How to Navigate Paying Expensive Hospital Bills
May. 22, 2023 Blogging for Change
According to Healthcare.gov, a 3-day stay averages $30,000. Even if you visit the emergency room for just a few hours, the bill could be high simply because hospital care is expensive in the United States. Unfortunately, these costs can affect whether people seek care at all, as this recent study reveals.
The best thing you can do in these situations is try to keep a level head and develop a game plan for verifying and paying your hospital bills. Here are some steps you can take to make sure you’re paying the right amount and exhausting all resources from financial assistance programs.
Get an Itemized Hospital Bill
Start by asking for an itemized bill (if you didn’t already receive one). Review every charge for accuracy. Note any charges for supplies or services you don’t believe you received.
Also, if you have insurance, talk to your provider to verify what they’ll cover and what portion you’re responsible for. Ask about specific charges to make sure you’re getting the right amount of coverage.
If you believe it’s warranted, contact the hospital or provider’s billing department to verify the charges or file a dispute. Don’t be afraid to ask questions.
How to Tell if a Hospital Bill is Accurate and Justified
Figuring out the accuracy of medical charges can be difficult. Most people don’t have much experience dealing with hospital billing. But as of January 1, 2021, hospitals are now required to publicly post the cost for about 300 standard “shoppable services,” such as lab tests, X-rays, and other kinds of imaging. This is called hospital price transparency.
The idea is that you should be able to search for a local hospital to find a publicly posted list of charges. However, not all hospitals are complying with the hospital transparency law, according to this recent review, so you may have a hard time locating costs for a particular hospital.
If you can find it, the list should include the medical code associated with the service, as well as how much the hospital charges each insurance provider for that service. You can match the codes from your bill with the codes in the master price list and verify that you were charged the correct amount. Keep in mind, unfortunately, private hospitals can essentially charge what they want.
For example, here’s the list for MD Anderson, a hospital in Houston that specializes in cancer treatment. Another tool to use is the Medicare Price Lookup tool for pricing an outpatient procedure. If nothing else, it serves as a comparison. As a general trend, many hospital bills have become extremely detailed about each cost charge, possibly in response to the new transparency law.
What to Know About Hospitals Overcharging
Hospitals typically don’t charge more than they’re allowed to, but private hospitals set prices with insurance companies, and those prices have no cap to speak of. The amount they can charge is shockingly high. Costs for emergency room care can vary wildly by hospital, according to this 2017 study.
Hospitals Overcharging Uninsured Patients
If you hear of or know someone who has been overcharged, it’s likely related to a Medicare or Medicaid issue. Federal and state governments determine the reimbursement rate for services covered by Medicaid and Medicare, so those costs function as a cost baseline. Hospitals also often charge much more when the patient has private insurance.
Apply for Available Assistance Programs and Charity Care
The first thing to do is to contact the hospital’s billing department to explain your situation, and ask what aid is available. Ask for the hospital’s charity care form to determine if you fit within the qualifying income guidelines for assistance. All nonprofit hospitals must offer some form of financial assistance or charity care to reduce or eliminate hospital bills for eligible patients. For-profit hospitals may offer it as well. It’s best to fill out the hospital’s charity care form before you leave the hospital—long before any bills land in collections.
Generally, the parameters for financial assistance programs are up to individual hospitals. Most programs calculate assistance according to your income as it relates to the federal poverty level. In Washington state, for example, the charity care law recently expanded to include “all Washingtonians within 300 percent of the federal poverty level” as eligible for hospital financial assistance. It’s worth checking your state laws.
Connect with a Nonprofit
Hospitals might also offer discounts or reductions according to certain criteria. They might also offer payment plans, but it’s best to explore the possibility of charity care or discounts first before agreeing to a payment plan.
If you’re rejected for charity care, you can appeal or look for other resources. Don’t give up. MMI partners with DollarFor.org, a national nonprofit that negotiates and advocates for patients.
Can You Sue a Hospital for Charging Too Much?
Are expensive hospital bills worth taking legal action? Likely not. Unless you believe that the charges were fraudulent (you were charged for goods and services that you never received), suing a hospital won’t help you settle your bills.