The American healthcare system is broken. With rising costs and decreasing coverage, many Americans feel powerless against insurance companies and healthcare providers. But there is hope – you can fight back against predatory billing practices and get the care you deserve.
In his book “Never Pay The First Bill” investigative journalist Marshall Allen provides practical strategies for pushing back against the healthcare industrial complex. After 15 years of investigating the health industry Allen reveals how individuals and employers have succeeded in forcing providers to play fair. This article summarizes his key insights from the book and provides tips for protecting yourself from billing errors, price gouging, and insurance denials.
Know Your Rights as a Healthcare Consumer
The first step is understanding your rights under the law Federal and state regulations protect patients from certain unethical billing practices For example
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You have the right to an itemized bill, so you can verify charges line-by-line.
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Providers must provide prices for procedures upfront upon request, allowing you to shop around.
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You cannot be charged more than your in-network co-pay/deductible for emergency care, even at out-of-network hospitals.
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Medical debts cannot be reported to credit agencies without notification.
Knowing these rules prevents providers from exploiting patient ignorance. Don’t be afraid to invoke your rights and appeal charges you view as unfair.
Scrutinize Medical Bills Closely
Always inspect medical bills closely before paying. Errors are common – one study found 80% of medical bills contain mistakes. Watch for:
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Duplicate charges: You get billed twice for the same procedure.
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Upcoding: Billing for more expensive services than provided.
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Phantom billing: Charging for services never performed.
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Incorrect coding: Using the wrong billing code for your diagnosis.
If you spot any suspicious charges, call the provider to dispute. Being an engaged patient minimizes overpayment.
Get Itemized Codes Before Services
To prevent billing surprises, always obtain procedure and diagnosis codes beforehand when possible. Diagnosis codes justify medical necessity to insurance while billing codes determine what you’re charged.
Armed with the codes, call your insurer to check coverage and estimate out-of-pocket costs. Verify the provider is in-network. Doing this homework protects against unexpected bills and enables smart decisions about your care.
Negotiate With Providers
Most patients simply pay the billed amount. But providers expect patients to negotiate – they inflate initial bills knowing insurance will haggle them down.
You should negotiate too. Explain your financial situation and inability to pay. Many facilities offer generous charity care and prompt pay discounts – you just need to ask. Negotiating shows you’re an empowered consumer unwilling to be exploited.
Utilize In-Network Labs and Facilities
When hospitalized, request your doctor utilize in-network facilities for procedures like imaging and bloodwork. Even if the hospital is in-network, out-of-network labs and clinics within the same building can lead to extra charges.
Check that each provider entering your room is in your insurance network. Kindly request in-network providers if not. Avoiding out-of-network bills prevents thousands in surprise costs.
Fight Insurance Claim Denials
Insurance frequently denies claims for dubious reasons or inadequate documentation. But you can fight back and win coverage.
First, get the denial code from your insurer along with their guidelines for approving that service. Then, ask your provider for help contesting the denial – they know how to word appeals to insurers. With persistence, many initial denials are eventually overturned.
Request Case Management
For complex medical situations requiring extended treatment, ask your insurer for case management. A case manager becomes your personal advocate, coordinating between providers to streamline care and reduce costs.
Case managers can guide you towards in-network facilities, set up provider payment plans, and assist with appeals. Their involvement can mean the difference between financial ruin and managed expenses.
Negotiate Payment Plans
If saddled with a burdensome medical debt, negotiate an affordable payment plan. Many hospitals and clinics offer zero-interest plans allowing you to spread costs over months or even years.
Clearly explain your budget constraints and ask for a plan matching your ability to repay. Being transparent about finances often leads to an arrangement that works for both sides.
Seek Legal and Financial Assistance
Nonprofit organizations assist patients struggling with medical debts. For example, legal aid societies provide free legal services for those meeting income requirements. A pro-bono lawyer can give guidance on contesting problematic bills and liens.
Religious institutions and crowdfunding campaigns also offer financial assistance for those dealt devastating medical debts. Do not hesitate to seek aid from your community when blindsided by costs.
File Complaints About Bad Actors
If facing truly unethical billing behavior, file formal complaints with oversight bodies like state insurance commissioners and Attorneys General. These agencies investigate and punish wrongdoing – your report helps protect others from being exploited.
You can also report hospitals to the IRS for aggressive collection tactics against low-income patients. Nonprofit hospitals risk losing tax-exempt status if proven indifferent to community needs.
Partner With Your Employer
Employers have leverage to demand fairer prices and billing practices from providers. Approach your company’s HR department about renegotiating contracted rates to reduce out-of-pocket worker expenses. Suggest they implement steps like requiring binding cost estimates before major procedures.
Band together with co-workers affected by unreasonable charges to lobby leadership for change. Employers aiming to attract talent are increasingly willing to amplify employee voices.
The Bottom Line
The healthcare system wants patients to feel powerless, overwhelmed, and unaware of their rights. By becoming informed advocates for ourselves and partnering with allies, we can fight back against predatory billing practices. While the process takes persistence and courage, we can negotiate a more affordable and equitable system when equipped with knowledge and community support. The information in this article will hopefully provide a starting point for claiming your voice as a healthcare consumer.
