Insider advice for lowering hospital bills
People who work behind the scenes in hospitals, insurance companies and collection agencies see the same problems with medical bills every day. When they speak frankly, they usually give very similar advice about how to get help, cut what you owe, or even have hospital debt erased. Find insider tips and advice listed below, all of which are from doctors as well as other medical professionals on the best way to get help with paying hospital bills.
Advice from hospital billing department insiders
People who work in hospital billing and financial counseling usually say that the most important move is to talk with them early, before a bill goes to collections. Almost every nonprofit hospital in the United States is required by federal law to have a written financial assistance or “charity care” policy that can reduce or wipe out bills for patients who meet income and hardship rules. In fact, the government requires Hospital charity care from ACA - Affordable Care Act. The Internal Revenue Service explains that tax-exempt hospitals must operate a formal Financial Assistance Policy that offers free or discounted care and tells patients how to apply..
Billing staff often tell patients to “ask for the financial assistance application” or “ask to speak with a financial counselor or patient advocate” before agreeing to any payment arrangement. Centers for Medicare & Medicaid Services (CMS) also tells patients to ask about financial assistance and patient advocates when they cannot afford a bill, at https://www.cms.gov/medical-bill-rights/help/guides/financial-assistance.
- Hospital financial counselors typically want to see proof of income, family size, and insurance status, and they will often say “apply even if you have insurance,” because charity care is meant for both uninsured and underinsured patients. Research on financial assistance for underinsured patients backs that up and shows that medical debt keeps many people from getting care unless these programs are used.
Hospital insiders also point out that many systems now use “presumptive eligibility.” That means the hospital screens public information, credit reports or income proxies to decide that a patient likely qualifies for financial help without a full application. Advocates who work with hospitals explain that presumptive eligibility is supposed to remove paperwork barriers and get more patients into charity care automatically. Financial counselors may encourage patients to ask whether presumptive eligibility has been applied, or whether a manual review can be done if income has recently dropped.
Insider tips from health insurance companies when it comes to a hospital
People in insurance call centers or that issue policies see another side of the problem, and they regularly tell patients to slow down and compare every hospital bill to the Explanation of Benefits, or EOB. The billing departments can also provide other resources that help people pay their medical bills. The Consumer Financial Protection Bureau (CFPB) notes that one of the first steps when a medical bill is unaffordable is to ask questions, confirm that insurance was billed correctly and find out whether a financial assistance program exists at the hospital or clinic.
Articles aimed at consumers repeat the same insider advice: request an itemized bill, match every line to the EOB, and watch for duplicate charges, services you never received, or amounts that should have been written off as in-network. A recent piece for Bank of America’s Better Money Habits, at https://bettermoneyhabits.bankofamerica.com/en/debt/how-to-deal-with-medical-debt explains how to ask for an itemized statement and verify that insurance information is correct before negotiating.
Insurance company financial counselors and billing coders often say that small coding errors are one of the fastest ways to blow up a hospital bill. Since medical bills are notorious for having errors, the first thing you need to do is closely review your hospital bill for errors. They can include double charges, medicines or treatments you didn't receive, etc. A wide variety of errors can be made, most of which are accidental Read about more ways to find billing errors.
- They will tell patients to ask questions such as whether the stay was coded as observation instead of inpatient, whether a provider was mistakenly billed as out-of-network, or whether a denied claim can be appealed with additional documentation. Journalists who interview billing specialists also stress that patients should not pay until they understand what each code represents and how insurance handled it. For example, an in-depth guide on avoiding surprise bills shows that patients should ask for itemized bills, compare them to insurer explanations, and push back when something appears wrong.
Tips on paying bills or getting care from a doctor
While doctors and nurses usually do not work in billing offices, but they see how unpaid bills affect patients and they often give quiet, practical advice. Many physicians tell patients to speak up early if they are worried about paying for a surgery, hospital stay or course of treatment. Clinicians can sometimes switch to equally effective generic medications, change the setting of care, or consolidate follow-up visits in ways that lower costs.
- Social workers and case managers inside hospitals can also connect patients with internal charity care, Medicaid enrollment help or local assistance funds. CMS reminds patients that they can and should talk directly with providers and office staff about lower prices, payment plans or financial assistance when they cannot afford a bill.
In addition, another insider tip is that you can negotiate directly with the doctor. Many hospital affiliated physicians negotiate as well, especially if they know you do not have health insurance. Be up front with your medical provider, and go over your situation. Ask them to find out if he or she will accept a lower payment on your bills or debts.
- What is becoming more common is doctors accepting the same amount for payment as they would have received from an insurance company if you had insurance. It is in effect a built in discount. Insurance companies have pre-agreed upon rates for almost all services and procedures with health care providers (sometimes as low as 50% of the medical bill). A not as well known insider tip is that the doctor may accept the same amount from you as well.
Front-line hospital staff and physicians also know how confusing emergency bills can be. They may encourage patients to check whether charges fall under federal “No Surprises” protections, which limit certain out-of-network emergency and air ambulance bills, and to file disputes when a bill is much higher than the “good faith estimate” required for scheduled, non-emergency care. CMS runs a patient-provider dispute resolution process when a bill is at least four hundred dollars higher than that estimate, described at https://www.cms.gov/medical-bill-rights/help/dispute-a-bill. In practice, this means many doctors tell their own patients not to ignore a disputed bill, but instead to collect all paperwork and ask for a review.
Suggestions from medical debt collectors
People who work for medical debt collection agencies, that also deal with unpaid hospital bills, see the worst-case situations, but even they often give advice that is focused on reducing harm. Reputable collectors and credit counselors commonly tell patients to ask for a detailed, itemized bill, to dispute clear mistakes, and to avoid putting medical debt on high-interest credit cards. Patients are urged to request an itemized bill and to check for services that should not be collected. and even look into options around settling - forgiven your medical debts.
Collectors and bank-affiliated financial wellness programs also tell patients that they are allowed to negotiate. A guide on medical debt negotiations explains that once errors are fixed, patients should work out a realistic payment plan and keep careful written records of every conversation.
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