While there are some standards around terminology and paperwork, hospitals and insurance companies tend to phrase or present things differently, often causing confusion which may, in fact, be the point. As we laid out in Part 1 of this guide, understanding those nuances is key to taking the next steps.
In other words, what particular issue or issues can you identify, whether it seems like price-gouging or an unexpected insurance denial? Note: these buckets may seem dense and overly detailed. We recommend following this 3-step process, which has led to significant bill reductions for our clients:. The first step to negotiating your hospital bill is to make sure you have in your possession — and that you understand — all of the relevant documents for your case. For a refresher on how to understand your hospital bill and insurance Explanation of Benefits, reread our section in Part 1: Understanding Your Medical Bills.
These include:. Your hospital bill is typically sent to you in the mail. It comes from the hospital and lists total charges along with any discounts offered, insurance company coverage, and what you as the patient owe. This is breakdown of ALL charges, line by line. If you have insurance, your insurance company should have sent this to you. Additionally, you can call your insurance company and ask them to send an EOB to you. Most billing issues that we encounter fall into 4 different buckets described below.
Contact us directly to make an appointment with one of our experts, who will be happy to spend 20 minutes going through your situation and to point you in the right direction.
What follows are descriptions of the 4 buckets. Click on any of the buckets in the list below to jump directly to its detailed description, including how to identify it and guidance on how to fix it:. Price Gouging is the hospital charging you far more than fair market price for services provided. As mentioned in Part 1 of this guide, hospitals charge consumers, on average, 4.
In this case, call the insurance company to walk you through the bill and confirm that the Plan Discount amount is correct. While many people may shy away from negotiating based on price, this is exactly what you should do. More work needs to be done in order to get a bill reduction. Fortunately, we offer a better set of strategies to help you get the results you need. We want to not just make the request but also give the hospital a strong reason to accept a lower amount, which we do in two ways:.
Arguing that the amount billed creates a hardship gets easier and more believable as the bill gets larger. Rather, simply state that you have multiple bills related to the procedure as long as this is true and that everything together makes it very difficult to pay.
Showing that prices being charged are out of the ordinary requires a bit of research. Insurance companies generally pay 1. Unfortunately, government-published datasets are very difficult to work with, and private companies charge a lot of money for this information. Submitting the request is the starting point for negotiations — and the best way to steer the conversation with the hospital away from a possible payment plan — but it is not the end-all, be-all.
In order to do this, all you need to do is write a settlement request letter. This letter gives the hospital something to respond to, and, more importantly, it forces them to start talking about price and not just payment plans or applying for financial aid. Proofread the letter to make sure all of the information is correct and that there are no spelling or grammatical errors.
Call the number on your hospital bill and ask how you can submit a settlement request. They should provide a fax or email. Note: You may be asked whether you want to go on a payment plan or apply for financial aid.
Many hospitals accept settlement requests but billing department employees are trained to redirect to other methods. Stand firm in asking about how to submit a settlement request. A day after you submit the letter, call the hospital to confirm that it was received and ask how long it will take for them to respond. You may have to call back multiple times over the next week to confirm receipt, but make sure you do. Patience and persistence are key. Keep checking on the status of your settlement request until you receive a response.
As a general rule, hospitals will not call you back unless you push them. If the hospital accepts your initial settlement offer, congratulations! Harness and his fiancee, Eliza Novick-Smith, spoke with the financial assistance department of the nonprofit hospital, Heart of the Rockies Regional Medical Center. However, it turned out that Harness' last two paystubs included overtime, and he just missed qualifying for aid, the couple said.
His situation is not unique. Prior to the pandemic, in , more than 29 million people in the U. Census Bureau. COBRA is federal legislation that allows workers to continue for a time with their former employer's plan.
However, the employer no longer subsidizes the cost. In some cases, it may lead people to miss out on necessary care. About 7. There can be errors , such as incorrect patient, provider or insurance information, as well as incorrect codes for the procedures and duplicate billing. Why you should have a plan Many Americans will eventually need long-term care. How to pay for it The big lesson Suze Orman learned from her recent health scare.
If you have no insurance, check with your providers to see if they offer a discount to uninsured patients. There are also federal requirements for nonprofit hospitals to provide financial assistance programs for low-income patients.
The aid varies depending on the state and the institution. Once you have explored all the options for payment, it's time to see if you can get your bill lowered.
Reach out, be nice, and tell the provider that you can't afford to pay the bill. You may cancel your subscription at anytime by calling Customer Service. Skip to Main Content Skip to Search. News Corp is a global, diversified media and information services company focused on creating and distributing authoritative and engaging content and other products and services.
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