Are You Overpaying For Your Medical Bill?

Did you ever get a medical bill that didn't look quite right or you couldn't afford? Well, it turns out you can usually do something about it if you call the billing office. Anyone can do it, but it turns out that extroverts and those with disagreeable personalities are the best at getting their way. This episode of CareTalk is brought to you by BetterHelp. If you've been thinking about starting therapy, there's never been a better time to give it a try. BetterHelp offers online therapy that's accessible, flexible, and tailored to your needs. Whether you're dealing with stress, anxiety, or just looking for personal growth, BetterHelp connects you with licensed therapists who can support you on your journey to becoming your best self. Never skip therapy day with BetterHelp. Visit BetterHelp.com slash CareTalk to get 10% off your first month and take the first step toward improving your mental well-being. That's BetterHelp, H-E-L-P dot com slash CareTalk. Welcome to CareTalk, America's home for incisive debate about healthcare, business, and policy. I'm David Williams, President of Health Business Group. And I'm John Driscoll, Senior Advisor at Walgreens. David, this is insane. Well, John, you know, it's not insane. That's like the old Crazy Eddie commercials that I used to hear way back in the day. But, you know, let's talk about medical bills, John. And first of all, you know, what makes medical bills different from other kinds of bills? Well, you never really know what you're going to get charged. And I guess from a provider perspective, they never know how much they're going to be paid. And so it's actually kind of a big mess. It's a big mess, John. You know, if you think about like the normal transaction in the American economy, you drive up to the gas pump, the price is there, you pump a certain amount of gas, that's what you pay. And it's not like I pay $3.76, you know, for regular, and you pay $6.81, and someone else gets it for free. And the gas station thinks they're charging $10. And sometimes they get one, sometimes they get four, and sometimes they don't get paid at all. So it's very, very weird, you know, sort of situation. And also, like, when I'm going to get gas, John, it's like, I want to fill up my car. I know what I'm going to get. And, you know, I know what it is. A lot of times I don't even want to be getting medical services, you know, and be dragged in an ambulance. That's exactly right. I mean, that's the nice way of saying it. The truth is, David, we have the most expensive system in the world with the most complicated set of bills and collections around what's the most vulnerable thing that you engage in as a system, which is healthcare. People go to healthcare when they're weak and vulnerable and nervous and uncertain about a whole series of other things. Like, can they get healthy? How quickly will it take to heal a broken bone or cure cancer? And then your first thought is, I need the best care I can get as fast as I possibly can. Not, geez, how much is this going to cost? And yet that cost, the billing, is an enormous burden on people all across America. John, there's some new research out there. It was a survey done by the USC Schaeffer Center for Health Policy and Economics, surveyed a thousand people or more. It published it in JAMA Health Forum. And this is about contacting a billing office if you happen to get a bill that you disagreed with or you couldn't afford. What'd you think of this study, John? Well, word up, you can negotiate. I mean, what was fascinating is that a strong academic center, the Schaeffer Center at USC, publishing in an extremely well-regarded, austere research publication like the Journal of the American Medical Association, that it took all of this work to figure out what anyone in healthcare already knows, which is negotiate, negotiate, negotiate when it comes to bills. I thought it was fascinating. It was interesting, John, that people called the office. If they called the office, they tended to get results. They get the bill corrected if it was wrong, even if they just thought it was unaffordable, they got it lesser. If they literally negotiated, they would get a better deal on it. Now, there's a lot of people who didn't call, and they just assumed it wouldn't make any difference if they called or not. Well, I don't think everybody knows that, David. Rather than what they used as the title, it should be negotiate everything when it comes to costs in healthcare. The second thing that was fascinating is that, from my perspective, I think one of the reasons you can negotiate is, again, the provider doesn't even know how they're going to get paid and when they're going to get paid. To some degree, by engaging directly when you get a bill, you start a process where you can actually get perhaps to something that you can afford. I think it's a call to action for anyone who gets a bill that they think is a little bit out of whack because what they also found is that the bill wasn't always correct in even the basics. There's a lot in this study, but I think the conclusion is everything's negotiable. John, remember when they used to put these magazines and little sales things on the airplanes, and there was this guy, I think it was Charles Karras, and it says, you don't get what you deserve, you get what you negotiate. He should be reincarnated as a billing guy. Now, John, a lot of these studies that you see, even though there's a lot of methodology and a lot of expense and a lot of academic jib-jab in there, it's sort of the blinding obvious, like, okay, the sky is blue. Now, they had some things they proved that were expected. If you have higher socioeconomic status, like if you have a college degree, high financial literacy, if you're insured, you tend to do better when you call. A thing that wasn't maybe shocking, but it was funny that they studied it, and what they found was that the people that do well are those that are extroverted, but also people like you, John, who are disagreeable. Those are the people that do well and get the better deal. It's fascinating because in general, when you're negotiating a service encounter that's not going the way you want, whether it's a billing or a service, all of us know if you approach it with an element of kindness and understanding, you're much more likely to get a result. The thing I thought was fascinating is the cranky naysayers, the people who are the most difficult, got the best deals. That was not intuitively clear to me, but again, negotiate and negotiate hard. Well, John, what I liked about it, I always like to read these academic studies and just look into the appendix or the methodologies and it says it's people that have a disagreeable personality. I'm like, how do they measure that? Here's some of the questions that they asked, John. If you have a yes answer to some of these questions, and I know that you do, then you're disagreeable. One is, I often get into arguments with my family and coworkers. I believe that most people will take advantage of you if you let them. This is my favorite one, John. If I don't like people, I let them know. Anyway, so those that have that disagreeable personality for whom it comes naturally, you're in good shape. If you don't have that, make sure to act like that when you call the office, I guess. Exactly right. Take on that personality. David, was there anything else in this study that you found useful as a consumer? What's it going to take to get a cheaper bill, to get a fairer price? There were some things that I saw in the study itself, but also in the write-up about it that were some good tips. One was about talking about errors on bills. One of the fundamental errors is actually like, was it this John Driscoll or this David Williams? We both have fairly common names. It could be somebody else running up a bill. There were some specific things, like if it's a hospital bill, you can ask for an itemized bill, and that could have many, many lines on it. A hospital is required to send you that within 30 days. You can imagine there's a lot of mistakes and things, especially because people don't usually look at this. The example given was an infant boy being billed for a pregnancy test. Now, I guess it's pretty unlikely that's legit, but maybe they might have. They might have run the test. However, it was inappropriate. Yeah. Then the other thing, I mean, this is, I think, is well known, but still should be mentioned, is that you may qualify for a reduction based on income. A lot of these hospitals are non-profit. They have charity care. You may be able to just qualify for that. That was good. Then I think there were some other things we can talk about, like the No Surprises Act, because this should have an impact on medical bills. Well, I think that what people don't realize is the federal government and the Biden administration has actually worked really hard to whether it's making prices more available, making sure hospitals understand that they've got the obligation to actually give you an itemized bill. There is actually wide bipartisan support for ending this surprise medical bills. The big example of what happens is if you go to the hospital and you went to the trouble to identify, yeah, the hospital's in network, my doctor's in network, and then you get these out-of-network bills anyway from people like anesthesiologists who are out of network, but they're working in the hospital. That's what the No Surprises Act is probably trying to put a stop to that. Some of those charges are still appearing, so just question if they're even legitimate. That was good. Then, John, always planning ahead is a good thing to do before you get the bills, before you're hospitalized, before you see the physician if you can. Maybe what are some good tips and tricks for that? Well, I think that if you have the opportunity, and a lot of people don't, to know that something significant is going to happen or significantly potentially expensive, you can actually ask for a good faith estimate. That is going to put the hospital or the doctor or the team on notice that you're serious, but they actually do have an obligation to give you a good faith estimate. That's right, John. If you don't have insurance or if you aren't using your insurance there, then if the bill comes in above that good faith estimate by $400 or more, you can dispute it automatically. That's a good thing, especially for those that are paying out of pocket. Even for those who aren't disagreeable, disputing it will almost always result in you getting a lower total cost if you're in those categories. It's a fortune that this stuff is buried in academic journals because medical bills are still one of the most common sources of driving people into bankruptcy. I don't think people who are going into bankruptcy know that a lot of this stuff is negotiable. Although there's also some good news there on, historically, late medical bills would hit your credit rating, that's no longer actually legal in the US. I think what we're starting to do is having some reasonable consumer rights here around fair billing. I just think the challenge, David, is nobody knows about it. Everyone listens to CureTalk, so they'll start to know about it. Let's make another point there about the credit reports and how medical billing comes in. I did learn something here or I was reminded of something that is important, which is that let's say you've got a bill and you want to pay it. It's a legitimate bill, maybe you've gotten a discount on it, doctor did a good job, hospital, whatever. You can typically request a payment plan from the provider. Let's say if you owe $1,000 and they pay off $100 a month, something like that. It's better to do that than it is just to put it on your credit card because if you get into financial trouble because your medical bills are adding up or whatever, if you have bad debt because you didn't pay your credit card, that's much more of a problem than if you didn't pay off this payment plan, which you might also be able to have extended and which may not have any interest associated with it. So, generally speaking, don't put a medical debt on your credit card unless you really have to. No, you really shouldn't. And the reality is that most hospitals and groups will actually accept a payment plan. A payment plan is just simply in the same way that people put bills on their credit card to defer payment, that payment plan is simply a way to defer payment and to get to a level of payment that you can afford. I think that's really, really important that folks understand that. Did you ever get a bill you didn't like? Oh, yeah, all the time. I mean, I don't think anybody likes a bill, David, but I think being on the inside of the healthcare system, you realize, A, if it's a good faith, if it's a bill that looks reasonable, I will pay it. If it doesn't look reasonable, I'll call and negotiate, and you can get better terms. There's just no question. There are some places where you can't negotiate, but everybody should try. John, I'll add one thing now that you prompted me for it, which is that sometimes the physician office or the hospital will bill you for something. They'll say, you know, insurance paid this and you owe that and you owe the remainder. You can negotiate it or whatever, but they may not always be right about insurance. I had a situation once, actually, with an ophthalmologist where the referral hadn't come in on time. They sent me this bill. They're not going to pay it because the referral didn't come in on time. It was beyond their deadline or whatever. I just called the insurance company, and they said, no, they should pay it anyway. They basically got it, so the insurance company ended up paying more. I basically appealed on behalf of the physician office, and the physician office got paid more, and therefore I didn't need to pay as much. Sometimes the provider hasn't tried as hard with the insurance company as they could, so I wouldn't let the insurance company up the hook. That's because you're a healthcare wonk, David. I think we've sort of given people the critical elements. Negotiate. Be disagreeable. Know your rights and make sure you have a good understanding up front. Realize that if the billing system isn't on your side, regulations probably are. If you aren't negotiating, somebody else is, and you should do the same. Well, that's it for yet another episode of CareTalk, a very agreeable episode, if I may say so myself. We've been talking about medical bills and what you can do about them. I'm David Williams, president of Health Business Group. I'm John Driscoll, senior advisor at Walgreens. If you liked what you heard or you didn't, we'd really like it if you subscribed on your favorite service.