Prescription For Savings: How to save big money on your medical bills or get them removed altogether
COLORADO SPRINGS, Colo. (KRDO) - Billing errors, bogus charges, junk fees, and “surprise bills” continue to plague consumers who receive medical treatment. In fact, sometimes, bills can be nefarious, clouded in confusion. And patients, like you, are paying the price.
Thus, begs the question: How can you save money on your medical bills or avoid some bills altogether?
PROACTIVE STEP #1
Make sure you’re in-network
This may sound like an obvious suggestion. However, it’s not always as simple as one may think.
Lindsay Lohr is a woman from Colorado Springs who works in the healthcare field. She knows how the system works. Ahead of an appointment, earlier this year, she double-checked her insurance directory to ensure her neurologist was in-network. They were. However, Lohr received a surprise bill weeks later for out-of-network charges.
The reason?
Her insurance claimed that, while the doctor was in-network, the facility at which she saw her neurologist was out-of-network.
Incredibly confused? That’s okay. Lohr was too. Which leads us to …
PROACTIVE STEP #2
Record and document everything
Lohr was fortunate in that she took screenshots of the website ahead of time and kept every document relating to her appointments.
"So this is basically all the information regarding my claim, how my insurance works, and helped me to decide what to do in the end,” said Lohr, showing a large stack of papers.
"This is my evidence!" Said Lohr.
If you’re like Lohr, and you’ve documented everything and you’ve stayed in-network, and you still question your bill – now it’s time to ask for help.
HOW TO SAVE MONEY
Your first option
Contact the Colorado Consumer Health Initiative.
Lohr wouldn’t allow anyone to gaslight her. She knew something wasn’t right.
After filing a complaint with the Colorado Division of Insurance, she reached out to the Colorado Consumer Health Initiative to help her with her case. ]
CCHI is a non-profit dedicated to cracking down on deceptive medical bills, which they still see a lot of. They jumped on board to help Lohr immediately.
"The system is doing what it was designed to do,” said Mannat Singh, CCHI’s executive director.
"By making it complex and making it hard to understand where you are covered, where you can receive care, and where there are opportunities for it to be affordable, it's protecting itself,” said Singh.
Singh’s team works with Colorado consumers on a daily basis.
"A program like ours shouldn't have to exist to navigate those things and appeal those things when they come out,” she said. “We're doing it now to help with the symptoms but the system itself is rigged against being able to receive care, when you need it, affordably, in a way that keeps people healthy.”
CCHI also helps patients identify junk fees, billing errors, and even illegal surprise bills, saving you money.
"New fees that are getting tacked on to consumers' bills that cover admin costs, that cover other things, that we believe are just transferring the cost to the consumer where the healthcare system is kind of failing to cover those for themselves or an effort to increase the cost of care to collect more money,” said Singh.
HOW TO SAVE MONEY
Advice from CCHI
- Don’t pay it first. Question it first.
- Check for errors. Make sure you’re billing billed in-network and call your provider and your insurance company to make sure nothing has been miscoded.
- Negotiate down. Most hospitals and providers will be more than willing to lower your bill if you know what to ask and how to ask it, especially regarding hidden fees. Some hospitals will also lower your bill if you can pay in full; on the other hand, if you qualify, you might also be eligible for a financial assistance program; CO law says non-profit hospitals must provide assistance to people with low incomes.
- Call a non-profit, like CCHI for free assistance and ask for the Consumer Assistance Program (CAP).
CCHI has been around for decades, but CAP has only been active for five years. They’ve already helped 2,600 Coloradans save a combined $7 million in medical bills and prescription costs.
"Question every bill. Gather every piece of information you have. Challenge what needs to be challenged. Document everything as well, while you're doing it. And if it's still not solving the problem or getting the bill more of a place where it should be, call a place like ours,” said Singh.
And CCHI has been seeing more fees, recently, that are questionable, fees many would consider “junk fees,” which are now illegal for preventative services. Sing says that sometimes it will be marked as a “facility fee.”
"All of the advocacy, at the end of the day, is holding the system accountable for what its ultimate purpose is, providing care. If the system is not providing care to people who need it then it is broken or doing what is designed to do,” she said.
According to KFF, 100 million people in the U.S. have some type of medical debt. This is why there’s more than one resource currently helping consumers get out from under that anguish.
"Some people can get charged an out-of-network rate even when they're not allowed to be charged that,” also noted Patricia Kelmar, the senior director of healthcare campaigns for the Public Interest Research Group (PIRG).
"Sometimes you'll notice that there's a test you never had or they billed you twice for something,” said Kelmar.
It shouldn’t be surprising that more resources to help consumers fight erroneous or bogus medical bills continue to pop up. According to KFF, healthcare expenditures in Colorado have easily more than doubled since 2006.
HOW TO SAVE MONEY
Advice from PIRG
- Open the bill right away. If it’s a surprise bill, take action right away. The No Surprises Act makes some out-of-network charges for emergencies illegal. If there’s no surprise, simply wait and double-check what your insurance will pay.
- Look at the itemized list of charges. And if you don’t have an itemized list, ask for one. Flag what you might now owe or what’s being too expensive.
- Fact-check for transparency. Most hospitals should be up to date on the new transparency law that mandates posting prices of 300 of the most shoppable services. Compare prices with other hospitals in your area.
- Be upfront with what you can afford. Hospitals want to get paid, so many will negotiate. Non-profit hospitals must also provide financial assistance for certain thresholds.
- Never use a credit card unless you can pay it off immediately. The interest rates are exponentially more expensive than what you would owe a hospital. Also, note, medical debt cannot go on your credit report.
View PIRG’s medical bill guide here.
Also, keep in mind:
- If you are paying cash, you have the right to a Good Faith Estimate, and you can dispute any bill that is $400 or higher than the GFE.
- On an itemized bill, each charge should have a clear, reasonable explanation.
- If your insurance company denies your claim. File an appeal. If you are rejected again, reach out to the Colorado Consumer Health Initiative.
As for Lohr? She won her case and her bill, of more than $200, was dropped.
“I'm a little bitter but I'm glad it worked out in my favor in this situation,” she laughed.
Two more resources to cut down your medical bills:
The Patient Advocate Foundation
PAF provides free case management and applications for financial aid.
FHC has a tool that allows you to look up the real cost of medical visits and procedures in your area, to make sure you’re getting a fair shake.
MORE TOOLS:
Click here to see which Colorado hospitals are compliant and non-compliant regarding transparency, according to PatientRightsAdvocate.org.
ResolveMedicalBills.com is another free service that offers help for lowering medical bills, they claim, on average, about 60 percent.
SolvHealth.com allows you to look up affordable, high-quality, same-day care for you and your kids.
Senior Healthcare and Medical Assistance: The State Health Insurance Assistance Program (or SHIP) helps Medicare enrollees navigate the Medicare system and provides free, unbiased, and individualized information.
What’s further being addressed at the legislative level?
KRDO13 reached out to several Colorado lawmakers. State Representative Stephanie Vigil was the only one to respond to our request for comment.
"We're using every tool at our disposal in the legislature and I'm proud of how far we've come, even though there is more to do,” said Vigil.
“I continue to maintain that healthcare is a basic need for survival and it should be regarded as a human right. As it gets tougher for families to budget for rising healthcare costs, we need to do more to support our communities,” she said.
Vigil added, "We remain committed to helping Colorado patients confidently access the care they need without the fear of financial ruin. I look forward to building on our efforts to reduce the price of necessary prescription drugs and ensure cost-saving measures are directly passed to patients."
KNOW YOUR RIGHTS
New Laws:
Federal No Surprises Act / Colorado Out-Of-Network Billing (started in 2021)
And
https://www.cms.gov/nosurprises
Increase Consumer Protections Medical Transactions [SB23-093]
https://www.leg.colorado.gov/bills/sb23-093
