Dear First Mates,
I hope all is well with you. I’m reaching out today about an issue that is close to my heart–and, unfortunately, weighs on the minds of far too many Americans.
As you may have experienced firsthand, healthcare costs quadrupled from 1980 to 2018, and they have continued to rise. What’s more, U.S. healthcare spending is nearly twice as high as it is in other similarly developed countries, with private healthcare spending accounting for most of that difference. And unfortunately, Americans have the medical debt to prove it.
That’s why I wanted to reach out today with a piece of advice and a few resources. First, the advice: Do not accept healthcare costs at face value. Challenge the insurance company. Challenge the healthcare provider. You are not the healthcare system’s client; the insurance company is. As such, you need to advocate on your behalf.
I ultimately recommend purchasing this book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, or the author’s easy-to-follow video course. These are great resources that include some of the general advice I’ve outlined below, as well as more specific guidance. For now, consider these tips:
Tip #1: Ask About The Cash Price. Medical providers often offer a hefty discount for out-of-pocket payments not processed through your health insurance provider. And if a healthcare provider says they must put your bill through insurance, they’re not telling you the truth.
This can be a wise move for those with a high-deductible health insurance plan since you may pay out of pocket for much, if not all, of the medical expenses that crop up in a given year. But be careful. Something extreme may happen, and you may incur enough expenses to surpass your deductible.
Those with lower-deductible plans and otherwise strong coverage should still consider asking about the cash price, especially with prescriptions or medical equipment. Your copay is sometimes more expensive than the out-of-pocket cost would be.
Take note: Your insurance company could have negotiated a better deal with the healthcare provider than the cash price. Unfortunately, in many cases, you’re unlikely to know until the bill comes due. These agreements are murky; some would argue intentionally so.
A personal note from Dave: I had a medical institution reprocess an outrageous bill from insurance to the cash price. Victory!
Tip #2: Use the Battlefield Consent Form. When you head into the emergency room, it’s often for, well, an emergency. As such, the forms you sign are often the last thing on your mind. Unfortunately, one of those forms relates to your financial responsibility and can sign you up for all sorts of costs down the road.
That’s why, when you are given the hospital’s financial responsibility document, you may want to consider adding this statement, called the Battlefield Consent: “Superseding other consents, I consent to responsibility (including insurance) for up to 2x Medicare following receipt of an itemized bill for appropriate treatment coded to the correct level.”
The Medicare rate is often much lower than the rate negotiated by private insurance companies, so this can help prevent a hefty bill down the road–or provide legal basis for challenging sky-high costs if needed.
Remember, hospitals are required to provide emergency care regardless of if you sign this form–something to keep in mind if they give you trouble for adding this copy to the agreement.
Tip #3: Request an itemized bill and billing codes. By requesting an itemized bill, you will ensure you have not been charged for services you did not receive (for example, being charged for two MRI scans when you only had one). Additionally, by requesting billing codes, you can ensure there has been no “upcoding.” Upcoding is when a provider overstates the severity of
the treatment (which can increase the cost of treatment), and it’s a fairly common practice.
Outpatient and inpatient care have different kinds of codes, but all of these codes can be looked up online. Allen recommends medicalbillingcptmodifiers.com and FAIR Health, but there are a number of other ones out there.
Tip #4: Request your medical records. If something seems fishy with a charge, request your medical records, as you cannot be charged for anything not listed in your records.
You can do so by calling the records department at your healthcare provider, or there may be a way to do so through the provider’s website. They may try to charge you, but you can try to get around this charge by noting you’re on a tight budget or by asking your doctor to request the records. (Doctors aren’t usually charged for such requests.)
Tip #5: Explore Financial Assistance Programs: These programs, sometimes called “charity care,” provide free or discounted health care to people who need help paying their medical bills. These programs may help patients who do not have insurance and patients who have insurance but are underinsured. I've even seen a case where someone didn't qualify but got the bill taken care of by this department - because they kept on fighting!
Ultimately, the main goal of this newsletter is to provide resources for you to fight back. Ask for a supervisor if the representative isn't helping you reduce the bill. If the supervisor isn't helping you, get their manager. And in some instances, it may be wise to get professional help, including Marshall Allen, Laurie Tood (The Insurance Warrior), or organizations such as Dollar For.
If you have successfully reduced or waived a medical bill, I'd love to learn about it. As always, don’t hesitate to reach out with any questions or for futher assistance. I’m always here to share thoughts and guidance.
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