment plan with your office?

  • Is there a discount if I want to pay this balance off all at once?

 With luck, you’ll walk away with a discounted bill.

Step 4: Create a payment plan or seek funding

Once you have your final bill amount, you’ll need to choose to pay it now or work on creating a payment plan. Spreading a large bill over several months or years will make it manageable.

If you’d rather not have this huge bill hanging over your head for a while, or your doctor’s office insists on immediate payment, consider other options. One way to pay off your bill is by taking out a personal loan or opening a Line of Credit. This will not only provide you with the funds you need to pay your bill immediately but will also be much less expensive than putting it on a credit card thanks to set monthly payments.   

Step 5: Going forward

To avoid an unexpectedly large medical bill in the future, you may want to consider switching your insurance plan to one that provides more robust coverage and less expensive copays and deductibles. Your premiums will likely increase, but the change may be financially worthwhile if you have ongoing medical expenses.

You should also find out if your employer offers a  Flexible Spending Account (FSA).  An FSA is funded by you – usually through pre-tax payroll deduction – up to $2,650 over the course of a year (that’s $101 per paycheck if you’re paid bi-weekly).   One of the great benefits of a FSA card is that the funds are frontloaded on a special debit card, which means you can use up to and including the full amount as soon as your insurance plan year renews.  Still not sold on an FSA?  Here’s a few more considerations - not only can it be used to pay for medical bills that your health insurance may not cover - but it can also be used for co-payments, deductibles, prescription drugs, and some over-the-counter medicines as well.  

Lastly, if you know that you expecting to have ongoing medical expenses for the foreseeable future, you may want to consider setting up a Health Savings Account (HSA).  The funds you contribute to this account are tax-deductible, grow tax-free and can be withdrawn to cover for qualified medical expenses.