Cracking The Medical Bill Mystery: How To Understand And Negotiate Your Medical Bills

Cracking The Medical Bill Mystery: How To Understand And Negotiate Your Medical Bills Featured

John Quincy Adams once said, “Patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish.” Well, I definitely need a little magic in my life because I have very little patience OR perseverance when it comes to deciphering my medical bills. 

Here’s the thing. As patients, we all know that medical bills are too complicated, but the healthcare industry realizes our pain. Many hospitals have held regular focus groups, offer online payment portals, and are embracing patient payment plans. The effort is definitely being made, but the road to a patient-centered medical billing experience is a long one. So, what do we do? We have to take matters into our own hands, and by matters I mean deciphering confusing medical bills and negotiating those bills on our own terms. Take a deep breath, it’s not as complicated as you think! 

Remember, not ALL of the letters you receive in the mail are bills. Yes, that may sound silly… but if you’re anything like me, you immediately go into panic mode when you receive an envelope containing any type of medical information. Bills and non-bills look very similar, so it’s easy to be confused. Here’s how you discern between the two: 

The non-bills will come from your insurance company. This document is actually your Explanation of Benefits (EOB) explaining how much the insurance company is covering for the medical services performed, how much you will eventually owe your provider, and how close you are to meeting your deductible, if you have one. The biggest sign? You will find the sentence “THIS IS NOT A BILL” somewhere on the letter! 

The REAL bills come from the people involved with your care. Hospitals, doctors, labs, and any other organization that actually provided you care are the ones you should expect actual bills from. These bills represent what you owe after your insurance company negotiated what share of the cost they’re willing to pay. Keep in mind that you may receive more than one bill from the same provider. If your care involved more than one procedure in the same visit, you could receive multiple bills. My suggestion? Keep track of everything – even if that means carrying a notepad or creating a new note in your smartphone. Keep track of each procedure, where they’re performed, and who performs the procedure. That way, when you look at your medical bill for the first time, you’ll know exactly what to look for and if you’re being overcharged for care you didn’t receive. 

Compare your bills to your EOB. Another helpful tip that could save you a lot of money. Has something been added that wasn’t mentioned in your EOB? Are you being charged for something that your insurance company already paid for? (That’s called double billing and happens much more often than you think, so be sure to check for that. Your provider can’t legally charge you for something that’s already been paid.)

Ask for an itemized bill from your provider. If there is any discrepancy between your medical bills and your EOB, you should call your provider immediately and ask for an itemized bill. I suggest the same course of action if you receive a summary medical bill, which is basically just a few numbers without a lot of useful information. If you’re confused and unclear about what you’re expected to pay for, call your provider immediately. If you receive an itemized bill and the charges still don’t make sense, call your provider and ask for someone to explain the charges. At the end of the day, this is your money and you should know exactly what you’re paying for. It’s important to remember that if you’re paying for someone else’s bill – such as your spouse or child – there’s a chance that the provider won’t be able to discuss the charges with you unless the patient gave you consent. You may want to make it a habit of signing a release form whenever you receive treatment from a new provider. Typically, it’s included in the paperwork you receive during your first visit. If you don’t receive one, ask for it! It will look something like this. This way, you have another set of eyes and ears that can legally look at and ask about your medical information. 

Still confused? Negotiate. Too nervous? There are people that negotiate medical bills for a living. Yep, you read that right. Obviously, sticking up for yourself and your wallet can take a lot of time and energy. Or, maybe you’re nervous about negotiating with your provider. That’s okay, many people are. That’s why healthcare advocates exist, professionals that will negotiate on your behalf. Here are a few organizations that will help connect you with an advocate:

Sometimes, these advocates will charge a flat or hourly fee, but not always. Some simply take their pay out of the money that they save you through negotiation. So, if your advocate takes 15% or 20% of the money you saved, you’re still better off than you would be by paying the medical bill in full.

No one wants to feel like they’re being tricked into paying for medical bills that they shouldn’t be. Until the medical billing experience becomes more patient-centered, it’s time for YOU to take action. Take notes, compare your bills to EOBs, negotiate, or have someone negotiate for you. The money you will save with be worth the effort!

Jenna Tropea

A social media and marketing junkie, Jenna Tropea covers a range of topics from healthcare technology to policy and regulations. Jenna received her MBA from Clemson University and enjoys discovering and sharing the latest news in health IT breakthroughs.