Chances are you've been hit with a medical bill far more expensive than you expected.
If so, you're not alone.
In this episode of CareTalk, David E. Williams and John Driscoll dive into the complex, confusing, and often painful world of medical billing, discussing how you can protect yourself from unethical and erroneous charges.
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Episode Transcript:
David E. Williams: Did you ever get a medical bill that didn't look quite right, or you couldn't afford? Well, it turns out you can usually do something about it if you call the billing office. Anyone can do it, but it turns out that extroverts and those with disagreeable personalities are the best at getting their way.
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Never skip therapy day with BetterHelp. Visit BetterHelp. com slash CareTalk to get 10 percent off your first month and take the first step toward improving your mental well-being. That's BetterHelp, H E L P dot com slash CareTalk. Welcome to CareTalk, America's home for incisive debate about healthcare business and policy.
I'm David Williams, President of Health Business Group.
John Driscoll: And I'm John Driscoll, Senior Advisor at Walgreens.
David E. Williams: David,
John Driscoll: this is insane.
David E. Williams: Well, John, you know, it's not insane. That's like the old Crazy Eddie commercials that I used to hear way back in the day. But, you know, let's talk about medical bills, John. And first of all, you know, what makes medical bills different from other kinds of bills?
John Driscoll: Well, you never really know what you're going to get charged. And I guess from a provider perspective, they never know how much they're going to be paid. And so it's actually kind of a big mess.
David E. Williams: It's a big mess, John. You know, if you think about like the normal transaction in the American economy, you drive up to the gas pump, the price is there, you pump a certain amount of gas, that's what you pay.
And it's not like I pay 3. 76, you know, for regular and you pay 6. 81 and someone else gets it for free. And the gas station thinks they're charging 10 and sometimes they get one and sometimes they get four and sometimes they don't get paid at all. So it's very, very weird you know, sort of situation.
And also, like, when I'm going to get gas, John, it's like, I want to fill up my car. I know what I'm going to get and, you know, I know what it is. A lot of times, I don't even want to be getting medical services, you know, and be dragged in an ambulance. That's
John Driscoll: exactly right. I mean, that's the nice way of saying it.
The truth is, David, you're, you're, we have the most expensive system in the world, with the most complicated set of bills and collections, around what's the most vulnerable thing that you engage in as a system, which is healthcare. People go to healthcare when they're, you know, weak and vulnerable and nervous and uncertain about a whole series of other things like, can they get healthy?
How healthy, how quickly will it take to heal a broken bone or cure cancer? And then your, your, your, your, your, your first thought is I want, I need the best care I can get as fast as I possibly can. Not geez, how much is this going to cost? And yet that cost the billing is an enormous burden on people all across America.
David E. Williams: John, there's some new research out there. There's a survey done by the USC Schaeffer Center for Health Policy and Economics, surveyed a thousand people or more and published it in JAMA Health Forum. And this is about contacting a billing office if you happen to get a bill that you disagreed with or you couldn't afford.
What'd you think of this study, John?
John Driscoll: Well, word up, you can, you can negotiate. I mean, what was fascinating is, is that a strong academic center, the Shaffer Center at USC, publishing in an extremely well-regarded, austere, well Research publication like the Journal of the American Medical Association that it took all of this work to figure out what anyone in healthcare already knows, which is negotiate, negotiate, negotiate when it comes to bills.
I thought it was fascinating.
David E. Williams: It was interesting, John, that, you know, people called the office. If, if they called the office, they tended to get results. They get the bill corrected if it was wrong, even if they just, you know, thought it was unaffordable, they got it lesser. If they, if they literally negotiated, they'd get, they'd go to get, they would get a better deal on it.
Now there's a lot of people who didn't call and they just assumed like it, you know, it wouldn't make any difference if they called or not.
John Driscoll: Well, I don't think everybody knows that, David. I mean, that, that's what the fact of, so the, the, the, the, what the, rather than what they used as the title, it should be negotiate everything when it comes to costs in healthcare.
The other, the, the second thing that was fascinating is, that from my perspective, I think the reason, one of the reasons you can negotiate is again, the provider doesn't even know how they're going to get paid and when they're going to get paid. And so to some degree, by engaging directly, when you get a bill, you start, you start a process where you can actually get perhaps to something that you can afford.
And I think it's a call to action for anyone. Who gets a bill that they think is a little bit out of whack because what they also found is that you know The bill wasn't always correct in in even the basics And so there there there there's a lot in this study, but I think the the conclusion is everything's negotiable
David E. Williams: John, I remember the old, You know, when they used to put these magazines and little sales things on the airplanes, and there was this guy, you know, I think it was Charles Karras, you don't get what you deserve, you get what you negotiate.
And he should be reincarnated as a, as a billing guy. Now, John, a lot of these studies that you see, even though there's a lot of methodology, a lot of expense and all, a lot of academic jib jab in there. It's sort of the blinding obvious, like, okay, the sky is blue. Now, they had some things they proved that were expected.
If you have higher socioeconomic status, like if you have a college degree, high financial literacy, if you're insured, you tend to do better when you call. A thing that wasn't maybe shocking, but it was funny that they studied it. And what they found was that the people that do well are those that are extroverted.
But also people like you, John, who are disagreeable. Those are the people that do well and get the better, get the better deal.
John Driscoll: It's fascinating because, because in general, when you're negotiating a service encounter, that's not going the way you want, whether it's a billing or a service. All of us know, you know, if you're, if you were, if you approach it with, an element of kindness and understanding, you're much more likely to get a result.
The thing I thought was fascinating is the cranky naysayers, the people who are the most difficult got the best deals. It's, it's, it's it was, it was, it was not, that was not intuitively clear to me, but again, negotiate and negotiate hard.
David E. Williams: Well, John, what I liked about it, you know, I always like to read these academic studies and just like to look into the appendix or the methodologies and all that.
And it says it's people that are, you know, have a disagreeable personality. I'm like, how do they measure that? So here's some of the questions that they ask, John, that this, if you have a yes answer to some of these questions, and I know that you do, then you're disagreeable. So one is I often get into arguments with my family and coworkers.
I believe that most people will take advantage of you if you let them. And this is my favorite one, John. If I don't like people, I let them know. So anyway, those that have that disagreeable personality for whom that comes naturally. You're in good shape. If you don't have that, make sure to act like that when you call the office, I guess.
John Driscoll: Well, I, I think that the, exactly right. Take on that personality. Yeah. David, was there anything else in this study that you found useful as a consumer? What is, what's it going to take? To get a cheaper bill, to get a fair, to get, to get a fair price.
David E. Williams: Yeah. There were some things that I saw in the study itself, but also in the write-up about it, that were, that were some good tips.
So one was about, you know, talking about errors on bills. One of the fundamental mental errors is actually like, it was, was it this John Driscoll or this David Williams? And we both have really competent, could it be somebody else running up a bill? There were some specific things like if, if it's a hospital bill, you can ask for an itemized bill.
And that could have many, many lines on it. Their hospital is required to send you that within 30 days. And you can imagine there's a lot of mistakes and things, especially because, you know, people don't usually look at this. The example given was an infant boy being billed for a pregnancy test. Now, I guess it's, it's pretty unlikely, you know, that's legit, but maybe they might've, they might've run the test.
However,
John Driscoll: it was inappropriate.
David E. Williams: Yeah. And then the other thing, I mean, this is, I think, should be, is well known, but still should be mentioned, which is that you may qualify for a reduction, like, based on income. A lot of these hospitals are nonprofit, they have charity care and so you can, you may be able to, just to qualify for that.
So that was good. And then I think there were some other things we can talk about, like the no surprises act because this should have an impact on, on on medical bills.
John Driscoll: I think that what, what you've, what, what people don't realize is the federal government and the Biden administration has actually worked really hard to a, to whether it's making prices more available, making sure hospitals understand that they've got the obligation to actually give you an itemized bill.
And the other, there is actually wide bipartisan support for ending this surprise medical bills.
David E. Williams: You know, the big example of what happens is if you go to the hospital and you went to the trouble to identify, you have the hospitals and network. My doctor's in network, and then you get these out-of-network bills anyway from people like anesthesiologists who are out of network, but they're working in the hospital.
You know, that's what the No Surprises Act is probably kind of trying to put a stop to that. So some of those charges are still appearing. So just, you know, question if they're even legitimate. That was good. And then John, always planning ahead is, is a good thing to do before you get the bills before you're hospitalized, before you see the physician if you can, maybe what are some good tips and tricks for that?
John Driscoll: Well, I think, I think that you, If you have the opportunity, and a lot of people don't, to know that something, something significant is going to happen, or significantly, potentially expensive, you can actually ask for a good faith estimate, and that is, is going to put the hospital, or the doctor, or the team on notice that you're serious, but they actually do have an obligation to give you that good faith estimate.
David E. Williams: That's right, John, and if you are if you are if you don't have insurance or if you aren't using your insurance there Then if the bill comes in above that good faith estimate by four hundred dollars or more you can dispute it Automatically, so that's a good thing, especially for those that are paying out of pocket.
John Driscoll: and even for those who aren't disagreeable Disputing it will almost always result in you getting a lower total cost if you don't have if you're in those categories So I think it's I think there's actually a It's unfortunate that it's that, that, that this stuff is buried in academic academic journals, because, you know, medical bills are still one of the most common sources of those driving people to, into bankruptcy.
And when, I don't think people who are going into bankruptcy know that there's a lot of this stuff is negotiable, because once it and although, although there's also some, some good news there on, you know, historically, late medical bills would hit your credit rating. That's no longer, that's no longer actually legal in the U.S. And so I think what, what we're starting to do is having a real consumer so having some reasonable consumer rights here around fair billing. I just think the challenge, David, is nobody knows about it.
David E. Williams: John, well, everyone listens to CureTalk, so they'll start to know about it. Let's, let's make another point there about the credit reports and how medical billing comes in.
I did learn something here, or I was reminded of something that is important, which is that, let's say you've got a bill and you want to pay it. It's a legitimate bill, maybe you've gotten a discount on it, the doctor did a good job, the hospital, whatever. You can typically request a payment plan. from the provider.
So let's say if you owe a thousand dollars and they pay off a hundred dollars a month, something like that, it's better to do that than it is just to put it on your credit card. Because if you get into financial trouble because your medical bills are adding up or whatever, you know, if you have bad bad debt because you didn't pay your credit card, that's much more of a problem than if you didn't pay off this payment plan, which you might also be able to have extended and which may not have any interest associated with it.
So generally speaking, Don't put, don't put a debt on medical debt on your credit card unless you really have to.
John Driscoll: No, you really shouldn't. And the reality is that most hospitals and groups will actually accept a payment plan and payment plans just simply in the same way that people put bills on their credit card to defer payment, that payment plan is simply a way to defer payment and to get to a level of payment that you can afford.
I think that's a, that's really, really yeah. It's really, really important that folks understand that. John, did you, did you ever get a bill you didn't like? Oh yeah, all the time. I mean, I don't think anybody likes a bill, David, but I think being on the inside of the healthcare system, you know, you realize a, if it's a, if it's a good faith, if it's a, it's a bill that looks, looks reasonable.
I will pay it if it doesn't look reasonable. I'll call and negotiate and you can get better terms. There's just no question. There are some proceed there. There are some places where you can't negotiate, but everybody should try John.
David E. Williams: I'll add one thing now that you prompted me for it, which is that sometimes the physician's office or the hospital will bill you for something.
They'll say, you know, insurance paid this. And you owe the remainder and you, you can, you know, you can negotiate it or whatever, but they may not always be right about insurance. So I had a situation once actually with an ophthalmologist where the referral hadn't come in on time. And, you know, so they sent me this bill like they're not going to pay it because the referral didn't come in on time.
It was beyond their deadline or whatever. And I just called the insurance company and they said, no, they'll, they'll, you know, they should pay it anyway. And they basically got it. So they ended up paying, and the insurance company ended up paying more. I basically appealed on behalf of the physician's office and the physician's office got paid more.
And therefore I didn't need to pay as much. So those, sometimes the provider hasn't tried as hard with the insurance company as they could. So I wouldn't let the insurance company off
John Driscoll: the hook. That's because you're a healthcare wonk, David. I think we've sort of given people the critical elements.
Negotiate, be disagreeable, know your rights, and make sure you have a good faith understanding up front and realize that if the billing system isn't on your side, regulations probably are, and that if you aren't negotiating, somebody else is, and you should do the same.
David E. Williams: Well, that's it for yet another episode of Care Talk, a very agreeable episode, if I may say so myself.
We've been talking about medical bills and what you can do about them. I'm David Williams, President of Health Business Group.
John Driscoll: And I'm John Driscoll, Senior Advisor at Walgreens. If you like what you heard or you didn't, we'd really like if you subscribed on your favorite service.
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