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The Surprise Hospital Bill: How to Deal with It

Print this out. Save it in your desk drawer. This will be your reference on how to deal with the intentional intimidating hospital billing process, also known as “the surprise medical bill.” It has been brought to Pratter’s attention that many health care consumers are frustrated and confused by hospitals’ billing practices. So much so, Pratter has the following advice:

Part One: Prevention:
1. Do not go “down the hallway” for routine medical care. The hospital is the most expensive location to get blood work or an imaging study or a surgery center procedure.  Look for freestanding medical providers (call and ask them if they are owned by a hospital or not) not owned by hospitals, including:
a) Surgery centers
b) MRI/CT/X-ray centers
c) Blood work centers

2. It is your right as a health care consumer to take your prescription for care to any medical provider, both in-network and out-of-network. There are often plenty of options in-network that are not hospitals.

3. Separate health care care from health insurance. Insurance is for a catastrophe. Use a hospital for catastrophe care when you have a real emergency or need to stay overnight. Use other medical providers for all routine care.

4. Ask for the price of your medical care at a hospital before you buy it. The hospital has to give you the price, known as the charge, or retail amount, per the federal law known as the ACA. This section is quoted below:

Public Health Service Act, Section 2718 of the Affordable Care Act. Bringing Down the Cost of Health Care Coverage.

(e) Standard Hospital Charges. Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnostic-related groups established under section 1886 (d)(4) of the Social Security Act.

5. Ask for the first name, last name and title of the hospital employee that gave you the price tag for your care item. This enhances accountability. Ask for the person to print or email you the price quote.

6. Ask for a paper copy of what the hospital wants you to sign electronically. The hospital wants you to sign that you agree to pay the secret price next month. This is referred to as the secret pricing scandal. Do not do it. Instead, write, "I agree only to pay all pricing disclosed before the time of my medical care” and initial it. Ask for a copy.

7. If the hospital does not comply with #4 through #6 above, you should seek care elsewhere. You have just received poor customer service.

8. Report the hospital for violation of ACA federal law by calling 1-800-MEDICARE or write to: Fraud Section, Criminal Division, US Dept of Justice, ATTN: Chief, Health Care Fraud Unit, 950 Constitution Ave, NW Wash DC 20530

Part Two: You Have Received a Hospital Medical Bill – Now What?

1. You will always receive an unitemized hospital bill. It’s standard poor customer service.

2. Never pay an unitemized hospital bill. You don't pay unitemized bills in the rest of your personal and business life.

3. Send a written request back with a copy of your medical bill (keep a copy too) asking for an itemized medical bill with the five digit CPT (Current Procedural Terminology) billing codes and the names of each billable item spelled out without any abbreviations. Tell them that you are not a doctor and you need to see the medical spellings to understand your medical bill.

4. If you receive an itemized medical bill, compare it to your insurance EOB (Explanation of Benefits). These can sometimes show up in the mail a month apart or more. See what the insurance company was billed and says was covered. Compare it to your itemized medical bill. Only pay those that match.  

For example, an Aetna policy stated that IV fluid administration was part of an ER visit code and could not be billed separately. The hospital billed this $360 IV fluid administration separately. Don’t pay this $360 in this example.

5. If you do not receive an itemized medical bill, do not pay your unitemized medical bill. Wait for the hospital collection department to call you, which could take three to six months, and politely state “Thank you for calling me. May I please have your first name, last name, title, and phone number? And please send me an itemized medical bill so that I can consider paying it. You failed to respond to my written request for an itemized medical bill. Surely, you don’t expect me to pay a bill without reviewing one.”

Part Three: The Hospital Has Sent You to Collections – Now What?

1.  Pay $5/month or $10/month on your bill. It does not matter if your bill is $5,000 or $5,000 or $50,000. The important point is that you are making a good faith effort to pay your bill so the hospital cannot turn you in to a credit agency to give you bad credit. This maneuver protects you until you get this matter resolved.

2. Non-profit hospitals (FYI – their websites end with .org if non-profit). If the hospital is non-profit by IRS standards, they cannot turn you over to a credit agency for bad credit until they are able to assess your current financial situation by you filling out a financial assistance form. The hospital will send you a form. You can either complete it or send another letter to them stating that you will not fill out this form or pay an unitemized medical bill. They must send you an itemized medical bill.

3.  Negotiate your claim. This is important for denied medical claims.

Option #1: Call the hospital anonymously and ask for the cash price for your care item. Tell the hospital you have no insurance and would like to know the cash price. Next, when speaking with collections, tell them you are willing to pay the cash price in monthly installments over the next year.

Option #2: Offer to pay what Medicare pays and nothing more. This will be found on pratter.us next month.

Offer #3: Offer to pay what Medicare pays and another 20% more. FYI – a regular health insurance company will often pay a hospital three times more than a Medicare payment. Hospitals often will want more than Medicare since Medicare is a poor payer of care. They feel entitled to more. Give them just a little more.

4. Small claims court. Note the following:

  • If the hospital did not provide you with the price of care before the time of service, quote the judge,

  • “I asked the hospital for the price of the medical care before the time of service as per my legal right under the federal law, ACA, Public Health Service Act, Section 2718(e). They failed to provide it to me, thus violating federal law. They chose not to provide the price for care to me. I needed care. I did not agree to secret pricing.”

  • If the hospital did not provide you an itemized medical bill before sending you to collections, quote the judge,

  • “I asked for an itemized medical bill both verbally and in writing. Here’s the proof (bring your letters and copy of the unitemized bill). And they failed to provide it to me. I am not in a position to pay any bill without reviewing it.” Legally, the court system will not make you pay an unitemized bill.

  • Denied medical bills. Sign up for Pratter’s service available for individual consumers come September. We will help provide the price the health insurance companies’ pay a hospital for your care. This price, known as the discount price, is always much less than the charge, also known as the retail price. Never pay more than a health insurance company for care. Always try to pay less as outlined in the above three options.

  • In a denied claim situation, the hospital will ask that you pay the charge, meaning the very expensive retail price. If you followed the instructions in Part One of this article, this would never happen to you. If you did not, show the judge the amount Medicare pays, the amount the insurance companies pay, and the cash price you were able to obtain. Recent court rulings do not expect an individual to have to pay more than a health insurance company. This follows the logic that an individual is not a multi-billion dollar organization like a health insurance company and should not have to pay more than an insurance company for care. So health care consumers are being protected from high costs of health care in our court system.

Don’t be bullied. Be the bull. Happy Pratterday!