Steps to Take When You Get a Surprise Medical Bill in the Mail
- Author: William Asher
- Posted: 2024-08-12
Many people's worst nightmare comes true when they get a dreaded surprise medical bill in the bill. This is what leads to bankruptcy for many Americans. In many cases, the healthcare provider has the upper hand on you when they send you a bill. However, there are measures that you can take to help yourself deal with a surprise medical bill. Here are six steps to take to help deal with surprise medical bills.
Call Your Insurance Company
In some cases, you are getting a bill because the provider did not properly submit the bill to the insurance company. Some surprise medical bills result from the fact that a provider merely entered a wrong code on the bill or even misspelled the doctor's name. This can resolve surprise medical bills with one phone call. In any event, the very first call that you make after getting the bill should be the insurance company before you even talk to the provider. If the insurance did reject the claim, you should know the reason why before you do anything else. This can just a case of a simply misunderstanding that can be fixed.
Negotiate the Bill
If your insurance is adamant that they are not paying the claim, you should get a sense of how much you would need to pay. Providers will charge you the list price of the services no matter how little the insurance company pays them. This will give you some room to negotiate. After all, the healthcare provider does not want to drive you into bankruptcy. Then, they will barely get paid at all. The first thing is to ask for the self-paying discount. Then, you should try to negotiate on top of that. Many people have success when they try to negotiate surprise medical bills. You may even be able to agree on a payment plan that can give you additional time to pay the debt.
Scrutinize the Bill
Some of the line items on the bill may be amiss. The charge could be exorbitant or a line item could be miscoded. Insurance companies look for certain codes when they are deciding whether to cover the claim. They may reject the claim out of hand when the bill does not have a code that they are looking for. Confirm that the bill was coded properly.
File an Insurance Appeal
You have several different ways to appeal the surprise medical bill. However, you need to begin to act quickly after receiving the surprise medical bill. Your plan may impose a limitation on the time that you have to appeal. When you file an appeal, you should include your reason why you feel that the claim should have been covered. In some cases, the insurance company will grant your appeal. More often than not, your appeal will be unsuccessful. However, filing an appeal allows you to file an additional appeal beyond that with your state's insurance commission. This is the more likely source of help for you as insurance appeals frequently rubber stamp the initial determination.
Contact the Media
If the circumstances behind the surprise medical bill are egregious enough, you may be able to find a sympathetic news reporter to cover your story. The media likes to cover surprise medical bills every now and then if the provider has overreached. In many of these cases, the provider ends up relenting and only charging the patient the co-pay. In fact, healthcare providers will routinely back down in the face of public pressure. They are afraid of the negative attentions and what could happen after that,
Contact a State Agency
Some states have laws that deal with surprise medical billing. They may not completely outlaw the practice, but they can put restrictions on the circumstances under which you would face a bill. Try to get online to see how your state covers surprise medical bills.
There are state agencies that can help customers who are struggling with surprise medical bills. Some states have patient advocates that can get involved to help people dealing with this problem.
You can also find some nonprofit patient advocate groups that can contact the provider on your behalf. When in doubt, the hospital may also have a patient rights advocate that can get to the bottom of the issue if you are having a problem with the billing department.
