Disputing Hospital Charges: Know Your Rights And Options

Medical bills can be disputed if they are incorrect or unaffordable. The first step is to review the bill and the explanation of benefits from your insurance company. If there is an error, contact the hospital and dispute the bill. If this does not work, you can write to the hospital's CEO and CFO or contact the hospital's board members. If you are unable to pay the bill, you can offer to pay a lump sum in exchange for a discount or negotiate directly with the doctor. It is important to be frank about your financial situation and never be afraid to negotiate. If you are unsure about the billing process, you can ask for help from a patient advocate or patient ombudsman.

Review your bill and explanation of benefits

Reviewing your bill and explanation of benefits is an important step in disputing high hospital charges. Here are some detailed steps to guide you through the process:

Understand the Explanation of Benefits (EOB):

The Explanation of Benefits is a document provided by your insurance company, explaining your insurance benefits as they pertain to a specific medical bill. It outlines the amounts billed by the healthcare provider and any plan discounts negotiated by your insurance. Understanding your EOB is crucial as it helps you identify potential errors or overcharges.

Compare the Bill and EOB:

Carefully review both your medical bill and the Explanation of Benefits side by side. Look for discrepancies or inconsistencies between the two documents. For example, check if the billed amounts match, if there are charges for services not received, or if certain discounts were applied correctly.

Identify Erroneous Charges:

Scrutinize the bill for any charges that seem incorrect or unexpected. Common errors include being charged for medications brought from home, full-day room rates for shorter stays, or supplies that should be included in the room rate, such as sheets, gowns, or gloves. Be thorough and question any charges that seem unreasonable or unclear.

Verify Procedure Costs:

Research the fair price or standard cost of each procedure or service listed on your bill. Compare these prices with those of other hospitals or healthcare providers in your area. If you find that your hospital is charging significantly more for certain procedures, you can use this information as leverage when disputing the bill.

Calculate Insurance Coverage:

Before initiating a dispute, understand how much of the bill is covered by your insurance policy. Review your insurance plan and identify which charges should be covered and which may be excluded. If you believe your insurer should cover more of the legitimate charges, be prepared to appeal any rejections or denials by the insurance company.

Document Supporting Evidence:

As you review your bill and EOB, make notes on any specific charges you wish to dispute. Gather supporting documentation, such as printouts of competitor pricing or industry standard costs. This evidence will be crucial when you contact the hospital to discuss the disputed charges and negotiate a resolution.

Remember, reviewing your bill and Explanation of Benefits is a critical step in identifying errors, overcharges, or discrepancies. It empowers you with the necessary information to effectively dispute high hospital charges and advocate for a fair and accurate billing outcome.

Research other prices and use them to negotiate

Researching other prices and using them as leverage can be an effective strategy when negotiating hospital charges. Here are some steps to guide you through the process:

Step 1: Understand the Pricing Landscape

Before negotiating, it's crucial to understand the pricing landscape for the specific medical services or procedures you have received. This involves researching and comparing prices charged by other hospitals or healthcare providers in your area for similar services. Websites like Healthcare Bluebook, Clear Health Costs, and FAIR Health Consumer offer tools to estimate costs and compare pricing. Additionally, if you are in Colorado, you can utilize the Colorado Hospital Price Finder to find the standard prices charged by different hospitals.

Step 2: Identify Insured vs. Uninsured Rates

Hospitals often charge different rates for insured and uninsured patients. Insurance companies typically negotiate lower prices on behalf of their insured patients. Therefore, understanding the "insured rate" for the services you have received is essential. Contact your insurance provider to determine the rates they have negotiated with other healthcare providers for similar services. This information will be valuable when negotiating with the hospital.

Step 3: Compare with Standard Procedures

For common surgical procedures, you can compare your charges with the transparent prices offered by reference centers, such as the Surgery Center of Oklahoma and Texas Free Market Surgery. These centers publish their prices online, providing a benchmark for what is considered reasonable and customary charges for specific procedures.

Step 4: Gather Evidence and Screenshots

As you conduct your research, it's important to gather evidence and documentation of the prices you find. Take screenshots or save pages from websites that show lower prices for similar services at other hospitals or healthcare providers. This tangible evidence will be crucial when you approach the billing department for negotiations.

Step 5: Contact the Hospital's Billing Department

Once you have armed yourself with pricing information, it's time to contact the hospital's billing department. Be polite and professional in your communication. Present the research you have gathered and politely request that they review your case and consider adjusting your bill to match the market rates or the rates offered to insured patients.

Remember, it is in your best interest to start the negotiation process early. Hospitals are often willing to negotiate, and by providing well-researched pricing information, you increase your chances of successfully disputing high hospital charges.

Refuse to pay for anything you didn't use

It is important to carefully review your medical bill and explanation of benefits. The explanation of benefits is a document provided by your insurance company that explains your insurance benefits as they pertain to a bill. If you've been billed for items or services you didn't use, you can refuse to pay for them and dispute the charges.

First, contact the hospital's billing department and inform them of the issue. Request an itemized bill to identify the specific charges in question. If the hospital is in-network, you can also contact your insurance company to open a dispute on their end, as they will likely be motivated to resolve the issue if they have been overcharged. Many hospitals and large medical provider networks have patient advocates who can help you reduce your bill and expedite the resolution of errors.

If the incorrect charges are not resolved through the above steps, you can escalate the matter by writing a letter or email to the hospital's CEO and CFO. You can also contact the hospital's board members through their offsite office and inform them of predatory billing practices. Additionally, you can utilize online tools and resources to research and compare prices for similar procedures at other hospitals, which can provide valuable information for negotiating lower charges.

If you are facing financial difficulties and are unable to afford the bill, it is essential to communicate this to the hospital. Nonprofit hospitals are required by law to offer financial assistance programs, and many other providers are often willing to work out payment arrangements or reduce your bill. You can also explore options such as Medicaid or Charity Care, which is federally funded and provides free care for those in need. Remember, hospitals are accustomed to working with patients on payment plans, so don't hesitate to ask for assistance.

Contact your insurance company

Contacting your insurance company is a crucial step in disputing high hospital charges. Here are some detailed steps to guide you through the process:

Understand your Explanation of Benefits (EOB)

Before you receive your actual medical bill, your insurance company will send you an EOB, which outlines your insurance benefits pertaining to the bill. Review this document carefully, as it will help you understand how your insurance company has processed the claim and what charges are covered under your plan. The EOB will typically include information such as the amount billed by the provider and any plan discounts negotiated by your insurer.

Compare your EOB with the hospital bill

Once you receive your hospital bill, carefully compare it with the information provided in the EOB. Look for any discrepancies or errors in the charges. For example, check if you have been billed for medications you brought from home, full-day room rates for a shorter stay, or supplies that should be included in the room rate, such as sheets, gowns, or gloves.

Identify potential disputes

If you find errors or charges that seem incorrect, make a list of these specific charges and the reasons why you believe they are inaccurate. For example, you may identify charges for items that are typically included in the room rate or services that were billed multiple times.

Reach out to your insurance company and explain the discrepancies or errors you have identified. They may have additional insights or information about the billing codes and charges. If they agree that there are errors, they may be willing to open a dispute on their end, which can help resolve the issue. Your insurance company has a vested interest in ensuring accurate billing, especially if they are being overcharged as well.

Gather supporting documentation

To strengthen your case, gather any supporting documentation that can help your insurance company understand the dispute. This may include print-outs of competitor pricing, information about industry-standard charges, or any relevant policies or procedures that support your claim.

Remember, it is important to stay organized and thorough throughout the process. Keep detailed records of your communications with the insurance company and the hospital, and don't be afraid to advocate for yourself and seek a fair resolution.

Threaten to move your bill into collections

If you're facing high hospital charges, it's important to know your rights and the steps you can take to dispute the bill. One option, as suggested, is to threaten to move your bill into collections. Here are some detailed instructions on how to navigate this strategy:

Understand Your Rights

Before taking any action, it's crucial to understand your rights when it comes to medical billing disputes. Know that if you didn't use your health insurance or if you don't have insurance, your healthcare provider is required to give you a "good faith" estimate of the cost beforehand. If the final bill exceeds this estimate by at least $400, you may be eligible to dispute the charges through a patient-provider dispute resolution process. This process involves an independent third party reviewing your bill and determining an appropriate payment.

Review Your Bill and Explanation of Benefits

Thoroughly examine both your medical bill and the Explanation of Benefits (EOB) provided by your insurance company. The EOB explains your insurance benefits as they pertain to the bill. By reviewing these documents, you can identify any errors or discrepancies that could form the basis for your dispute. Look out for incorrect charges, duplicate billing, or services that were not provided.

Gather Evidence and Compare Pricing

Verify that you were charged correctly by using tools like the Hospital Price Files Finder or, if you're in Colorado, the Colorado Hospital Price Finder. Compare the prices for similar procedures at nearby hospitals, as well as cash prices and pricing information from websites like Healthcare Bluebook and Clear Health Costs. If you find that the charges are significantly higher than comparable services elsewhere, you can use this information to negotiate a lower rate or support your dispute.

Contact the Hospital's Administration

If you identify errors or excessive charges, start by contacting the hospital's administration. Write a letter or email to the hospital's CEO and CFO, explaining the issues with your bill and requesting a review of the charges. You can also contact the hospital's board members to bring attention to predatory billing practices. Often, employers and providers are willing to implement price transparent healthcare models to save costs for patients.

Threaten to Move the Bill into Collections

If your initial attempts to resolve the issue with the hospital are unsuccessful, you can escalate the situation by threatening to move your bill into collections. This strategy may prompt the hospital to take your dispute more seriously and engage in negotiations. However, be aware that if you do move the bill into collections, debt collectors are required to first attempt to collect the debt from you before reporting it to credit reporting companies.

Remember, it's important to keep detailed records of all your communications and attempts to resolve the dispute. You have the right to request verification of the debt from debt collectors and to dispute any inaccurate or unverified information. Knowing your rights and being proactive in disputing high hospital charges can help protect your financial interests and ensure fair billing practices.

Frequently asked questions