Six steps to handling a medical bill now

January 9, 2012

Mark L. Friedman, MD, FACEP, FACP

1) Scrutinize the bill. You may need to request a copy of the itemized bill, especially for in-patient hospital bills with multiple charges. If you have any questions, call the provider's billing office. When in doubt, request a copy of the medical record. An often overlooked step to handling a medical bill is confirming that you are not being billed for services not rendered.


2) If you have medical insurance and the provider is billing your insurer, the next step is to wait for the explanation of benefits (EOB) from your insurer. Do not pay the bill until you receive the EOB and see what your insurer has paid and what is your responsibility. If you pay the full bill up front, it becomes your responsibility to pursue a refund from the provider.

3) Once you receive the EOB from your insurer you will see the discounted amount, what if anything the insurer has paid, and the deductible and co-pay balance. If the bill is accurate and fair, you have received a significant discount, the insurance company has paid its share, and you received reasonably good service, pay the bill. After all, doctors and hospitals deserve to get paid, too. If you are left with a payment that is too large to handle, feel that the service was unnecessary or substandard, or that the insurer has not paid its share according to the contract, or if you are uninsured or must pay out of pocket first, read on.

4) Negotiate the bill if payment has been unfairly denied or underpaid by the insurer or if the balance due is unreasonably high. The provider wants to get paid, and is your natural ally in any dispute with the insurer, so should provide any documentation. If the insurer is not being cooperative you can always complain to your corporate benefits department or even the state insurance commissioner. Don't give up if you think you are in the right, and keep careful notes.

5) Once the insurer has paid, discuss the balance due with the provider's billing office. They are usually authorized to set up interest-free payment plans, accept partial payments, or accept payment by credit card. Politely explain that you understand the billing person lacks the authority you need and ask to speak with the billing supervisor. Explain why the provider should give you a break on the balance due. One tack is to explain that under your current financial situation you are unable to pay the bill in full, but you will try to pay at some indefinite point in the future. If all else fails, heave a big sigh and say, "I guess you'll just have to send me to collection." The billing agent on the phone will not care, but the supervisor and provider will, so be sure that's who is on the phone. Collection agencies take a "cut" of 25 percent or more off the top of what they collect and they collect on a small percentage of their cases (or else the billing company isn't doing a good job), so a supervisor might be persuaded that a 20 percent discount in exchange for immediate payment will suffice. If you're stilling hitting a brick wall, contact your FSH patient advocate for help.

6) Audit the bill. It is legitimate to question a bill even after it is paid. In the case of a substantial bill, it may be worthwhile to retain a professional bill auditor. These people, who usually work for insurance companies with backgrounds in nursing or clinical fields, will go to the hospital, review the medical record, and compare it to the bill to confirm you got what you paid for. In the event an error is found, the hospital is obligated to pay back any overcharges.

Originally published Jan 9, 2012 3:58:15 PM.