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Five Things To Do When You Get a Medical Bill

Recent events have caused much uncertainty around health insurance – what will be covered and how much it will cost. In these times of confusion and fear, it is increasingly for New Yorkers to know how they can lower their medical bills. Here are five tips which can help:

(1) Remember: medical bills are negotiable. There is no fixed cost for any service in medicine. The cost of every single service and medication depends on who is paying—whether it’s a private insurance company, Medicaid, Medicare, or an individual. Individuals paying directly without insurance are often charged the most. Unlike almost every other type of bill you receive, you should think of a medical bill as a starting point for a negotiation. At the same time, you must be mindful that unpaid bills can be sent to a collection agency, which can have negative consequences for you. Therefore, unpaid bills should not be ignored, but they can be negotiated before (and after) a collections agent is in the picture.

(2) Identify what you are looking at. Is this a bill from a provider (doctor/hospital/ambulatory surgery center), or is it an Explanation of Benefits (“EOB”)? EOBs are documents from your insurance company saying what you owe, but they may not be the correct amount, and they are not the final bill.

(3) If it is a bill, are you responsible? There are multiple reasons why you may not be responsible for paying the bill you receive, including:

  1. Is the bill for a service you received? Bills can contain mistakes. It may include items that you did not receive, especially if it is a hospital bill. Look over it carefully and highlight any items you have questions about. If you do not get an itemized bill, ask for one.
  2. Are you surprised to find that a doctor or lab is out of network? New York State has a “surprise bill” law, which protects patients who, without notice, receive a service from an out of network provider at in-network facility, or who are referred to an out of network provider. If that is what happened to you, you may be eligible to sign this “Assignment of Benefits” form to have the insurer communicate directly with the provider.
  3. Has your care been denied as “not medically necessary?” If your insurance company denied your care, you can appeal to them, and potentially to the New York State Department of Financial Services (“DFS”). Appeals can win, and if you do, you do not have to pay. Tell the place which is billing you that you are appealing the decision, and try to hold off on paying them until the appeal is decided. 
  4. Make sure you’re not Medicaid eligible. This is especially important if you are not working as a result of your medical care. Contact a navigator to ensure that you are not Medicaid eligible, because hospitals, and doctors who accept Medicaid, cannot bill Medicaid patients.

(4) Even if you are responsible for the bill, negotiate. Doctors, labs and hospitals do not always expect to get paid the entire bill—other than your co-pays---  paid for, this is especially true if you are being billed by an institution. Hospitals are required to offer financial assistance, so you should request an application, since it could lower your bill dramatically. Even if you are not eligible for financial assistance, you can:

  1. Make an offer. You can offer to pay a set amount all at once, or negotiate to pay a smaller amount monthly in regular installments.
  2. Make a plea. Explain your situation, if you are financially unable to pay, tell them your story and request a bill reduction by appealing to their better nature.
  3. Compare what you are being billed to the “usual and customary rate.” You can look up what the procedure generally costs in your zipcode on FairHealth. Look it up and use the number as a starting point for your negotiation.

(5) Enlist help. You can file complaints easily online with the New York State Attorney General or DFS. They may be in touch to help you resolve the issue. You can also contact Community Health Advocates, the free New York State Consumer Assistance Program at (888) 614-5400. If you prefer to seek the assistance of a private lawyer, you can contact our firm for a paid consultation, or to assist in negotiations.