Personal Finance Coach: Understanding your medical bill

Adrianna Gregory offers guidance to protect your budget and your credit as you deal with medical expenses, whether you are waiting on the bill from a routine check-up or a trip to the emergency room.

This post is part of our ongoing series, “A Uniquely American Injustice,” on navigating medical debt and health expenses. Find all of our posts in the series here.

By Adrianna Gregory

At TrustPlus, we know that dealing with medical bills can be daunting. As Financial Coaches we often see the toll on our clients from medical debt, which hampers one-in-three U.S. adults and is now the largest source of debt in collections, more than credit cards, utilities, and auto loans combined.

To expand our expertise on medical debt and health expenses and strengthen our ability to guide our clients, my fellow coaches and I recently read Never Pay the First Bill: And Other Ways to Fight the Healthcare System and Win, by journalist Marshall Allen.

Here are steps, informed in part by Allen’s book, that you can take to protect your budget and your credit as you deal with medical expenses, whether you are waiting on the bill from a routine check-up or a trip to the emergency room.

When you receive any letters related to your medical care, read them carefully as soon as you can and store them in a safe place. There may be mistakes on the bill that you can immediately start resolving with your doctor or hospital.

If the bill you receive from your doctor or hospital does not include a detailed list of services with associated pricing, ask for the itemized breakdown. A full list of the different charges enables you to check for errors or upcharges.

If you’re insured, look for another letter from your insurer called the Explanation of Benefits, or “EOB.” This notice from your insurer should include information about how much your health provider charged, how much your insurer paid, and the amount you are expected to pay. Compare the itemized bill from your doctor or hospital with the EOB to look for differences in the services described or the amounts charged.

First, review your personal information on the bill and explanation of benefits. This includes your name, contact information, and any insurance carrier details. If any of those details are not correct, contact your medical provider or insurer to update them.

Next, take a look at the itemized breakdown of services you received on the bill from your medical provider. Each service should have a five-digit code alongside it; those numbers correspond to a standardized list of medical procedures you can use to check if you were priced fairly.

To check accuracy and pricing, visit www.fairhealthconsumer.org and navigate to a page called “medical and hospital costs.” You’ll be asked to specify your insurance situation, your zip code, and the five-digit code on your bill. You should be taken to a page that shows the fair market value for that procedure in your area, including in-network and out-of-network ranges.

• Does the summary of the five-digit code on your bill match your memory of the care you received?
• How do the costs shown as fair market value in your area compare to costs shown on your bill?

Contacting the billing department is a good first step to ask about errors you may find. You may also request medical records directly from your hospital or medical provider to provide evidence.

You have the right to negotiate the bill with your medical provider.

Call the phone number listed on any mail you’ve received, as a first step. Before you make the call, prepare a written summary of your research and what you would like to negotiate: this can make it easier for you to press forward if you receive pushback from the billing department. Take detailed notes about the call, the date, the name of the person you spoke with, and any offers made, and keep them for your records.

Many hospitals and medical providers have financial assistance policies based on income, so ask about discounts, which can lead to savings.

You may also be able to negotiate a settlement with the hospital provider, or set up a payment plan that keeps the bill from going to collections.