A Nurse's Strategies for Negotiating Medical Bills

Michelle Katz helped save her husband’s life by quickly administering CPR when he had a heart attack. Then she went on to help save $8,000 in the medical bills that he subsequently incurred.

She was in the perfect position to help start his heart again because she is a nurse. And she could then help him with his bills because she has a wealth of experience as a health care advocate and administrator. In fact, she herself was once a patient with more than $150,000 in medical debt that she managed to negotiate down.

I recently interviewed Michelle on my radio show, Talk Credit Radio, to get her expert advice on how to negotiate medical bills. Here is an edited excerpt from that interview. (You’ll find links to the entire podcast at the end of this article.)

Gerri: Michelle, you have been following the healthcare industry for about 15 years now and you’ve seen what’s going on with healthcare costs, which we just see continuing to rise. What are some of the top strategies you recommend for consumers who are facing large medical bills and just don’t know where to start because they’re overwhelmed?

Michelle: Overwhelm comes with disorganization. You’re going to have bills flying at you at different times. Before you even leave the hospital, get an itemized bill just so you know what bills are coming in — whether they’re from the radiologist, the anesthesiologist, the labs, whatever. Get an itemized bill because you will almost always find mistakes in these bills.

Gerri: Is that typical for them to give you one of those itemized bills? I don’t remember getting one when I’ve gone to the emergency room.

Michelle: Right before you discharge, the nurse will ask you if you understand your protocols, and everything you’ve been through, and all the treatments from here on forward. At that point you say, “Is it possible that I could have a copy of my itemized bill?” Sometimes they’ll say it’ll take a few days. At that point you ask how many days will it take and when can I pick it up — within a week, five days? And make sure this is all documented. Some hospitals are really organized. They’ll actually make you a printout before you leave the hospital. But at other times, just make sure you’re persistent.

Gerri: You had over $150,000 in medical debt from an accident. How did you approach it? I can’t imagine the feeling of getting those large bills.

Michelle: The bills just kept on coming in. Once I thought I paid one bill, another bill came up — which is why getting itemized bills is the first step everybody should take.

I couldn’t afford it, so I was in tears. I finally found someone in the billing department and I explained my situation. I was a student. I didn’t have health insurance. I had no idea how I was going to put myself through school as well as pay these medical bills. And believe it or not, they were willing to work with me.

The thing people need to understand is try to get your composure, don’t scream at the person on the other line because sometimes you’re going to get the wrong person. Really important — get the right person. If that first billing person has no idea, ask for the supervisor. And usually, the supervisor has heard all the stories — everything.

Be honest, and also make sure you get a negotiated rate. You can negotiate this down, look for mistakes with this billing person as well as negotiate the rates.

Gerri: Michelle, what about while you’re in the hospital? What kinds of things can you or should you be doing to make sure that you’re actually getting the health care that they’re billing you for?

Michelle: The big thing I tell people — I know it’s hard when you’re in a hospital, because I’ve been through it — is to get a notepad and keep a journal. It’s great to keep a journal of just basically how you’re feeling. Doctors do like to see this. “I’m feeling this way today,” as well as who came in, what was done, notes on maybe how to change your bandages. Go over this with the nurse who comes in. The nurses usually almost always are able to explain things and it helps them do their job better.

Gerri: And then you can list what medication you received and what procedures were done. I read about your husband’s situation, where you found that he had been billed for a medication that, had he been given it, would have been an overdose for him.

Michelle: Exactly. We call that “fat fingers,” where the medical file is sent down to the billing department and sometimes they accidentally push in an extra code or an extra number. And in our case, they said they gave him extra units. It would’ve been an overdose. And it looked funny to billing when I brought it to their attention.

Keep in mind, they’re doing so many other different bills and billing procedures for different people that this can be overlooked, so it’s important that all of us are our own health care advocate.

Gerri: Yes. Although it just amazes me in this day and age with the technology that these bills still have so many mistakes. Have you seen an improvement because you’ve been watching this for 15 years? Do you find fewer bills have mistakes, or are we still dealing with a lot of them?

Michelle: In every bill that has been brought to me, I can find at least 20% mistakes. And the reason why I’m finding more mistakes now is that I’m getting people more aware of this process and people are starting to ask. Whereas in the past, we just assume insurance covered everything, don’t worry about it. It’s amazing what happens when insurance stops covering procedures, how people start looking at their bills.

Gerri: Absolutely. We have higher-deductible policies now. We may have a higher co-pays. You may end up seeing a provider who’s out of network so you may be responsible for some the bill. So I don’t think you can assume going in that just because you have good insurance you’re not going to end up paying a lot of money.

Michelle: Yes, and there’s a lot of things happening with the exchanges where the hospital that you thought was in your insurance may not be in the exchange. So be sure you read the policy and you write down what hospitals are in your policy because I’ve seen this happen too many times. You go to a hospital, you think they’re covered in your policy, and they’re not, and then you’re left with this huge bill. And that goes for doctors, too.

Gerri: Any other specific tips for problems that you see happen all the time?

Michelle: The big thing is ask questions and negotiate if you are with appeals process with insurance companies. A lot of times they don’t expect you to push forward. And what I mean by this is when you get denied a claim, really always ask why. Submit that appeal form. Be very persistent. The first time is always a no. The second time, the insurance will look into it further. And worst-case scenario, if everything gets denied, you’re seeing problems, you can go to the Department of Insurance of your state as well the attorney general to help you out in dealing with the insurance companies and other issues you have with billing.

Gerri: Should patients be doing this in writing or on the phone, or can you do a combination of the two?

Michelle: I would definitely do a combination of the two and always have something in writing and always verify. If you send a fax — every time I send a fax talking about bills or negotiating or I get a rate, I always call (too). I write the patient’s name, the time I called, the date and a summary of what was said every time I’m on that phone. Every time you send a fax and email, call them to make sure they actually got it.

Gerri: Medical bills are negotiable, but it is up to you, the patient, to become proactive and negotiate those medical bills if you want to save the most money.

Listen to the rest of the interview with Michelle Katz. Download the interview here, listen online or get the free podcast on iTunes. To learn more about how Michelle’s books visit HealthCareHacker.org.

Image: iStock

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