“How I Dealt With a Surprise $4,800 Medical Bill”

Depressed man slumped on the desk with his hands holding credit card and currency

In 2011, Thomas Nitzsche needed two surgeries to have some pre-cancerous areas removed. Even though he did have health insurance at the time — and that health insurance covered 80% of his procedures — the St. Louis, MO resident was shocked to discover that he still ended up owing $3,000 for one of the procedures and $1,800 for the other.

“It’s important to check the itemized bill to look for any errors and duplicate charges once it arrives, since this is something that is reported to happen frequently,” Nitzsche said. His bill was error free, so he called the billing department and requested to apply for financial aid. “Unfortunately [the hospitals] didn’t offer aid, and it seems most do not,” says Nitzsche. “Nor do pharmaceutical companies often advertise the copay assist. While the hospital will likely ask for supporting documentation of income and monthly expenses … in all cases, I’ve had to ask for assistance myself.”

Since Nitzsche dealt with two different hospitals for his procedures, he faced two different policies in terms of dealing with the hospital bills, as well. In the course of haggling, Nitzsche was able to get 60% of his larger bill forgiven and he was put on a payment plan for the balance. The smaller bill was denied financial aid, but they did offer to put him on an extended, 24-month, repayment plan. “According to the billing department, simply the act of applying for aid — whether approved or not — allowed them to extend the repayment from 12 to 24 months,” said Nitzsche. “Obviously the thresholds and policies vary by facility. I was also put on a medication for an extended period of time, but was able to get a manufacturer’s co-pay assistance card to completely cover the cost.”

[Co-pay cards are designed to help people with private insurance pay for the co-payments required to obtain prescriptions at the pharmacy. Often these types of cards are offered by pharmaceutical companies. Ask your doctor’s office or pharmacy about it, or learn more here.]

After having gone through the process of dealing with a costly medical bill, Nitzsche recommends patients do the following when faced with potentially expensive medical procedures, medicines or exams:

1. Get an up-front estimate of what your portion of the cost will be

“That way you aren’t surprised or stressed out when the bill arrives, and you can start to plan accordingly,” he said. “For some expensive services, like MRI’s or dental work, you may even be able to shop around. I got orthodontic work from a dental school as a young adult at a deep discount this way.”

2. Pay attention to medical bills as soon as they arrive

By handling his bill in a timely manner, Nitzsche was able to avoid any seriously negative ramifications that could have affected his credit. “I paid as agreed and was able to settle everything with no impact to my credit, since it was never reported and it was all handled in-house and not sent to a collection agency,” he said. “I was working as a credit counselor at the time, so the experience helped me with clients facing similar situations. Unfortunately many do not reach out for help until the bills have already gone to collections, at which point you cannot get financial aid or an in-house payment plan to keep it from damaging credit.”

3. Never settle for the original fee

In most cases there is always some way to receive assistance, whether that’s in the form of a reduced bill or a more lenient timeframe to pay it back. “Call the service provider right away and inquire first about financial aid and then about a payment plan,” suggests Nitzsche. “If you have multiple large bills and are not able to get financial aid or set up on a payment plan — which should be rare — you can contact a nonprofit credit counseling organization to see if a Debt Management Plan would be a good fit.”

4.  Don’t overpromise what you can afford to pay

Once you start the repayment, stick to it every month to prevent the bills from defaulting and going into collections, Nitzsche suggests. “In some cases, just one missed or late payment can break the agreement and result in this action,” he added. “So set reminders, auto payments, etc., and if you do have to make a late payment, call them and get an agreement in place.”

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How to Negotiate a Medical Bill Like a Pro

Couple Reading Letter In Respect Of Husband's Neck Injury

Rising healthcare costs are something that pretty much every American has to deal with, and unfortunately soaring deductibles and out-of-pocket limits only make the situation worse. In fact, one survey found that average annual deductibles have grown by a whopping 255 percent between 2006 and 2015.

So that’s the bad news. The good news, however, is that everything — including medical bills — is negotiable.

Michelle Katz, LPN, MSN, author of “Healthcare Made Easy: Answers to All of Your Healthcare Questions under the Affordable Care Act”, has spent more than 15 years negotiating for her own medical bills, and now writes books and gives lectures around the country to help others negotiate their own bills, as well.

While it might take a little practice, if a little negotiating could say you hundreds (if not thousands) on medical bills, it’s probably worth the effort, right? Here’s what Katz has to say about the process, and how you can start negotiating today.

What are some of the most common medical bills to negotiate?

MK: Dental, surgeries and blood work, you can negotiate all of it. And while it all depends on the facility, I have typically found that ambulance bills tend to be some of the hardest to negotiate. The key is getting to the person whom I call the “dealmaker,” who traditionally is the person who handles billing. This can be anywhere from the director of billing to the office manager to the president of the facility. Keep in mind that you do not want to start all the way up top — you should always go through the correct channels first. For example, some CEOs of integrated systems have only a general idea of what is happening in their billing department, if at all.

Additionally, a local hospital is usually easier to deal with than an integrated system where there is a lot of bureaucracy, and it will all depend on the outsourcing groups [like radiologists, lab work, anesthesiologists, etc.], as well.

What are the top five things people need to keep in mind when negotiating a medical bill?

MK: First, collect all of necessary information ahead of time. In other words, ask for a copy of your medical record, an Explanation of Benefits [from your insurer] and an itemized bill [from your doctor]. Then, figure out the right person to get in touch with. Put everything that you do in writing, and take copious notes when talking with others. Be firm and persistent, but also pleasant and patient. When an agreement finally is made [Katz has seen this take anywhere from a few days to a few years, with the bigger the bill taking longer to get resolved], get those details in writing.

What language should people use to negotiate?

MK: It all depends on the facility and what you need. What I tell people is to always stick to the facts and try to keep the emotion out of any correspondence. I have seen too many times where people ramble about their condition, etc. If you’re negotiating against an incorrect fee, stick to the facts like, “in my medical chart it stated xyz, which does not reflect line xyz of my bill sent out on January 15, 2016. See attached.” You also want to be sure you say something like, “I’ll hold out on any collections process until this issue is resolved and the mistakes are corrected.”

For a situation where there was no invoicing mistake, but a person would simply like to negotiate for a lower fee, it’s usually better to negotiate before receiving any services, and again get everything in writing. Make sure all fees are covered and accounted for, and that whatever contract you come up with together states that fact so you don’t receive any surprise bills in the end. In many of these cases, if you offer to pay cash within a certain amount of time, the discount can be significant — about 20 percent. You can also ask your doctor if they can work out a deal if you know you are going to have a few visits in your future. It’s best to be honest and let the person know you can’t afford the full price for whatever reasons. I have had clients who are going through divorces and are in between jobs that have stated that and got huge discounts.

Is there anything else people should be doing to keep the process as streamlined as possible?

MK: The process takes time, and within that time period a lot may happen, like administration changes. So be sure you are always keeping up, and if you don’t hear something, don’t just assume it was taken care of. Along those same lines, don’t feel you need to respond [to a bill] immediately, since it can be an extremely emotional situation and you may want to take some time to go through everything and write your questions down, but do respond in a timely manner, at least within the deadline of the bill. If your financial situation changes during the course of your negotiation — for example, if you’re let go from your job — let the person you are working with know, and ask if there is any other financial assistance.

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