Have a Surprise Medical Bill? Here's How to Negotiate, Dispute and Prevent

Deb Shields
October 8th, 2019 October 8th, 2019 |
Read time: 11 minutes

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Are you struggling to pay for unexpected medical costs? If so, you’re not alone. A 2016 Kaiser Family Foundation and New York Times survey found that 20% of insured Americans, and more than 50% of uninsured Americans, experienced financial challenges in paying medical bills.1

You could cut your household expenses, dip into your savings or even take out a loan to pay your outstanding medical expenses. But if those ideas don’t appeal to you, keep reading this article for tips on how to negotiate or dispute your medical bill.

You’ll also learn more about what you can do to reduce your chances of receiving surprise medical bills in the future.

One option to help alleviate the strain of surprise medical bills may be supplemental health insurance. Even if you have a major medical policy, you could be underinsured and may benefit from supplementing with additional benefits for covered medical services.

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How to Negotiate or Dispute a Medical Bill

While you’re recuperating from an illness or injury, the last thing you want to worry about is how you’ll pay your medical expenses. But taking a few actions when your bills arrive may help lower the amount you owe.

Review for billing errors

Unfortunately, medical billing errors are fairly common. In fact, Medical Billing Advocates of America’s CEO Pat Palmer said in 2016 that her organization found mistakes on approximately 75% of the medical bills they reviewed.2

To ensure that your bill doesn’t contain errors, carefully look through the charges associated with your treatment. If your statement doesn’t include a list, call your provider and request an itemized bill.

Check your billing statement to ensure the following information is correct:

  • Dates of service
  • Names of providers that performed treatment
  • Types of medication you received
  • The billing codes for service match the treatment you received. Online services such as VeryWell Health provide easy-to-follow billing code lists
  • You were billed only once for each service – duplicate billing sometimes occurs
  • Your insurance company has been billed and paid their portion before your provider billed you.

Found an error or have questions? Call your provider’s billing office to have charges reduced or eliminated entirely from your medical bill.

Get professional help. It takes time and energy to review your bills and negotiate with your provider’s office. If circumstances make it difficult for you, there are many online services who can handle this process. Just as if you’d hire a lawyer to go to court, or an accountant to calculate your taxes, you can have medical bill and negotiation professionals work on your behalf.

Appeal out-of-network charges

A surprise medical bill may be the result of “balance billing”. Balance billing may occur when you receive a bill because:

  • Your provider charges you an amount beyond what your insurer covers for out-of-network care and beyond cost-sharing

OR

  • You received services from a health provider who doesn’t participate in your insurance network.3

The latter situation occurs relatively frequently in emergency situations, when you may be unaware that you are receiving care from out-of-network providers, being transported to a hospital by an out-of-network ambulance service, or even having out-of-network lab services.4

Illustrating this scenario, a recent NBC News report featured the story of a patient who received an emergency appendectomy at an in-network hospital, without realizing her surgeon was an out-of-network provider. She then received a surprise medical bill for thousands of dollars that her insurance company refused to pay.5

State Regulation of Out-of-Network Costs
Emergency Services: Requirements vary by state for emergency care, but most states require that you not be billed extra if you were taken to a hospital that isn’t in your network.6

Specialists: Many states have a requirement that plans cover out-of-network services at in-network cost-sharing rates if you need care from a specific specialist who is not in your network.7

Learn more about health insurance networks.

Call your insurance company immediately

If your unexpected medical bill is due to out-of-network provider charges, especially because you needed emergency care, contact your insurance company. When you file a formal appeal, your insurer may work on your behalf to negotiate reduced charges.

To support your appeal, contact the provider (physician, ambulance service, surgeon, etc.) who can document and help support your claim that you legitimately needed to access out-of-network medically-related services.

You also can contact the National Patients Advocate Foundation, a nonprofit organization that provides medical bill assistance by helping patients with appeals to insurance companies.

Contact your state’s insurance commissioner’s department

As of December 2018, the Commonwealth Fund reported that 21 states offer consumer protections against balance billing.8 Although the protections vary among each state, the amount you are responsible for paying may be limited due to state regulations.9

To learn more about whether or not your state has balance billing consumer protection regulations, check the Commonwealth Fund report.

To find your State Insurance Commissioners’ contact information, visit the NAIC website and select your state from the drop-down menu on the right-hand side of the page.

You also can file a complaint with your state about unexpected out-of-network billing charges using the Consumer Reports’ surprise medical bill tool.

Congress Considers Legislation for Relief from Surprise Medical Bills
How common is balance billing? A 2018 University of Chicago survey reported that 57% of American adults have been surprised by a medical bill that they believed would have been covered by insurance, with 20% of those bills due to a doctor being an out-of-network provider.10

Consumer outcry over surprise billing practices has caught the attention of Congress.  Despite state-based balance billing consumer protections, self-insured employer-sponsored plans are exempt from state regulations.11

That’s because these plans – which affect more than 60% of people who get insurance through work12 – fall under federal jurisdiction, which means they can be regulated only by Congressional legislation.

The Lower Health Care Costs Act of 201913 is a proposed Senate Health, Education, Labor and Pensions Committee bipartisan legislative package focused on lowering hospital and overall healthcare system costs. Passed on June 26, 2019 out of committee,14 the proposed bill limits the amount providers can collect for out-of-network services, and aligns with the House’s Energy and Commerce Committee’s benchmark rate proposal.15

Ask your provider about payment options

If you’re unable to get a medical bill reduction using the steps above, contact your provider’s billing department.

Under the Affordable Care Act (ACA), non-profit hospitals are required to have financial assistance policies in place for emergency and medically-necessary care.16 The billing department can work with you to negotiate payments and set up a payment plan that works with your ability to pay.

Although Americans collectively borrowed $88 million in the past 12 months to repay healthcare costs, according to Gallup and West Health’s 2019 survey,17 try to resist the pressure of paying off medical debt by taking out a loan which will usually require repayment with interest. Instead, try to negotiate an interest-free payment plan with your provider.

Be sure to get your negotiated billing agreement in writing, and keep making your agreed-upon payments on time.

What happens if you don’t pay medical bills?

Medical debt won’t disappear if you ignore it. If you don’t pay medical bills, your provider will probably turn your case over to a collections agency. If that happens, you’ll likely be subjected to a barrage of calls, mail and texts requesting repayment.

Medical debt that has been sent to a collections agency can stay on your credit report for up to seven years,18 affecting your ability to obtain loans or credit cards in the future. Continuing to ignore medical debt that’s been sent to collections will result in the debt growing even larger, as it accumulates interest and fees.

Eventually, a collections agency could even file a lawsuit against you for not making payments. Each state has its own statute of limitations, which is the amount of time that a provider or collections agency has to take legal action against you.19

If you don’t plan to pay your medical debt at all, make sure that you don’t accidentally “restart the clock” on the statute of limitations. The date of your last bill payment starts the clock.20  Making additional payments or acknowledging you’re responsible for the debt extends the amount of time the collections agency or healthcare provider has to take legal action against you.21

Be aware that even if the statute of limitations runs out for legal action, it still doesn’t wipe away the debt or shield you from the collections agent. Collections agencies can employ other tactics to try to compel you to pay including:22

  • Reporting the amount owed to credit bureaus
  • Selling your debt to another company to continue to pursue you
  • Collecting from your estate, spouse or beneficiaries if you die

Check with a lawyer about options for protecting yourself from legal action.

Please note: the materials available at this website are for informational purposes only and not for the purpose of providing legal or tax advice. You should contact your attorney or tax professional to obtain advice with respect to any particular issue or problem.

How to Prevent Future Surprise Medical Bills

Americans worry about their ability to pay medical bills that they could accumulate in the future.

A 2019 Gallup and West Health poll reported that 45% of surveyed respondents were concerned that experiencing a major health event could lead to bankruptcy.23

And they’re right to be concerned. Since the passage of the ACA, more Americans are underinsured, and encountering difficulties affording their insurance coverage, and paying for healthcare and resulting medical bills.24

So what can you do now to help avoid unexpected medical bills down the road?

Shop around for healthcare

When you’re contemplating a big purchase, you probably take the time to research your choices and determine where you can get the best deal. When it comes to non-emergency medical situations, why not do the same?

If your doctor has proposed non-urgent medical care or services, seek a second opinion, ask friends or family members for recommendations about providers they trust, and look for the best rate for treatment or services you need.

Verify services and providers

Ask your provider for a detailed written description of the proposed treatment plan with a cost estimate. In addition, inform your provider of your insurance’s network coverage, and request that providers involved with your treatment participate in your network.

Then, contact your insurance company to confirm what your out-of-pocket costs would be for the proposed treatment based on your policy’s features.

Supplemental insurance coverage

Purchasing additional insurance may help reduce the amount you pay out-of-pocket for medical services.

Gap health insurance

This supplemental insurance pays a lump sum benefit when you experience a covered accident or illness. You can use the payment you receive to pay for any number of expenses or bills you’re facing, from medical bills to your major medical plan’s deductible, childcare costs or to pay your mortgage.

Like other supplemental insurance products, monthly premiums tend to be relatively low because the policy’s coverage and benefits are more limited and may require carrier approval in order to enroll.

Find medical gap insurance options available for you.

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Hospital indemnity insurance

This type of insurance provides first-dollar fixed benefits for medical expenses related to hospitalization, surgery and outpatient therapy services.

Hospital indemnity insurance benefits typically include coverage for:

  • Hospital room and board
  • Intensive care
  • Physician visits during hospital confinement
  • Surgeons, assistant surgeons, anesthesiologists, chemotherapy and radiation therapy, and physical therapy, to name a few.

Monthly premiums are relatively low for hospital indemnity plans because the benefits are limited. However, these plans are highly customizable. You can select a per injury or illness deductible as well as the benefit levels that best fit your needs.

Get a quote to see different plans and compare costs.

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Critical illness insurance

This type of plan pays a lump-sum cash benefit if you are diagnosed with a covered medical condition. You can use benefits to pay your:

  • Health insurance deductible
  • Out-of-pocket costs
  • Specialty drugs
  • Experimental treatment
  • Costs related to time off work, increased childcare needs, additional spending on gas or travel expenses and out-of-network care.

Also known as specified disease insurance, supplemental insurance and limited benefit insurance, critical illness insurance covers the following:

  • Cancer
  • Heart attack
  • Stroke
  • Major organ failure
  • Coronary artery bypass
  • Angioplasty
  • Coma
  • Paralysis
  • Severe burn

You have the option to select benefits under your critical illness plans to meet your financial and healthcare needs.

To see plans and compare costs, request a quote. It just takes a minute to get your results.

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Summary + Next Steps

It can be stressful dealing with unexpected healthcare expenses, but you have options to get medical bills reduced or even forgiven.

Thanks to consumer protections in many states – and now under consideration for federal legislation, insurance companies and providers are more likely to work with you to resolve your medical debt.

Planning non-emergency care services and having additional health insurance to support your major medical coverage can reduce your out-of-pocket liability the next time you need care.

These supplemental forms of health insurance may help when it comes to surprise medical bills and out-of-pocket costs:

Want help in obtaining supplemental coverage? Call 888-855-6837 to speak with a licensed agent, or find a local agent to work with.

Need Supplemental or Short Term Insurance?

Apply in 3 Easy Steps

  • Get a quote within seconds
  • Compare multiple plans
  • Finish application online
Originally Published On May 20th, 2013
Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

Footnotes