Fundamentals of Patient Empowerment
BY MARSHALL ALLEN
Our health care system keeps making us pay more for less, often unfairly. But if you follow some basic steps you can make sure you get a fair deal. Here are seven patient empowerment steps we should all take when we undergo health care.
Get the prices up front - The federal government requires hospitals to post prices on their websites for common procedures and tests, including cash rates and the price they have negotiated with each insurance company. These prices can vary exponentially for the exact same services. Check to see if your local hospitals are posting prices for whatever service you need. If it makes sense for you, go to the place with the best price. Unfortunately, many hospitals are defying the federal government’s rules by failing to post their prices. If a hospital is not posting its prices, demand that it comply with the federal government’s requirements. It’s your right to have those prices. Without them, it’s easier for the hospital to overcharge you.
Tell them you want their lowest price - Hospitals and other health care providers have been accustomed to making some patients pay much more than others for the same type of services. Working Americans are typically required to pay a lot more than patients on the government’s Medicare or Medicaid plans. People on some insurance plans also may be told to pay more than people on other plans. There is no reason you should pay more than any other patient would pay for whatever service you need. When you check the prices, tell them you want the same deal that other patients may be getting.
Get an itemized bill - Hospitals are accustomed to giving you a lump sum total on your medical bill. They often don’t break down the charges for each service you received. You’d never stand for that at the grocery store or when you get your cable or cell phone bill. It’s your right to have an itemized bill that breaks down the costs associated with each service that you or your loved one received. You can get it from the hospital or doctor who is billing you. If they won’t give it to you, get the breakdown from your insurance plan. Make sure your itemized bill includes the billing codes the medical provider used to document each charge. Again, if the health care provider won’t give you the billing codes, and you are insured, you can get them from your insurance carrier.
Check your itemized bill for errors - It’s incredibly common for medical bills to contain mistakes. Often they contain charges for things that did not happen. You may also see overcharging for things that did happen. Hospitals may use medical billing codes for services that are much more complex than what actually occurred - like a code for a lengthy and medically complicated exam when it was actually a quick and simple one. Look up the billing codes on your itemized bill online and see if they accurately describe the services the patient received.
Make sure the prices are fair - Use the billing codes for each charge to check to see if you got a fair price. You can check prices on hospital websites or by calling other health care providers who offer the same services and asking for their prices. You can also go to FairHealthConsumer.org and put in the billing codes to check fair price estimates in your area.
Contest any inaccurate or unfair prices - If you see a mistake or overcharge on your bill, contest it to the billing department of whoever is sending you the bill. Often these problems get corrected right away. But you may need to ask for a supervisor, and don’t be surprised if they don’t immediately correct the problem. If you’re insured, you can also bring the problem to your insurance provider. But they often take the side of the doctors and hospitals doing the billing, so don’t be surprised if they don’t back down. You may need to persist.
If necessary, consider suing in small claims court - Small claims courts exist in every state and allow less powerful consumers to defend themselves against unfair practices, at low cost and without needing an attorney. In most states, the dollar limits for cases are high enough to cover common medical bills. If you’re getting overcharged and the medical provider won’t play fair, small claims court might be a good option. When you sue in small claims court you level the playing field. The medical provider will need to defend their billing practices in front of a judge. That’s an expense and a hassle for them. Your lawsuit might motivate them to settle the dispute in a way that’s fair.
Sometimes it’s hard to push back and it feels paralyzing to even try. But it’s often easier than you think and you could save hundreds or even thousands of dollars with each victory. Plus, the cost of inaction is too high. Do you really want to keep paying more than you should for health care? Of course not - so let’s fight back!
Marshall Allen is the author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win”