Surprise medical bills: what can you do?

In February 2020, Steve Morrow took his wife, Kris, to get a eye procedure for a degenerative eye condition called keratoconus.

They weren’t sure how much the procedure would cost – Kris’ doctor said it would depend on how severe it was. eye was and how complicated the procedure would be. But since it was done in the doctor’s office, they were only responsible for an amount of $ 50 co-payment. Their OPP insurance plan would cover the rest.

“We paid a co-payment for the procedure and I thought we were done, ”says Morrow, who runs the Paddle About kayak website in Gilbert, AZ. “Three months later, we received an invoice for $ 3,550 from the supplier. “

It didn’t stop there. Even after repeated phone calls to their Insurance the company and the supplier, the bills kept coming in.

Surprise billing is common

The Morrows aren’t alone when it comes to surprise billing – when you get a bill for medical services that is much higher than you expected.

“Surprise medical bills are at an all time high,” says Gail Trauco, oncology nurse and patient advocate who founded Medical Bill 911 to help people cope with these unexpected charges.

About 20% of hospital bills come with unexpected charges, she says, even for those who are fully insured. According to the Kaiser Family Foundation, there are millions of surprise bills every year.

The costs add up. If your plan does not cover off-grid care, your Insurance the company may deny coverage altogether. Or you could be responsible for paying the difference between what the insurance covers and what you are billed (a practice known as balance billing). You can end up owing hundreds or thousands of dollars.

What are the causes of surprise invoicing

Surprise billing occurs because part of your treatment was not covered by your insurance plan.

This is common in an emergency. An ambulance could take you to an off-grid hospital, where your care is not fully covered. Or you might need things that aren’t fully covered, like an ambulance, a rescue flight, or emergency surgery.

You may also receive surprise bills when it is not an emergency. Even if you visit a hospital or network facility, you may be charged fees for providers you have no choice, such as anesthesiologists, radiologists, and pathologists.

“Many providers can be off-grid, resulting in astronomical billing costs,” says Trauco. You may also be billed for unplanned imaging, lab work, or surgery.

Another source of bill surprises is inaccuracies and billing errors. “Medical bills contain up to a 30% error rate,” she says.

This is what happened to the Morrows. Even if their insurance company covered the eye procedure, the supplier continued to invoice them incorrectly. “It was a mess,” said Morrow. “But after several phone calls to the supplier and the insurance company, we got it all sorted out.”

What you can do

“You should never pay a high medical bill, or a medical bill, when it first arrives in your mailbox,” says Trauco. If you look at an invoice and it doesn’t look quite correct, the number you are seeing may be in error.

Before paying a questionable medical bill, learn the facts. Ask your provider for a copy of your medical file with itemized charges.

Make sure the records include:

  • Billing codes
  • Consultations
  • Medication
  • Procedures
  • Surgeries

When you get your records, says Trauco, go through them in detail and ask yourself these questions:

  • Are the admission diagnosis and discharge diagnosis correct?
  • Are the admission dates correct?
  • Are the surgeries correct?
  • Did I give each medicine?

You may find errors and charges that you can dispute. Many invoices have fees or duplicate charges for things you haven’t received, like tests, procedures, or medication.

How to negotiate

Just because you receive an invoice doesn’t mean you are responsible for paying it in full. “All medical bills are negotiable,” says Trauco.

Call your insurance company first. Request a single exception. They can agree to cover the bill at a network rate. If they say no, you can appeal.

Then call the provider. “Tell your story and say you are in financial difficulty. Ask who you need to talk to and contact them by phone, ”says Trauco. “Polite persistence is a powerful tool. “

Try asking your provider to reduce their charges to a network tariff. It can save you around 30% of the total cost. You can also request an “immediate payment discount,” which reduces the amount you owe if you pay immediately.

You can also get help from the Patient Advocate Foundation at

Take the time to do your research and be patient as you negotiate.

A new law

Congress recently passed a new law called the No Surprises Act to protect consumers from surprise billing for unexpected off-grid care. It will cover most private health plans and will take effect on January 1, 2022.

The new law:

  • Banning of balance billing (the difference between a supplier’s fees and the amount authorized by your insurer)
  • End surprise billing for off-grid emergencies
  • Put an end to surprise air ambulance bills
  • Require your consent for the planned procedures
  • Require insurers and providers to negotiate the payment rate, instead of you having to negotiate

The new law does not cover ground ambulance services. It also doesn’t prejudge your state’s surprise billing laws.

How to avoid surprise invoices

Since the new law does not come into effect until 2022, you still need to be very careful with your medical care and billing. “Be your own lawyer and do your homework. Know what you owe before you go, ”says Trauco.

If you need to have surgery or a scheduled procedure, find out in advance what is covered. Call the facility, even if it is networked, and ask for a list of all providers who will be involved in your care. Make sure they include providers that you don’t choose yourself, such as anesthesiologists or radiologists.

Then call your insurance company. Confirm that each provider is networked. Don’t rely on the insurance company’s website. It may be obsolete.

In an emergency, ask to be taken to a network hospital.

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