Editorial Policy

What can be done about medical charges?

Erica Sandberg

May 20, 2014

QHi Erica,

Is there anything that can be done on medical billing charges? I had a procedure done; I wasn't told the amount upfront, then received an outrageous bill. My insurance carrier says it is the “fault” of the medical company. What are my rights, if any? The bill was sent almost two months after the service. Is there a turn-around time for insurance carriers to send medical charges that the insurance does not carry? Is there a disclaimer that patients should be aware of? Had I have known of the charge, I would have postponed the procedure.

I have already made payment arrangements with the billing company. What can I do on my end, if anything? –Sahara

ADear Sahara,

Due to personal experience with a broken leg and a surgical center that charges double what the hospital would have charged, I empathize with your plight. Being slammed with a massive, unexpected bill can be devastating.

Physicians and hospitals are not required to inform you of how much procedures are before they're administered. As a patient, it's up to you to get that information. Unfortunately, precise answers can be tough and time-consuming to obtain, particularly if you ask the wrong people. Quizzing the doctor or nurse will often get you nowhere. Even the person at the front desk may not know of the total price, only the copayment.Ask Erica

Since you are insured, the best place to learn the amount you may be liable for is your insurance carrier. This is not always practical, though, particularly if you're in the emergency room desperate for immediate help. But, if it's a planned procedure, find out what your deductible is, and whether or not the doctors, treatments and places are fully, partially or not at all covered under your plan.

Take extensive notes when you speak to anyone in this process, get the name of the person you're speaking with and have them send you a summary of the conversation. If you don't have insurance or want to further cover your bases, return to the doctor's administration line and insist on getting an accurate quote.

As for the bill you were sent, a few months delay is not unusual, nor is it illegal. But you may have recourse against “balance billing.” This is when a healthcare provider expects you to pay the difference between what they charge and what your insurance company picks up. State laws vary on this practice, so contact your insurance commission to find out how you might be protected.

I'm glad you've arranged to deal with the balance, because even a small medical debt can wreck a credit report. When left unpaid for too long, it will usually be sold to a collection agency. That will sink a credit score like a rock. Evidence that it went bad will remain on your record for seven years, even if you satisfy it.

You also could have attempted to negotiate the debt. For example, after receiving the $2,000 bill for my titanium plate and a bunch of screws, I wrote to the surgery center, explaining that I felt that half was more than fair. After a bit of back-and-forth calls, they accepted, cashed my check, and that was the end of that. Reason and a well-drafted letter can work wonders.

A final thought: If it turns out that you require costly and unaffordable procedures again, talk to your provider and explain your financial constraints. Many offer payment plans. If they don't, and you have a credit card, you can charge the expense and pay over time. Just be dedicated to deleting the balance within a few months — or your credit and money well-being will be in need of urgent care, too.

Got a question for Erica? Send her an email.