Most people don’t realize that a balance bill can (and should) be negotiated.  Every step in the healthcare process has been negotiated by hospitals, providers, pharmacy benefit managers and even facilities.  The assumption that, we as the consumer, have no power to impact our out of pocket costs is blatantly wrong.  You may have heard that the Trump Administration and Congress are feverishly trying to find a way to mitigate “surprise bills” on the part of the consumer/patient. Ever heard the phrase “it’ll take an act of congress?”  Don’t wait for congress to figure out your personal situation, or you’ll be waiting… for a long time. 

  1. Don’t incur it in the first place 

The site apnews.com recently reported that 1 in 6 ER visits or hospital stays trigger a surprise bill.  The best way to overcome this is to not go to an ER or hospital unless absolutely necessary; and when you do STAY IN NETWORK.  The truth is, most incidents can be addressed in a Now Care or out patient facility. Even if you’re unsure (and you’re not currently bleeding out) start at a Now Care, this establishes your effort to not incur a surprise bill and communicates to the insurance company that you did everything in your power to “follow protocol,” but if this leads you to an ER or a hospital don’t fret about the bill, you have more control than you think.

2. Be your best advocate and learn about how billing works
Here’s the truth: in America, we have the greatest healthcare in the world with the (arguably) the most broken payment system. Kaiser Health news reported that 50% of bills are wrong.  Can I repeat that? Fifty percent, half, 1 in 2 bills are wrong.  What does this mean for you, a tremendous opportunity to protect your personal bottom line. 

We have a coding system that is intensely complex, realize that the code the billing office uses may or may not be covered by your insurance company.  On Mother’s Day I sliced my finger open and needed stitches, after finding an in-network (and open) facility, I checked in at the Now Care and in-take desk told me my insurance company didn’t cover a cut on my finger (really, that’s crazy, I know what my plan covers and what my co-pays are and they cover an injury like this), I politely asked her to try another CPT (Current Procedural Terminology) Code and try again.  She did that; one number different and, low and behold, my cut and stitches were covered at 100%.  

Having this presence of mind isn’t always possible when things are life threatening; when this is the case do everything in your power to still STAY IN NETWORK, and remember that after the fact we’ll have to do some due diligence.

3. Ask. Ask. Ask many more times.

Our personal research revealed a few things when trying to negotiate a balance bill:

First is that the facility/provider want their money, it costs them more to chase you than to accept a lower out of pocket. Use this to your advantage

Second, the majority of people you’ll ask about negotiating your balance bill DO NOT have the authority to impact it.

Third, it statistically took us five tries to get to the person who could actually make a call on reducing our out of pocket.

Fourth, once we got to the right person, asking to have the bill reduced in very general terms, led to a very small reduction, like ten percent.  When we came to the table and said, “we can give you half right now if you’ll reduce it” led to much more favorable results. Think about this like you’re negotiating with a used car salesman, its the salesman’s job to make as much money as possible for that car and its your job to keep as much as you can in your pocket. 

We are fortunate to live in America, where we can have provider attention sometimes in a matter of minutes and not months; where we can have surgery when it’s necessary, not based on a que.   All the political talk about healthcare is unlikely to impact us on a micro level for a very long time; and I don’t know about you but any time the government gets involved in decisions I make for myself and my family is unwelcome.  Take control of your health and of your own well-being both physically and financially instead of allowing lobbyists and politicians to decide how you’ll be impacted when you’re the most vulnerable.