What I Learned From Pushing Back on a Medical Bill
Several years ago I was faced with large medical bills due to an issue that was missed by two medical professionals before I was diagnosed. The oversights could have cost me my life - I was lucky. So when I got these big bills for services that not only didn't help, they potentially harmed me, I decided to fight back.
Here’s what I learned about the whole process, which has also lead me to being a better healthcare consumer in general.
The back story
I have a genetic condition that puts me at an extremely high risk of blood clots so when I experienced a weird pain in my calf a couple days after a long flight, I checked into the closest ER. That’s the only place to go when you think you have a blood clot, at least if you don’t have an established relationship with a hematologist.
A radiologist performed a deep vein ultrasound and found nothing. I was released with no diagnosis and ibuprofen for the pain.
A couple weeks later, the pain had spread with visible swelling, so I visited my primary care physician, who diagnosed me with swelling of the veins. No treatment, just avoid inflammation. Four weeks later, my leg was swollen and I could hardly walk. I decided I needed a better answer.
Side note: You MUST be your own healthcare advocate
An ancillary lesson here is that you sometimes have to push back if you suspect your healthcare providers might be missing something. In this case, anytime I claimed I thought I had a blood clot, I was told to go to the ER, but the ER would only scan my deep veins, which is where the real risk is — the medical system is often just CYA, which means if you’re not really at risk of dying, they’re not as worried about figuring things out.
So I went around the system by calling a varicose vein clinic, where I knew they’d give me a complete leg ultrasound. When the vascular doctor called her assistant in to watch as she got started, I knew I’d done the right thing.
She found that both of my secondary veins were almost completely clotted from end to end. I was immediately put on blood thinners and directed to a hematologist for ongoing care.
This was a dangerous situation and I’m lucky that I was able to resolve it. But it was also an extremely frustrating situation because so many previous providers weren’t even willing to look into this, and yet they were billing me for their CYA services. I decided to fight back.
The cost of a missed diagnosis
The bills started rolling in from the earlier testing:
$843 for the ER doctor who stopped by my bed for 2 minutes to tell me I was fine and should take ibuprofen
$120 for the ER radiologist who missed my clot
$99 for my primary care physician who told me I just had swollen veins and maybe try eating gluten free for a bit.
I even received a $10 bill from the lab for a pregnancy test, which was required at the ER before they’d scan me.
I researched it, and because no one was “technically” wrong, I didn’t have a case for negligence. And because I actually received these services, it wasn’t an error. But I still didn’t think I should have to pay for these doctors who didn’t dig deep enough to solve the mystery.
What I did
I wrote letters.
First, I called the billing department for each doctor and asked how to file a dispute. I wanted to make sure I played by the rules to avoid harming my credit. (Medical bills are quick to go to collections if you ignore them.)
In each instance, a 60 day hold was placed on my account as required by law, and I was given an address where I needed to send my letter.
In each letter, I detailed specifics from the visit and then stated my case. I basically said that because this particular healthcare provider missed the problem by failing to examine me with extra care due to the fact that I was 80% more likely to HAVE this issue, I didn’t think I should have to pay for the service.
In every single case, my letter was ignored, and I received another bill a month later. At that point, I followed up with an electronic message to each billing company with a copy or attachment of my original letter, stating that I expected a response to that before I would pay the bill.
After that, I received either an email response, mailed response or phone call within a week.
Here’s how it turned out:
$843 for the ER doctor — I received a mailed response from the hospital billing coordinator advising me that they had done a peer review and the doctor had followed procedure. He apologized for my pain and said I still owe the money. They basically went with a technicality, but at least they reviewed it.
Outcome: I still owed the money.
$120 for the ER radiologist — The charge was cancelled although the doctor does not admit error.
$99 for my primary care physician — After months and months, I finally received a phone call from the billing coordinator, who was extremely apologetic for the delay and seeking to understand what my issue was. After I explained my thinking, she agreed to waive the charge, although she was very clear that this was a write-off and not a reversal of the charge.
Outcome: Success, but mostly due to the fact that my doctor no longer actually worked there.
Total amount avoided: $219. It was a 20% reduction, which isn’t great, but a decent enough discount to placate me.
The bigger lessons for everyone
So what’s the lesson here for the rest of the world? A few things:
1. Everything is negotiable. In this particular situation, I took the stance that I should not have to pay the out-of-pocket costs, even though there was nothing technically wrong. But in a different situation, especially if I’d been admitted to a hospital and my insurance company did not chip in to cover the majority of the cost, I would have at least taken on the total cost and tried to negotiate a lower overall bill.
I’ve learned that you can almost always achieve a 20% discount just by asking in some of these cases. And with hospitals, they are always willing to do a payment plan, so if you don’t have the money, don’t just put it on a credit card — ask for a payment plan.
The sooner you make this initial offer after receiving your bill, the higher your chances of success will be.
2. You have to be your own advocate. My mom taught me this back in 2000 when she went through successful treatment for breast cancer.
No one else cares about your own well-being more than you, and no one else is going to fight to get you what you need so you just have to be persistent.
When I received follow-up bills with no acknowledgement of my letters, my first instinct was to just pay the dang bills. But a follow-up message saved me over $200 and got me a definitive answer on the rest.
Seem overwhelming? There are companies that do this for you as well.
3. It’s complicated. The way our healthcare system prices things is convoluted and confusing and almost impossible to plan for, even when you know what you need to have done. This video on researching the costs for maternity care demonstrates that.
But if I could offer just one piece of advice to this couple, it would be to push back on that bill. I bet they wouldn’t have to pay it in full. Here’s how.
Disclaimer: The content of this post is for informational purposes and is intended to be educational only. It does not cover every possible nuance and is general in nature, and should not be relied upon as individual tax or investment advice. For a personalized evaluation of whether this makes sense to you or how to perform the transaction correctly, it’s best to work with a paid professional who can guide you within your personal circumstances.