'Never Pay The First Bill' And Other Advice To Battle A Suspiciously High Hospital Bill
Legal experts say, just because you received care doesn't entitle a hospital to a bonkers high price. Still, fighting an unreasonable bill takes some work.
Hospitals now have to tell you their prices. That could help you plan where to get care.
But today, let’s talk about how it could possibly save you hundreds or thousands on a bill you’ve already received.
Here’s a crib sheet.
Demand a copy of the itemized bill.
Former ProPublica reporter Marshall Allen has investigated the health care industry for 15 years. His book, Never Pay The First Bill, lays out some of the best advice you’ll find anywhere on how to avoid getting ripped off.
Start with the suggestion made in the book title. That first bill you receive often shows vague totals.
Allen compares that to leaving a grocery store with a receipt that says you spent $54.50, but that won’t disclose how much you paid for the milk or anything else in your cart.
Demand an itemized bill every time, he says. You have a right to it, and can get it from the hospital or your insurer. You want to know every service, billing code and price.
Now check for errors and price gouging.
Sometimes bills are wild. Allen writes about one woman who got billed $1,200 for a pregnancy test. In another case, a biller wanted more than $300 for a medical exam that never took place.
“If it’s not accurate and if it’s not fairly priced, well, then you contest the bill,” he said. “Even to the point of suing them in small claims court if necessary.”
In the case of errors, demand that the hospital fix them. Loop in your insurer and, if you have job-sponsored insurance, your employer. After all, your employer wants to save money, too.
And request your medical records. You may find you were billed for services you didn’t receive. (Allen’s book offers more details on this.)
Next, look up prices. Start on your hospital’s website.
Pore over the site for a “price transparency” section. Try Googling the hospital name with the phrase “price transparency.” You’re looking for a page on its website where you can download the full price list.
Many hospitals don’t make this easy. They embed html code to block their price lists from web searches. I’ve also found some hospitals bury their price files under obscure headings like “Legal” or “CMS,” make the links weirdly small and inconspicuous, or tuck them into odd corners of a page.
You may find a partial price list or an interactive price estimator tool on your hospital’s website. Those offer limited information, so keep searching for the full, downloadable spreadsheet.
Under federal regulation, your hospital must post this. Some facilities are complying. Others violate the rule. If your hospital doesn’t post a complete price list, alert the feds by filing an online complaint.
Use the billing codes to see what your hospital bills other people.
Search the price file for each of the billing codes on your itemized bill. For each code, the hospital must disclose the cash-pay price and the price for each health plan that has a contract for that service. (You may also see a column labeled something like “gross,” “chargemaster,” “cost” or “standard charge.” These amounts are much higher than the real prices. Ignore them.)
If the cash price is lower than your price, or you notice one insurer gets a far better deal, ask to pay that amount. You can do this whether you have insurance or not.
“The way our health care system has operated,” Allen said, it’s like “you and I decide that we're going to go to McDonald's together, and we're each going to get a Big Mac. And they charge me $3 and they charge you $10.”
“Our responsibility as consumers is to say, ‘This is not right,’” he said. “‘I'm not going to allow you to charge me more. … And I don't really care if you and my insurance plan made a deal together that I would pay $10 for my Big Mac.’”
Other websites let you look up prices, too.
You can also check what other hospitals in your area bill for the same services. This could help build a case if the price you got charged is exorbitant. Check competitors’ websites.
Several free tools out there also help you check specific or average prices in your area. These include the Health Care Cost Institute’s Guroo site, Healthcare Bluebook, FAIR Health and Turquoise Health.
Some of these sites will keep improving as more hospitals comply with the federal rule to publish prices, allowing data scrapers to pull together ever more information.
Some experts also recommend checking what Medicare would bill. A hospital usually won’t agree to that price for a patient not on Medicare. But it might agree to, say, 150% or 200% of it. That could still be far better than the figure on your bill.
What if the biller won’t fix mistakes or budge on exorbitant prices?
If the health care provider refuses to fix mistakes or back down from a sky-high price, Allen’s book explains how to block many bills by suing — without hiring a lawyer.
His book gives you the steps to gather the evidence you need and go to court over a bill that you can show is incorrect or unreasonable.
Fighting unfair bills takes work and not everyone succeeds. But pros like Allen say many do. It’s worth a try considering the other options are cutting a check that someone doesn’t deserve, winding up in collections or getting sued.
Remember that prices are negotiable.
The key thing to know is that legal experts say you don’t owe a health care provider an unfair amount of money just because the biller likes that price.
We’ve got more on the legal reasoning behind that, as well as other tips for handling your medical bills here.
Celia Llopis-Jepsen reports on consumer health for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.
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