Best Results Organizing

Last week, after I shared How to Track, Lower, or Cancel Your Recurring Subscription-Based Bills, a number of readers and clients were curious about the bill negotiation services listed, and quite a few wished there were a similar service for other types of expenses. In particular, I kept hearing that people wanted help negotiating (and fixing) bloated medical bills.

Estimations vary widely, but according to the latest medical billing statistics, upward of 80% of (non-pharmaceutical) medical bills contain errors that end up resulting in extra costs. This is problematic for everyone: you get bills you can’t afford, the providers don’t always get paid what they are due, and it all leads to widespread mistrust of the healthcare industry, per Medical Billing Errors Statistics: Impact on Patient Trust – A Complete Analysis.

WHY ARE THERE SO MANY ERRORS IN MEDICAL BILLING?

• Complexity — The US healthcare system has a hugely complex set of billing procedures. The more complex any system, the more you introduce the possibility of mistakes. Errors could be made by healthcare providers in billing or by insurance companies in the process of reimbursing medical costs.
• Failure to verify insurance — Although every doctor’s office and medical facility asks you for your insurance card, photocopies it, and queries whether your insurance has changed, that doesn’t mean that the person whose job it is to do the typey-typey will actually enter the information correctly. I’ve often seen clients have their old insurance companies/plans billed even after they’ve changed policies or gone on Medicare.
• Data entry errors and poor medical coding — Did you know that 52% of denied claims are due to coding mistakes? And almost 70% of billing errors are related to coding mistakes!

When you go to the doctor or to a hospital, various staff members are responsible for documenting what happened (what lab tests were run, what medications were given, what procedures were performed, etc.).

Next, someone has to enter the codes for each of those tests, medications, or procedures by selecting the proper code (from thousands) and then typing that code.

Bad handwriting, mistyping, or miscommunication on the part of the healthcare worker(s), and mis-coding are all possibilities for introducing mistakes. In terms of miscoding, it can be an issue of typing the wrong code, outright, or unbundling (where they mistakenly bill for multiple coded procedures or services that should be covered by one comprehensive, collective code).

• Poor training, disorganized billing procedures, and delayed filing — Healthcare provider offices generally do a great job at providing healthcare, but often struggle with hiring and maintaining a back office that handles billing and insurance issues.

One of my clients owned a (let’s call it) healthcare-adjacent office; a staffer involved in billing was unsure of some insurance procedures and had somehow failed to submit insurance billing for an entire subsection of patients for more than a year before the behavior was uncovered. How would you feel about getting a healthcare bill 18 months after services were rendered? How likely is it your insurance company would pay it?

• Red tape — Every year, changes in the software (and now, introduction of artificial intelligence) in medical records software means new opportunities for someone, somewhere, to make a boo-boo.

 

It’s not just the billing department’s fault!

On top of the creation of such errors, the perpetuation of them is, sadly, laid at the feet of healthcare consumers (i.e., patients).

Yes, it’s the job of the various levels of administration in the healthcare community to stop making these errors, but in the end, it’s our responsibility to know what our insurance policies cover, review our bills when they arrive, compare the bills with our insurance coverage, research whatever seems like an overage, and question excess charges.

Yes, I heard you groan.

None of this means you’re stuck with massive bills. You have options for verifying the charges, lowering costs, and even getting help reducing and paying for correct bills. 

According to a 2023 University of Southern California study, 25% of individuals “who reached out for any reason had their bill corrected,” and a significant number were able to acquire a payment plan or lowered rates. 74% of those who sought help for a billing error reported the mistake was corrected, and of those who sought help with an unaffordable bill, 76% received some kind of financial relief. Among those attempting some kind of price negotiation, 62% got a lower bill.

So, it’s worth trying to solve the problem, but it all starts with organizing yourself to set the record straight! 

HOW TO DIY ASSESS AND NEGOTIATE YOUR MEDICAL BILLS

When a medical bill arrives, don’t be too quick to pay it. Instead, follow this path:

• Know how your insurance plan works. If don’t have a handle on it, read Paper Doll Explains Your Health Insurance Explanation of Benefits.
  • What’s your deductible (and have you reached it yet)?
  • Have you reached your out-of-pocket maximum for the year? 

• Examine your bill — Yes, you have to open your mail. I know it can seem scary, but just like you must see the doctor rather than just hoping an illness or injury will go away, you have to investigate your bills.
  • Are the dates of service accurate? Are you being charged for services on dates you weren’t even there? 

If you’re in the ER on a Friday night and the hospitalist (the doctor who oversees your case while you’re there) writes orders to admit you, but there’s no room available until Saturday at Noon, you might get billed for an ER visit on Friday night as well as a hospital room for Friday, Saturday, and however many more days you’re hospitalized, even though you never had a room on Friday. That can be a multi-thousand-dollar mistake!

• • If it says why you were treated or seen, does the description of services, procedures, or tests seem right? 
  • Is there something weird on the bill? People have been charged ridiculous amounts for “mucous recovery systems.” That’s a box of tissues. 
  • Are there outsized charges for toiletry items or “administering” over-the-counter medications? An overzealous keystroke could turn a 1 into a 10 or a 10 into 100 count, dramatically increasing costs.

• Request an itemized bill — If you’re dealing with a hospital, the initial bill they send you is a big, fat summary that gives you no indication of what they’re saying they provided. Immediately call to request an itemized bill; if they give you guff, send a request via Certified Mail. Once you get the itemized summary, scrutinize it like it’s your job.
  • Review it in detail, line-by-line. Can you square the referenced services with your experiences? If you were unconscious or otherwise unaware of every type of treatment you received, you should still be able to note anything egregious. Are they saying they amputated a limb that you still have? That they removed an appendix that’s still inside you (or that you had removed several years previous to this claim)? I recently read about a woman who fought a hospital charge for a circumcision — for her infant daughter!
  • Do you see any duplicate charges?
  • Were you charged for something that should have been included? Most insurance plans don’t let surgeons charge for follow-up office visits within 90 days of a major surgery or 10 days of minor surgeries. 

• Check to see if the coding is accurate — In addition to incorrect codes due to human error, fraudulent charges may come from “upcoding” where a procedure or treatment is coded as something more complex than what you received. Coding includes:
  • Current Procedural Terminology (CPT) codes for procedures (developed by the American Medical Association)
  • ICD-10-CM for diagnoses
  • HCPCS Level II for supplies, drugs, and services not covered by CPT codes (developed by the Centers for Medicare & Medicaid Services.

• Cross-reference your bill and your Explanation of Benefits (EOB), whether on paper or in your insurance plan dashboard.
  • Has your medical provider already (and properly) billed your insurance company? If your bill seems Daddy-Shark-sized, it may be that the provider sent you a bill without having already processed the claim through your insurance.
  • Check to make sure the healthcare provider filed the claim with the right insurance company.
  • Look at your EOB to see if your insurance plan has rejected the claim. If so, you’ll likely see remark codes, letters or numbers next to why the claim was not paid. Somewhere in the EOB will be footnotes corresponding remark codes, clues to potential errors in the coding. I once helped a client figure out that her doctor’s office filed a claim stating that she’d had two flu shots, 30 days apart. She’d actually had one flu shot and then, the next month, the first of two Shingles vaccinations.
  • The remark codes may also tell you that the reason your claim was not paid is valid. For example, most insurance companies only cover an A1C blood test for people with diabetes every 90 or 120 days; while your provider’s office should know this and not perform tests more often, it’s ultimately your responsibility to make sure you know what your insurance plan will cover and call your provider’s attention to conflicts before you accept service.

• Research the average cost (in your state) of whatever medical procedure you had done. Both the Healthcare Cost and Utilization Project and the Healthcare Bluebook have databases spelling out these costs. You can also use FairHealthConsumer.org to find the fair market price of medical procedures.  

• Make a list of the issues in bullet-point form so that you are clear on what you want to explain and challenge. Take note of the claim number(s) so that the healthcare provider billing office and/or insurance company knows which claims you’re discussing.

• Call your healthcare provider’s billing office. 
  • Be polite. It’s the old, “You get more flies with honey than you do with vinegar” routine, although nobody ever wants flies. But you do want fewer pesky charges.
  • Stick to the point. They can’t help you if they aren’t clear on the problem.
  • Detail what looks wrong, using your list to guide you. Let them know you think there are (or may be) administrative or medial errors in the billing and specify your evidence.
  • Ask for clarification — in writing, if necessary. 
  • Don’t agree to pay if you still don’t understand a charge, or think they’re still mistaken.

• Dispute bills you think are still wrong with your provider and/or insurer. Consider seeking outside assistance (as described below).

• Negotiate payment options, if necessary — If the bill is correct, you still have alternatives if you can’t afford to pay it now and in full. Many providers, particularly hospitals, will work with you to arrange payment plans, lump sum discounts, or even financial hardship assistance (also called charity care or uncompensated care). 

 

SEEK ASSISTANCE NEGOTIATING YOUR MEDICAL BILLS

DIY is great, because you reap all of the cost savings.

DIY is also awful, because you have to spend your precious time on the phone with medical billing department phone trees, weary employees, and insurance providers. If you’re still recovering from whatever caused you to need medical care, or if you have a chronic condition, this may use up all of your time, energy, and spoons.  

 
And, of course, if you are recovered and back to work, you’re probably trying to maximize your time to catch up on everything you missed while being waylaid by illness or injury.

How do you decide it’s time to bring in outside help?

• If you’re feeling so overwhelmed by the process that you procrastinate on even picking up the phone, that’s a good indication that progress won’t be made without support. The longer you go without addressing bills that seem wrong, the less likely you’ll be to recoup mistaken or excessive charges.
• If your bill is enormous or your insurance issues are complex, and you’ve got no idea where to start, get help.
• If you suspect that the crazy-huge bill isn’t merely because they forgot to bill your insurance company but because there are errors or overcharges for which you don’t feel confident about your investigative skills, call in the experts.
• If you’ve already attempted to negotiate wackadoodle charges or resolve disputes and all you’ve got to show for it is an empty bottle of Tylenol for your headache, sore throat, and cauliflower ear from battling billing departments by phone.

How to Find Experts to Help with Negotiating Medical Bills

If you’re overwhelmed by the DIY process, seek a professional. As a Certified Professional Organizer, I have done the legwork with clients to help them handle the DIY portion of the medical billing nightmare. I’ve sorted and collated paperwork, helped clients draft letters requesting itemized billing, and sat by their side on speakerphone, helping interpret medical billing language and supporting them while they ask questions. 

However, this isn’t my area of expertise; while I’ve racked up many hours in solving my own and my clients’ medical billing headaches, it’s always best to call upon an specialist. Similarly, just as many of my NAPO colleagues who specialize in financial organizing may be able to offer support, so too may our fello specialists in the American Association of Daily Money Managers (AADMM).

But your best bet, particularly if you’ve got frustrating, complicated, or huge medical billing issues, is to work with an expert.

Medical Billing Specialists

In general, seek someone using the professional title of medical billing advocate or medical bill negotiator.

This kind of specialist can review your bills for both obvious errors (like billing an elderly man for removal of an ovary or billing you for medication you never received and which would never be used to treat whatever you had) and mystifying coding errors, as well as instances of overcharging.

Then, with your authorization, they can negotiate with healthcare providers and insurance companies on your behalf to reduce costs.

Medical billing advocates and negotiators specialize in reviewing medical bills, cross-referencing them with insurance, and identifying errors (and instances of fraud). Their services also include negotiating with healthcare and insurance providers to correct the errors, obtain discounted rates, and sometimes get more beneficial payment arrangements.

To find a medical billing advocate to analyze and potentially negotiate your errant healthcare bills, start with the professional directories in this field:

• National Association of Healthcare Advocacy (NAHAC)
• Alliance of Professional Health Advocates (APHA)
• UMBRA Health Advocacy
• Greater National Advocates

If the sticky wicket of the billing problem is your insurance company, an associated organization is the Alliance of Claims Assistance Professionals and Advocates (ACAP), whose members provide medical claims assistance and patient advocacy for a fee. 

Note: some advocates and specialists will work on a contingency basis, taking a cut of whatever they save you; others will charge a flat fee. Before engaging the services of a professional, make sure you understand their billing methods.

Related Specialists

Additionally, the Patient Advocate Foundation (PAF) connects healthcare consumers and their families with case managers who can help with both health and expense-related support, including access to care, assisting with applications for health insurance and related government programs, appealing insurance denials, getting support for co-pays and insurance premiums, applying for free or low-cost healthcare programs, and obtaining billing discounts or setting up payment plans. 

Other professionals may also be able to provide support. For example, patient advocates (whether independent, associated with healthcare systems, or provided by your employers’ Employee Assistance Program (EAP)) may be able to walk you through the wonkiest parts of the billing and insurance and help you resolve questions and problems.

If you suspect fraud or are dealing with a particularly complex legal dispute, you may need to hire an attorney specializing in the legal side of resolving medical billing claims. And, if you do believe you’re dealing with an instance of fraudulent medical billing, you might want to contact the offices of your state’s attorney general or insurance commissioner.

ENGAGE A BIG MEDICAL BILL NEGOTIATION COMPANY

Between the time I started researching this post and publication, a number of the larger billing negotiation companies, designed to take advantages of scale to negotiate billing on a patient’s behalf, like CoPatient, have ceased operations. Still, you do have options. 

Medical Cost Advocate

Medical Cost Advocate (MCA) — In addition to medical bills, MCA also negotiates dental bills and health insurance claims. They also provide on-call advocacy for employer groups, and concierge healthcare advocacy services for families and executives needing more ongoing insurance and billing assistance than they have time to address.

Once you create a personally-identifying account profile (a step you can skip on future visits), use your login ID to share billing information, check the status of any bill negotiation, and review a final report of any achieved savings.

Start with some data entry. Confirm information about the patient (whether that’s you or your dependent), like date of birth, mailing address, phone number, etc. Include your insurance provider’s information (if you have coverage) to cross reference who has responsibility for which costs.

Next, either upload the bill or enter the billing information in their system so MCA has information about the medical provider, the procedure or services to be assessed and negotiated, the amount already paid and/or still due, and the status, such as whether you have submitted the bill to your insurance carrier.

You’ll also enter payment authorization for MCA’s negotiation services, approve the terms and conditions, and authorize a credit or debit charge (equal to the percentage of the savings they negotiate).

MCA charges 35% of the total savings achieved on negotiated medical bills, and takes nothing if not successful. When everything is complete, you’ll get emailed a savings report.

Note that Medical Cost Advocates won’t take on billing negotiations for costs under $600, so this is better used for big bills related to a hospitalization or root canal, not your doctor’s office co-pay.

MCA claims that their services typically save their clients anywhere from 20% to 50%. While there’s no guarantee your bill will be lowered, bill submission process is easy enough to make it worth your (small) effort.

Goodbill

Goodbill offers similar medical bill negotiation services but specializes in hospital billing.

Goodbill’s user interface is intuitive. You start with a simple screen that asks you basic questions about your experience and the billing. 

After you authorize Goodbill to access your hospital bill and medical records, they combine team expertise with Goodbill’s AI software to review and analyze your bill and medical records with the goal of identifying bogus, unnecessary, or inflated charges, bad coding, or related mistakes.

If Goodbill finds discrepancies between what they should have billed and what they did bill, they’ll sent you a draft of a formal negotiation letter, enumerating the mistakes and the possible savings. If you approve, Goodbill will forward the letter to the hospital and follow-up with negotiations as necessary until the problem is resolved.

Goodbill charges a fee only if they’re able to negotiate a discount. While I could not identify the specific fee structure on their site, it’s a percentage of the savings, with a cap of $1,000.

 

If you’re unable/unwilling to follow the DIY approach to negotiated your costs in the first place, there’s no monetary risk to you to turn the problem over to either company.

DollarFor

Although DollarFor previously offered medical bill negotiation services, they have suspended this offering. However, they have a robust library of DIY negotiation tips and resources, including a hardship letter template, a sample negotiation script, and settlement letter template, worth your exploration.

MEDICAL BILLING IMPACT ON CREDIT HISTORY

Finally, know that medical debt no longer has the same impact on your credit score as before. As of April 2023, the major credit reporting agencies (Equifax, Experian, and TransUnion) have made the following changes:

• Debts smaller than $500 aren’t listed on credit reports and no longer impact credit scores.

• Consumers have a one-year grace period before medical bills in collection appear on credit reports, providing ample time review, negotiate, and resolve disputes over medical billing and insurance errors.

• Repaid older debts should be removed from your credit report. Unpaid medical debt older than one year and greater than $500 will still show up on your credit reports for up to seven years, potentially damaging credit scores. However, if you (or your insurer) repay medical debt already in collections, the credit bureaus will remove the debt from your reports.