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tips for negotiating medical bills

I have about 6 different bills from my delivery and my insurance company is giving me grief over what they will pay. Turns out not a lot. Have any of you had success getting bills reduced from hospitals, doctors, testing companies etc. Would very much appreciate any help you can give.

Tue. Sep 25, 1:43pm

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Your insurance company shoud have a grievance process- find out what it is and use it. It might not be easy to find- I had an issue with my insuance company earlier this year and it took me quite a bit of digging to figure out how to challenge a denied claim. But, in the end they paid everything.

Usually, they'll deny a claim because you went to the wrong hospital or got a procedure that they don't cover. If these things were out of your control, you have some leverage- for example, I was taken by ambulance to a hospital that wasn't covered by my insurance, so they denied the claim. When I explained that I was unconsious at the time and had no say in where I was taken, they allowed the claim.

Ask your insurance provider to explain just what was denied and why- talk to an actual person rather than doing this by mail.

Good luck!

Tuesday, September 25, 2007, 1:53 PM

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Quick question, and sorry for being a little off topic...my sister is getting some medical care in the USA (her husband is American and lives there) We are Canadian so we have a different system.

Do you pay first, and then the insurance company reimburses you?

Tuesday, September 25, 2007, 2:11 PM

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many fctors determine how much you pay and when you are required to pay. check with the doctor's office AND the insurance company BEFORE the visit!!! sometimes you need "pre-authorization" in order to be reimbursed for costs...you can't gather too much information, but you can suffer the consequences of not gathering enough!!

Tuesday, September 25, 2007, 2:26 PM

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Typically, for routine things, the doctor bills the insurance company, and then bills you for whatever it cannot recover from the insurance company. This may be subject to a copay that you have to pay at the time of the appointment, which iis usually a very nominal amount (i.e. $15).

Tuesday, September 25, 2007, 3:32 PM

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I had an accountant-friend tell me that if you have a halfway decent argument for why you shouldn't pay a medical bill, file a small claims suit. Costs you $20 in court fees, and doctors/clinics would rather eat the loss than invest time and money in getting a couple of hundred out of you.

Tuesday, September 25, 2007, 3:36 PM

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3:36 Brilliant advice! that was exactly the sort of thing I was looking for...

Tuesday, September 25, 2007, 3:44 PM

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I simply called the hospital and explained that my insurance only covered 80% of what was allowed. They wrote off the rest of the surgery bill there on the spot and sent me a confirmation.

Tuesday, September 25, 2007, 4:11 PM

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I called up the customer service number on my bill because I don't have health insurance and they knocked the bill down 20% and gave me a way to make payments over 2 years. It took a phone call, about 20 minutes of time.

Wednesday, September 26, 2007, 2:54 PM

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unless there were forseen complications, why would a health insurance company pay for delivery costs? i mean, it's optional, voluntary, not medically necessary for a woman to get pregnant. why should others have to pay for that choice to come to life? there were nine months to prepare for the delivery and any associated costs could easily have been researched well before the bill was received. why wasn't this worked out with the hospital in advance?

Wednesday, September 26, 2007, 3:07 PM

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because if women didn't have children, civilization would hault. is that what you're asking for?

Wednesday, September 26, 2007, 3:16 PM

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omg 3:07 what is with your post? How offensive!

This is what making health care a business does to people!

Wednesday, September 26, 2007, 3:20 PM

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i think if you can afford to raise a child, you should be able to pay for the cost of delivering that child. i don't think women should stop having chlidren, obviously, but i think that women who choose to give birth in a hospital should have to pay in the same way that someone who has a mole removed has to pay.

Wednesday, September 26, 2007, 3:29 PM

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So after decades of medical research to make childbirth safe for women and children these methods should become only available to those who have money.

I actually feel so sad that people have this world-view.

Wednesday, September 26, 2007, 3:42 PM

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why is it offensive? if i had a bill coming my way, for anything from minor surgery to a specialist visit to routine dental work, i would find out beforehand much of the cost i would be responsible for paying. is that such a foreign idea? when a woman is pregnant, she has many months to prepare and plan for the birth, whether with a mid wife or in a hospital setting. there is enough time to ask questions and, if necessay, wait for the answers. if they have time for nothing else, the insurance companies and hospital accounting departments have time to tell roughly you how much you'll owe after a procedure. it's a totally avoidable situation to find oneself in---owing more than one planned for regarding medical bills---in the case of birthing a baby. just because you disagree with my point of view doesn't mean i'm offensive....it means you don't agree with me. period. i am inclined to find it more offensive that a person knows she is going to have a baby and doesn't do any footwork with respect to calling the insurance company and talking with a representative before the birth about the associated costs.

Wednesday, September 26, 2007, 3:43 PM

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Um... Wow. Here I was thinking that 3:07 was just being satirical... and thus funny. And then I was going to say something about people who can't seem to wrap their heads around a parody...

and then, 3:43.

Just plain, wow.

Dude, insurance should cover child birth because that's what we have insurance for- By your logic, why should they cover anything?

It's almost impossible to plan medical costs for a birth- you go in wanting a natural childbirth with no interventions and the next thing you know, you're getting interventions that the doctor says are medically neccesary, or even worse, a C-section. And all the while, some claims adjuster at your insurance company's home office may decide that these procedures don't fall under the definition of "medically neccesary" or even better yet, call them "voluntary out-of-plan expenses..."

So, your carefully planned birth is now a major medical procedure and it's not like you've really got time to phone the insurance company to get prior approval for emergency procedures... and the next thing you know, $2000 has quickly become $20,000.



Wednesday, September 26, 2007, 5:05 PM

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a person can explore the potential costs, potential risks and potenttial procedures so as not to be complettly blindsided with the medical bills. a person can inquire with their insurance company about what is always covered and what is never covered. a person can find out if they are responsible for additional costs besides the act of delivery--such as technicians, drugs, emergency procedures, nursery costs, use of scale and other instruments, blood work, etc. a pperson can get a clue about what they are going to have to pay, even from people not associated with a hospital or insurance company. knowing what exactly falls under "covered" and "uncovered", "in-plan" and "out-of-plan" is the responsibility of the member/insured. read the information packet that every insured person receives and ask relevant questions. why is that so difficult to do for some poeple?? the more that people don't properly research their potential medical expenses, the higher the premiums the rest of us will have to pay to make up for the costs that others cannot afford after-the-fact.

Friday, September 28, 2007, 10:46 AM

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America is a cold hearted country in some respects. Happy to not live there.

Friday, September 28, 2007, 11:16 AM

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is this a conclusion you've reached after reading opinions from a web site forum?

Friday, September 28, 2007, 11:46 AM

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I'm not 11:16, but as a citizen of these united states, I gotta tell you, 11:16 has a point. In some respects, America has become a VERY cold-hearted place.

We continue to cut all our safety nets and then blame those who fall for not building their own safety net. This is not the same country my grandfather defended and helped to build.

Friday, September 28, 2007, 12:18 PM

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america may be in the wake of a cold-hearted administration, but americans themselves are not cold-hearted. "we" don't make cuts to effective and needed programs, but by sitting back and waiting to see what happens, we may as well. your grandfather and mine fought for our right to protest the policies of our government with which we disagree. there have been very few protests, at least very few that made it to the media-waves, in the light of all of the tax cuts/perks and all of the funds being diverted to the war. i think people feel like protesting may be un-patriotic when in fact it's something our ancestors fought for and a main reason they came here to begin with.

Friday, September 28, 2007, 12:27 PM

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11:16 here

Hi guys, I'm sorry, I was blunt and that can be at times rude. But, to answer 11:46 question, reading many of these forums on health care, including this one, I do sometimes feel that the country is cold hearted.

The OP is talking about childbirth. I felt sad that such an amazing event in her life could involve bills that she may be overwhelmed by.

But I know Americans are good people, I just don't like the system, frankly it breaks my heart.

Friday, September 28, 2007, 12:56 PM

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Wow - I can't belive some people put dollar on everything, even childbirth, how coldhearted this is. Wow.

Friday, September 28, 2007, 1:25 PM

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and THIS is about bill negotiation?

Where did this go awry? The American insurance industry is just that... a money-making proposition. Fight for your rights is all you can do, because it's what you pay for, INSURANCE. It is not a charity. So if you can't afford insurance, you pay in full for teeth cleaning, the pain of childbirth, etc. The procedures we consider routine as Americans can be costly, such as mammograms, colonoscopies, office visits. I feel cursed and blessed at the same time because a) I'm 50 years old and am having both procedures this week; b) my doctor no longer accepts AMEX as my CO-PAY for office visits (which are $35, by the way, not $15) and c) my husband's daughter is a baby who just had a baby and the American taxpayers paid for that... I don't like that idea either. (She's in another state, which is a whole other domestic issue.) The cost of my diabetes and health repercussions because of it (reading glasses, meds) is enormous and without insurance, I don't think I'd be alive. My husband, the sole breadwinner, lost his job in August, so these issues are huge for us. My $400 glasses with the fancy lenses will just have to wait, but my colonscoy can't. One thing for sure, I wish my Bally Total Fitness membership was free!

Tuesday, November 06, 2007, 6:09 AM

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sorry OP, but why are you trying to negotiate your bills? I'm sorry, but what happened to people working and supporting their own lives?

Personally, I'm sick of having money taken out of my paycheck to be put into taxes to pay for other's expenses. I took care to provide for my own life, why didn't they? And I didn't have anything spoon fed to me, and neither did my father nor mother, who both came to this country poor - my father without even an education - and made something of themselves.

Furhter, I'm sick of working just as hard, if not harder than the person next to me, making responsible choices, and then having to help support other's irrisponsible choices in the process.

For examples - free healthcare to single mothers? Uhh, how about just being careful and not getting pregnant? Often explited by mothers who lie 'oh, the baby has no father'.

Free healthcare to.'lower class' households that didn't take the care to provide for their own families?

BS if you ask me. I resent having that money taken from me. I'd donate some of it, I donate money already. But having it forcefully taken from me, because I've worked hard and earned more is unfair.

Tuesday, November 06, 2007, 9:38 PM

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9:38...this isn't about getting a free ride. It's just not fair that a doctor is willing to accept a total of $100 from an insurance company for the same appointment or procedure that they charge an uninsured person $250 for. That leaves $150 worth of room for negotiation from where I'm sitting.

Tuesday, November 06, 2007, 11:14 PM

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US healthcare operates in a market economy, although not an efficient market as that term is defined in economics, and the majority of healthcare transactions occur at negotiated prices. It is also to a considerable degree rationed, brokered, and cartelized. It has been US policy to try to use these factors to drive cost out of the system, but since driving out cost involves reducing someone's revenue, every provider and broker has a powerful incentive to shift burdens in any way possible, because the alternative is to lower their own income. It's now widespread, not universal, custom for the provider to invoice for services at high prices they know will not be paid, even when there is a prior written contract between provider and payer specifying the exact price of the service. Whether the negotiation occurs before or after the service is a matter of detail. If there's no contract, the provider has a legal claim to reasonable compensation for goods and services rendered, and neither party is obliged to accept the other's idea of what is reasonable. If they don't agree, they might end up in court.
The above is partly economics and partly business law. The business law part would have been considered 8th grade level knowledge a century ago. The economics side has gotten more advanced in recent times with, for example, the Michael Porter five forces model.
Because the self pay patient has less market power than the brokered (employer insured) patient/payer cartel, the flow of subsidy money is from the self pay patients to the employer insured patient/payer.

Wednesday, November 07, 2007, 10:59 AM

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Interesting, because where I live insurance companies have a pre-negotiated amount for maternity. What is over that amount needs to be written off and if you have to pay 10% out of pocket it is usually for lab tests and that sort of thing. Clearly the person who said it should be optional is a man. No woman and most men would argue that pregnancy shouldn't be covered by insurance. I could understand birth control options not being covered but pregnancy?

Wednesday, November 07, 2007, 11:56 AM

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maternity costs

This black and white thinking isn't unique to the U.S. Its unfortunate that this man has such displaced anger toward women and their health costs. I think if he's going to take this route he might want to look at the how much money is utililized toward men for such unwarranted procedures/medications related to their inability to sustain an erection or stds. Two years of viagra or valtrex meds alone would cover the same expenses as giving birth and guess what, insurance covers them. On top of this, unless you have insurance through a company a woman will need to pay extra money toward the premium (mine is $150/mo. extra) with a 1 year wait period. If he wants to get mad at anyone it should be at all the deadbeat men spreading their irresponsible seeds around and not taking responsibility or better yet focus on why healthcare costs are really rising. Look at all the new construction going on at all the hospitals in the U.S. Every hospital wants to be the best at everything and at the expense us.

Wednesday, November 07, 2007, 2:23 PM

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Insurance Paid Less

Hi
I am charged by my Hospital for $2700 for a Radiology service.
My insurance company has paid only $600 and balance $2100 was on me.
And my insurance company rejected that no pre authorization has been taken.
But for the same radiology service another service provider has charged me $1200 before six months and my insurance co reduced the billing to $560 with some discounts and all it. It was paid by insurance company itself.

Now how to reduce my current bill and since it was paid less earlier, I took the radiology service with different service provider thinking it will be same everywhere.

Please can any one help me here to tatics to reduce the bill .

Thank you

Wednesday, May 20, 2009, 5:26 PM

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Help with medical bills

We are patient advocates and can help you understand your medical bills and dispute insurance under payments. Please see our website if you would like help and feel free to contact us.

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Thursday, June 18, 2009, 2:00 PM

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Medical Bill Helper

Medical Bill Helper negotiates medical bills for consumers. We don't charge unless we save at least 10%.

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Thursday, January 21, 2010, 6:00 PM

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OP, contact your State Insurance Commissioner. Every state has one.

Thursday, January 21, 2010, 9:23 PM

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So I guess there's no way to flag a spam post? Really, Peertrainer?

Thursday, January 21, 2010, 9:41 PM

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Medical bill review

Medical billing errors are common. Consumers should not pay a medical bill that they do not understand. This includes hospital bills. Ask your hospital to send you an itemized bill and scrutinize the charges. be sure to ask for clarification of anything you don't understand. Coding is very complex and can lead to inaccuracies that should not be paid without question.

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Sunday, October 30, 2011, 12:21 PM

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they deny you the information on cost

The four-year-old posts from 2007 are interesting. Four years ago I would have thought what a lot of people were saying: find out ahead what the costs will be, if you can. (Of course, in a medical emergency that all goes out the window!)

Three years ago I needed a non-emergency procedure, which even with insurance I thought I might need to budget for. (My insurance would pay 80%.) However, I could not find out what the procedure would cost! The doctors office said they had a confidential agreement with my insurance company and wouldn't tell me. The insurance company said it was confidential and they couldn't tell me!

I said to the rep, "Look, can you tell me whether my portion of this will be hundreds of dollars or thousands of dollars? I need to know whether I can afford to make vacation plans."

And he replied, "I know what you mean, but no we do not give out that information."

So I wrote the state Attorney General. The AG's office responded that it was perfectly legal for the doctor to tell me I needed a procedure and to schedule that procedure without anyone ever having to tell me how much the bill would be until I owed it.

Meanwhile, my pet got cataracts and the veterinarian said, "It will cost $3500 to fix this." Why is health care for pets so much better?

Sunday, October 30, 2011, 6:33 PM

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Every medical bill should be scrutinized, as should all insurance statements. Medical billing and claims coding is very complex and the rules are very challenging which makes mistakes very common.

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