After Vox's Sarah Kliff spent a year digging into what she considered "astounding" medical bills, she assembled a six-step playbook for patients who want to reduce, or even eliminate, their bills.
'Surprise' medical bills, explained in 5 charts
About Kliff's ED billing project
Across 2017 and 2018, Kliff read through more than 1,000 ED bills from all 50 states and Washington, D.C., as part of a sometimes-controversial project to examine ED prices.
In her reporting, she encountered numerous patients who'd attempted, with varying degrees of success, to negotiate down their medical bills. Here's her advice to patients seeking to reduce their bills, based on interviews with 12 patients who fought their medical bills.
The patient's playbook for fighting medical bills
1. Challenge what's on the bill and how it's coded
The first step for patients seeking to challenge a bill, according to Kliff, is to identify how their medical visit was coded and to ensure the bill accurately reflects services provided.
Sue Null, a professional patient advocate at Systemedic, recommends that patients request an itemized bill, which patients can use to identify high prices, duplicate fees, or incorrect charges.
Kliff warns patients that it can be challenging to get such a bill, as "sometimes hospitals do not make it easy to get these records—and you might be transferred through a few departments as you go."
Once patients get a copy of their bill, Kliff recommends they look at the facility fee, which covers the overhead costs of the visit and is priced in a one-to-five scale, based on the severity of each case. Kliff writes that she's seen "a decent number of success stories from patients who challenge the coding of their facility fee."
One such patient, Sam Metcalf, was coded as a level 5—the highest level—when he went to an ED for what he thought was bronchitis. "Somebody came in, did a short exam, and then prescribed me some pills and sent me on my way," Metcalf said. Metcalf reached out to a patient advocacy firm that convinced the hospital to code Metcalf's bill as a level 1—wiping out his out-of-pocket bill entirely.
2. Request a prompt-pay discount
Next, Kliff advises patients to request a prompt-pay-discount.
Kliff writes that hospitals might find it "easier to take a smaller payment rather than chasing down a bill you might never pay"—although she acknowledges that requesting a discount doesn't guarantee that patients will receive one.
3. Call, call, and call again
Something Kliff said she's heard from "nearly every patient" she's interviewed is that "[n]egotiating a medical bill almost always involves time on the phone."
Null advises patients that they need to reach the "right person," meaning someone who has the authority to change their bill. "Sometimes you have to push your way all the way up to the CFO's office," Null tells patients.
One patient, Melissa Jackson, called her hospital repeatedly for more than a year in an effort to wipe out a medical bill she received for an emergency surgery from complications with childbirth. "I learned the tricks, like you have to call when they open or, even better, start dialing a few minutes before they open," she said.
4. Hire a patient advocate—or a lawyer
Health care billing codes can be difficult for patients to understand, so Null recommends that those with complicated bills consider hiring a professional patient advocate—or, if that fails, a lawyer.
Some employers offer patient advocates as an employee benefit, Null added.
5. Turn to social media… or the press
If none of the other recommendations work, Kliff suggests that patients shine a public "spotlight" on their bill.
"This is something I've seen in my own work," Kliff writes, "About half of the [ED] bills I've covered as a journalist were cleared after I began inquiring about the charges. In total, I've had nearly $100,000 in bills reversed in the course of this emergency rooms reporting project."
Kliff advises that patients gather their billing documents and send an email to a reporter. "If you're not having luck with a reporter, social media can be helpful," she writes. "Tweeting or posting on Facebook (and tagging the involved parties) is a pretty low-effort way to get some attention to your case."
6. Accept that negotiating doesn't always work
Kliff advises patients that, even if they take all of these steps to fight their medical bill, the provider can still say no, Kliff writes. In fact, in some cases, trying to lower a medical bill can backfire, according to Kliff.
Timothy Boudreaux went to the ED last year after cutting his finger open with an apple peeler. When he received a bill for $152, he noticed that the hospital had classified him as uninsured even though he had insurance. So he called the hospital to give them correct insurance information, thinking it might reduce the cost of his bill, but then he received a new bill—for $200. Apparently, Boudreaux had forfeited a discount the hospital gives to uninsured patients.
When Boudreaux asked the hospital if he could withdraw his insurance from the claim, "[t]hey refused," he said (Kliff, Vox, 3/22).
New: The patient financial experience toolkit
As hospital margins remain narrow, health systems face enormous pressure to protect their revenue. At the same time, the rise of patient consumerism has pushed hospitals to offer a best-in-class patient experience. These goals can actually support each other: by offering an ideal patient financial experience, providers can increase a patient’s satisfaction, as well as a patient’s likelihood to pay.
Access this toolkit to get 8 resources to help revenue cycle leaders implement the ideal patient financial experience.