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You Got a $10,000 Hospital Bill. Now What?

These seven tips can help you shoulder sky-high medical charges — and maybe get them reduced

posted by Caroline Mayer, October 3, 2013 More by this author

Hospital emergency sign

Caroline Mayer is a consumer reporter who spent 25 years working for The Washington Post. Follow her on Twitter @consumermayer


Hospital emergency sign
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Every day, it seems, there’s a new, terrible tale of someone being hit with a whopping hospital bill.
 
The New York Times recently wrote about John Fugazzie, 57, a laid-off New Jersey supermarket executive without health insurance who received a $171,569.44 bill for his six-night hospital stay after suffering a heart attack.
 
If you get a four-figure, five-figure or six-figure hospital bill, what should you do? What can you do?
 
The Good News on Fighting Hospital Bills

I’ll give you some tips shortly, but first I want to tell you about some encouraging news on this front:
 
First, the Internet is helping to show the wide disparity in charges from one hospital to another. This may not only help keep prices more competitive, it could help you negotiate a lower bill.
 
(MORE: 6 Ways to Negotiate Lower Doctor Bills)
 
And that’s the second positive piece of news. These days, many hospitals can — and do — negotiate, if you ask.
 
Sometimes, they’ll work with you to create a payment plan; in other instances, they’ll reduce their fees, especially if you can pay the entire tab upfront. Since the prices hospitals charge often aren't based on their actual costs, Gerri Detweiler, director of consumer education for Credit.com says “patients can and should negotiate.”
 
Perhaps even more important, says Tony Dale, founder and chairman of the Karis Group, an Austin-based patient advocacy and bill-mediation service, most hospitals have generous financial-assistance programs to help trim large bills even if your household income is above the poverty line.
 
Firms like Dale’s represent one more bit of good news. There are now a growing number of people and companies that assist distraught patients in lowering their hospital bills. They include professional bill negotiators, patient advocates and attorneys.
 
Why Disputing Hospital Fees Is So Hard

None of this is to say that challenging a sky-high hospital bill will be easy.
 
For one thing, it takes a lot of detective work to track down all your medical bills and decipher their billing codes. For another, it can be frustrating, even aggravating, to deal with a hospital billing office, especially if you’re a patient.
 
(MORE: A Health Economist Confronts His Family’s Medical Costs)
 
And you need to act fast to get financial relief. “You cannot bury your head in the sand and try to work something out six to nine months after the bills are due,” Dale says. “You must apply for help within 90 days of incurring the bill.”
 
Here are seven tips from experts on how to handle a hefty hospital bill:
 
1. Get organized. As soon as you’re handed your first bill, be meticulous about keeping track of every one you receive. You may want to create a spreadsheet.
 
There could be many bills — from the hospital, an assortment of doctors, the lab and the ambulance that took you to the medical center. Some won’t come from the hospital itself, but from the particular provider that performed a service.
 
Don’t hesitate to call the hospital-billing department to double check on charges you haven’t seen yet but know you’ll need to pay.
 
2. Vigilantly review the bills. “It’s very common for hospital bills to contain errors and overcharges, so make sure you’ve actually received the services they said you did,” Detweiler says.
 
Candice Butcher, vice president of Medical Billing Advocates of America, says if you’re discharged in the morning (as most patients are), protest if you’re socked with a full daily-room rate for the date you left the hospital.
 
And if you brought your medications with you, make sure you weren’t charged for them by the hospital. “This frequently happens,” Butcher says.
 
Also, dispute any additional fees on the bill for routine supplies, like gowns, gloves or sheets. These items should be factored into the hospital daily-room charge, because, Butcher says, they are “considered the cost of doing business.”
 
3. Challenge your health insurer’s decisions, when warranted. Keep track of any hospital bills the company rejects on grounds that the procedure or drug isn’t covered by your policy. If you believe the insurer should be paying more, don’t hesitate to appeal its decisions. You’d be surprised how often carriers overturn their earlier rejections.
 
4. Negotiate bills once you know how much you’ll have to pay out of pocket. If you just want extra time to send the money, Dale says, “it is relatively easy to speak with hospital or clinic business office staff to arrange a payment plan.”
 
(MORE: Avoiding Sticker Shock at the Drugstore)
 
Conversely, you may be able to wrangle a cash discount for agreeing to pay your entire cost at once.
 
You may also be able to successfully bargain down the particular dollar amounts you’ve been charged.
 
Tell the billing department that if your insurance requires, say, a 20 percent co-payment to the hospital, you’ll pay only 20 percent of the insurer’s negotiated rate with that hospital. That’s usually far less than the initial rate quoted — the figure charged to uninsured patients.
 
Go online to check the rates other local hospitals charge for the procedure you had. Then, if you find your bill was way out of line, use this data as ammunition to try to get your fees lowered. You can get this type of information at such sites as Clear Health Costs, Healthcare Blue Book and FAIR Health.
 
Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation.
 
5. Consider hiring a pro. Since hospital bills are hairy, messy beasts, it may be worth your while to bring in a patient- or medical-billing advocate (Detweiler recommends the advocacy firm Copatient.com, which charges 30 percent of what it saves you) or an attorney. “It’s like hiring a CPA to do your taxes,” Dale says.
 
Be sure you won’t be required to pay this expert any fees upfront. Patient advocates typically charge 20 to 30 percent of your savings; some put a cap on their fees. Karis’ firm, for example, charges no more than $3,000. Attorneys often charge 30 percent of the savings they achieve.
 
6. Find out if you’re eligible for hospital financial assistance. You may be required to go through the rigmarole of applying for Medicaid and being rejected before the facility will provide its assistance, though.
 
7. Explore alternative fundraising. Many patients facing exorbitant hospital bills (and their families) have begun turning to crowdfunding websites as a last-resort way of raising money to help cover their expenses. Sites for this strategy include GiveForward.com, GoFundMe.com, YouCaring.com, FundRazr.com and Indiegogo.com.
 
Crowdfunding sites like these make it easy to create a Web page for your medical fundraising drive. Then, donors (typically friends and family) make contributions there using their credit cards or via PayPal. You can read more about using them in a story I wrote about crowdfunding medical costs for Kaiser Health News that appeared in The Washington Post.
 
I hope these tips will be helpful if you find yourself facing a staggering hospital bill. Health care is costly, but no one should be forced into a financial disaster because of it.
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