How To Fix Your Medical Bill Problems

A hospital bill appears on a consumer’s credit as a collection account, even though he never got a bill. A consumer’s auto insurance company lets a medical bill slip through the cracks, and it winds up on her credit report, also in collections, even though she would have paid it to avoid the damage to her credit.

A hospital patient pores over her bills after a pricey stay that wasn’t covered by insurance. She finds she has been triple-billed for her room. She was also billed for three tests that were never done, for food she didn’t order (she brought her own), and she was charged $100 for “antiviral measures” that turned out to be a box of tissues for her room.

These are just a few of the stories and complaints that have been shared by our readers in response to my story, Four Medical Bill Myths That Can Cost You Dearly.

Patients are understandably frustrated and angry. After spending valuable time getting their medical bills corrected or trying to fix their credit reports, either of which may or may not result in a successful outcome, many of them want to know, “Where can I complain about this?”

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‘I’ve been working on these issues for a long time and it’s not clear who to call,” says Mark Rukavina, Executive Director of The Access Project. “If (patients) do take a step or two that doesn’t lead them through the right door, they just get ‘no’ for an answer, or no resolution. They end up paying it or not paying it and can get into trouble.”

Here are some suggestions…

File an Appeal

While this article is intended to focus on filing complaints, rather than just straightening out medical billing problems, sometimes the two go hand-in-hand. So it’s worth mentioning that if your insurance company has refused to cover a medical procedure equipment or prescription, start by asking them to reconsider that decision. There could be a simple coding error that led to the denial, and with correct information, that bill may be covered. If that doesn’t work, you can follow the instructions in your plan documents to appeal the decision.

If the internal appeal doesn’t work, find out if you have the right to an external appeal which may help if there is a dispute over whether a procedure was medically necessary, for example. “External review is typically an independent body such as a state insurance body that reviews these things,” Rukavina explains. “You might take that to the external review board and say, ‘What choice did I have?'”

Try Your HR Department

Most people get health care coverage through their employers, so if your problem seems to lie with your insurance company — they refuse to pay for a bill you think should have been covered or they are taking too long to pay a bill, for example — you may want to enlist the help of your employer’s HR department. “They are paying a lot for the insurance and they want to make sure they are getting their money’s worth,” Rukavina explains.

The Joint Commission

The Joint Commission on Accreditation of Healthcare Organizations accredits and certifies some 19,000 healthcare organizations. Its focus is on safety and the quality of care, so don’t bother to file a complaint about billing or payment disputes. But if you believe your health or safety was compromised while you received care from one of the organizations it accredits or certifies, by all means file a complaint.

Turn to the Government

There are two government agencies that may be able to help if your efforts to resolve the problem through your insurance company doesn’t work. Your state attorney general’s office likely has a consumer affairs division, or something similar, that collects complaints from citizens, provides information about state consumer protection laws or programs that may help, and/or helps to resolve complaints.

Your attorney general’s office may refer you to another state agency that handles those kinds of complaints. The New York State Department of Financial Services probably does not come to mind when you think about healthcare billing issues, for example, but it published a report describing complaints it received from consumers who were being billed large amounts for out-of-network medical bills.

In addition, some states’ Division or Department of Insurance (or something similar) may help as well, says Rukavina. Some states have an insurance ombudsman’s office that helps people sort out difficult insurance billing problems. It may be helpful to file a complaint even if the agency can’t help with your individual problem. Insurance commissioners can use complaints to identify “problematic insurance carriers who don’t seem to be paying claims, for example,” he notes.

Finally, share your complaint with your state and federal legislators. Remember, they are the ones who consider healthcare-related legislation. In addition, they may have staff members dedicated to helping constituents cut through red tape, particularly with state or federal agencies.

No Insurance?

You may feel even more overwhelmed if you don’t have insurance, since you are essentially going it alone. The first thing you’ll want to do is to be sure to get an itemized bill from the provider, scrutinize it carefully, and don’t be afraid to ask questions about what the various codes mean, and what services were performed.

Then don’t be afraid to negotiate your hospital or medical bill. Keep in mind that most insurance companies pay far less than the amount a provider bills. You should be trying to get that same kind of deal, especially if you can pay it off fairly quickly.

If your efforts to do that are not getting anywhere, ask to speak to a supervisor or find out if the hospital has an ombudsman’s office that can help. Our reader, Kat, whose overbilling woes were described at the beginning of this article wrote in a blog comment:

If you find out you have a medical bill, ask for itemization, ask for information, and ask for the Ombudsman. An Ombudsman is a part of a hospital who is required to stay impartial, and can often help you fight outrageous billing errors. The best way I’ve found to reduce medical debt is by getting on the phone, staying on the phone, and staying calm. It’s actually really funny to hear billing departments get increasingly panicked when you stay on the line, calm as ever, and demand the information in a way a reasonable person can understand, and insist that they need to make sense.

The Affordable Care Act also offers some protections that may prove helpful if you received medical services at certain hospitals. Take advantage of it while you can since who knows whether those protections will still be around in the future?

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Image: Adrian Boliston