IF THERE’S ONE fundamental reason people get frustrated by healthcare costs, it’s this: We think healthcare is like 99 percent of the things we buy. The price is the price. A trip to the hospital is no different than a trip to the pharmacy. I strained my back over the weekend, Advil is the cure, and a bottle of 100 pills costs $10.29. But the reality is that paying for healthcare is more like buying a car. It’s a negotiation. Here’s how to negotiate your way through some of the biggest health insurance headaches today.
What to Do When You Don’t Have Time
And you probably don’t: It takes a professional medical advocate an average of 22 phone calls to resolve a billing dispute.
The headache: You don’t have the time you suspect it will take to untangle the thorny billing issue you are facing.
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Who can help: A patient advocate.
The solution: You share your information with a medical billing advocate and they take over, researching options for reducing your bill and doing much of the legwork. Some nonprofits offer this service for free; there are also for-profit advocates, such as those listed in the AdvoConnection Directory. Some corporate benefits packages include access to companies like Wellthy, which offers patient advocacy services.
The headache: Your bill is on its way to a collection agency because it’s been outstanding for too long.
Who can help: You, or a patient advocate.
The solution: It takes chutzpah—and a willingness to risk your credit getting dinged—but if you let a medical debt persist long enough to go to collections, you may be able to negotiate a better deal. “The older it gets, the more the billing office will want to get rid of it,” says Linda Michelson of the Medical Bill Advocate. When you hear from collections, make a settlement offer that’s supported by data: Find prices via the nonprofit FAIR Health. Note: The three major credit bureaus have made big changes, and you now have a year—up from six months—before medical debt in collections harms your credit. Also, paid-off debt will now drop off your report.
What to Do When Someone Made a Mistake
It’s pretty likely. About 50 percent of bills that the National Patient Advocate Foundation encounters have an error. (Other estimates are higher.)
The headache: There’s an error in your bill. For example, a few stitches on your arm was billed as Tommy John surgery.
Who can help: Your insurer.
The solution: Call your insurer and let it know about the problem so it can do the tangling with providers—after all, your insurer foots most of the bill, so it has a strong incentive to make sure it’s right. Note: Thanks to the new No Surprises Act, all hospitals are now required to treat emergencies as in-network services. (Major exception: Ambulances can still bill as out of network, so consider Ubering if you have the wherewithal.) And you can’t get an out-of-network bill for services you didn’t have a choice in. For example, if your in-network gastroenterologist has an out-of-network guy put you under before a colonoscopy, your bill should show the in-network price for anesthesia, too.
The headache: Your insurer denies you coverage after a procedure.
Who can help: Your doctor.
The solution: Every insurer offers an appeals process that essentially amounts to arguing your case against the reasons for denial. You want to gather as much evidence as you can for why your care was necessary—think authoritative sources like medical journals and, most important, a thorough explanation in writing from your doctor of why your situation called for the procedure.
What to Do When You Don’t Have the Money
More than 3 million Americans owe more than $10K in medical debt.
The headache: You opted to pay for a procedure out of pocket—but it turned out to cost way more than you were told.
Who can help: A government arbitrator.
The solution: Under the No Surprises Act, which took effect at the beginning of 2022, if you pay out of pocket for a service, you should be given a good-faith estimate of its cost in advance. If the bill comes in more than $400 above that estimate, you can submit a claim to the U.S. Centers for Medicare & Medicaid Services (see how at cms.gov/nosurprises/consumers), and an arbitrator will determine what’s fair.
The headache: The bill is correct, but more than you can afford right now.
Who can help: The hospital billing department.
The solution: You’ve got options depending on how out of reach the expenses are. Some hospitals offer a “prompt pay” discount: If you can put the whole thing on your credit card on the spot, they might knock off up to 10 percent. And if you have a deeper need, most hospitals offer payment plans or financial aid for patients under a certain income threshold. Application details should be on its website.
When the Trouble Is the Principle of the Thing
The headache: You’ve been wronged, plain and simple.Remember the story of how one person paid $199 for a Covid test out of pocket and his friend used insurance at the same place and got a bill for $6,408? Like that.
Who can help: The media.
The solution: Show proof you have unjust, sky-high bills to a journalist. If the story breaks big, your provider will be under major pressure to relent, or a sympathetic public could help with something like a GoFundMe campaign. “That seems to have by far the best track record at getting people’s bills to disappear, if you’ve got a story good enough that someone might cover it,” says health-care economist Loren Adler.
This story originally appeared in the September 2022 issue of Men’s Health.
Kevin is a writer and editor living in Brooklyn. In past lives he’s been an economist, computer salesman, mathematician, barista, and college football equipment manager.