Shocking medical bills
And what to do about them
I once got a medical bill for $92,000.
I remember opening the envelope, sitting down on a stool in our kitchen, and staring at it in shock. Ninety-two thousand dollars? How could that be possible?
The bill was for a stay in the hospital, less than a week, for a partial bowel obstruction that eventually resolved on its own.
I wasn’t in the ICU. I didn’t have surgery. I didn’t have chemo or a complex procedure. I had just sat in bed with IV painkillers and fluids, ate awful hospital food, and waited to get better enough to go home. And I had health insurance.
I couldn’t fathom it. I had had complex surgery, radiation, PET scans in the past. No bill was ever on this order of magnitude. It did not compute.
It was the first time I realized how massively wrong the U.S. healthcare billing system was. I knew it was problematic. But this was more than that. It was horrifically upside-down. It was a disaster waiting to happen for each patient.
100 million people with medical debt
Soaring medical bills have had a far-reaching impact.
The Kaiser Health News wrote about the terrible state of U.S. medical bills recently: 100 Million People in America Are Saddled With Health Care Debt
In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.
A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.
“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”
The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.
Another survey of people who had declared bankruptcy found that 58% said that medical expenses were a contributing factor.
What can we do?
Before this year, if you had come to me as an alarmed friend with such a bill, I would have suggested you 1) take a very close look at the bill (Is it the right date? The right doctor? Procedure? Billing code? Did they file this with your insurance?) and then 2) call the billing department to find out more.
Many times, I have followed this path myself and learned there was a mistake somewhere in the system — they somehow didn’t have my insurance card on file, for example, or they billed me twice — and the scary bill was recalculated.
This year, patients have better protection in some cases, thanks to the No Surprises Act, a consumer protection law that went into effect January 1, 2022. (Side note: Starting last year, the Hospital Price Transparency Rule also went into effect, so hospitals are required by law to post their prices publicly. Unfortunately, researchers have found that only 6% of hospitals were fully complying.)
In the case of the No Surprises Act, for people with private insurance, “surprise” medical bills refers to extra out-of-network charges that spring up even when your main doctor or hospital is in-network. For example, you might go to the emergency department at a hospital that is in-network, but the particular doctor who sees you is out-of-network, so you might have received an extra, higher bill. But starting this year, that out-of-network doctor also has to bill you at your in-network rates.
The latest New York Times Well newsletter details the No Surprises Act and what to do if you still get a surprise bill: “How to Dispute Surprise Medical Bills” (gift link, open access from me to you). It’s full of useful information. I didn’t think I would learn much, but I did.
Among what I learned:
If you have a routine, scheduled appointment — say, a colonoscopy — and you pick an in-network doctor, you can’t be surprised later with any out-of-network charges. Anyone service (say, labs) or doctor related to the appointment has to bill at your in-network rates, too.
Ditto on emergencies.
You can request an itemized bill with all the billing codes listed, and the hospital or clinic must supply it to you.
Any hospital/clinic that bills in violation of the No Surprises Act can be fined $10,000 per incident.
If you have questions, call the free government hotline, the No Surprises Help Desk, at 1-800-985-3059 from 8 a.m. to 8 p.m. ET, 7 days a week.
You can also submit a complaint to the federal government online.
You might be able to get help from your state’s consumer assistance program, if your state has one.
This section from the NYT newsletter also gave me hope:
“You might be able to make the bill go away without a formal complaint, Allen [Marshall Allen, a health literacy expert and author on a book about medical billing] said. He recently advised a woman who had received an illegal, surprise medical bill to contact the hospital’s billing department in writing. She told the department that the bill was in violation of the No Surprises Act and said it needed to contact her insurance company to resolve the charges. ‘Within 24 hours, she had a call and many, many apologies from the head of the billing department,’ he said.”
Don’t pay the first bill
The expert quoted by the Times, Marshall Allen, has written a book called Never Pay the First Bill — a fitting title for the medical billing morass.
When I got my $92,000 bill, I called the billing department at the hospital and asked the lady who answered about the sky-high charge. “What had happened? How could this be right?”
“Oh, it hasn’t been submitted to your insurance company yet,” she told me. “Just wait. We’ll send a new bill once it has been adjusted. Don’t pay that one. A new one is coming.”
(Why send a bill out if it’s not a bill to actually be paid? Why shock and worry people?)
So I waited. I tried not to think about it. Worrying wouldn’t help anything, I told myself.
Eventually, a new bill did arrive in the mail, weeks later.
The amount had been adjusted dramatically, to $8,000 — more than 90% discounted — because that’s what my insurance allowed.
And my insurance paid in full.
Whew. Whew. Whew.
I was lucky.
I was also grateful I had insurance. If I didn’t, would I have been on the hook for the entire amount? This is how bankruptcies happen. This is why the U.S. healthcare system has to get fixed.
I hope you never have to face a shocking bill. But if you do, I hope these tips help.
To recap:
If the amount seems erroneous, don’t pay the first bill.
Call the billing department and ask.
Call the government hotline or your state assistance program for help.
If the amount is wrong, send a dispute in writing and point out the relevant laws.
For more on medical billing dysfunction, see Kaiser Health News and NPR’s investigative collaboration, Bill of the Month, in which reporters examine a puzzling medical bill. Here’s the latest one: His-and-Hers Cataract Surgeries, But His Bill Was 20 Times as Much.
Good luck, my friends. I hope you have a week ahead with only wonderful surprises in the mailbox and compassionate care every step of the way.
To our journeys,
Brianne