As a follow-up to this diary, here is
a list of things you can do to help reduce your medical bills. It is arranged roughly in chronological order.
1. Be prepared. Especially if you are going to an emergency room, you must be prepared. Take a pad and pen. Write down everything you see and hear even if it is not addressed to you. If you can get away with it, keep ER curtain or exam room door open when the doctor is not with you. You may overhear a lot of interesting stuff about your case from the doctors and staff which will help you understand your bill. You may gain insight in what was done and sometimes more importantly, what was not done. For example, you will know whether you heard the doctor order one or two IV setups when you see you are billed for two.
2. Take a companion and do not leave your companion in the waiting lounge. Your companion can take notes if you are unable, and even if you are able, the mere presence of a witness can prevent a multitude of later problems with the bill. Anytime you talk to someone, whether in person or on the phone, write the date, the time, the name of the person, their title, and a summary of what they said.
3. If you have a choice, go to an urgent care facility instead of an emergency room. Every little thing will be a lot cheaper.
4. If you can, do not let the emergency room or even urgent care give you durable supplies. Many hospitals wildly overcharge for supplies. Take your own medicine with you as well, but do not ingest it unless the doctor gives you permission. For example, when I broke my ankle I took a bottles of Motrin, Tylenol and plain aspirin with me. If I ingest 2 Motrin from the hospital, I will be billed around $5 per pill. Take your own ice pack. I had to accept the air splint for my ankle from the hospital, but the next time someone from my household has an ankle injury, I will take the air splint with me and save $160. I will also take the crutches with me. I had to accept the hospital's crutches because I was there on a Sunday when the medical supply store across the street was closed. If my injury had occurred on a weekday, I would have had the hospital staff wheel me to the car. Then my companion and I would have driven across the street to buy crutches.
I think every community should have local non-profit which serves as a clearing house for the cheap rental of durable equipment. My landlady has in storage a full-featured hospital bed less than five years old left over from when she was the primary caregiver for her mother. My landlady was unable to give the bed away to anyone, not even to local nursing homes. I never knew she had the bed, but I knew a man who had recently purchased a full-featured hospital bed after a back injury. He is not using the bed anymore. It could have been a marriage made in heaven. My landlady did lend me her mother's 4-footed cane. She told me about the bed when she brought me the cane. Maybe a church could collect durable equipment in a corner of the church basement.
5. As you leave, ask the cashier if you can lock in a discount by paying a cash deposit. Many health care providers, even for routine services like regular office visits, will give at least a 20 percent discount for cash payments. Many times, you will NOT have to pay 100 percent at time of service if the bill is quite large. A good faith deposit is often enough to secure the discount. The providers understand that you might not have all of the cash you find you need at the ready when you first came to your appointment.
6. If you are required to pay in full to lock in a discount and your credit limit can handle it, pay with a credit card. It makes any subsequent dispute much easier. After you file your written dispute with the credit card company, the health provider will be required to substantiate the bill in writing, a copy of which you will receive. You will have the opportunity to rebut. The whole procedure can be time-consuming but has the potential of saving you hundreds of dollars.
7. Request an ITEMIZED bill. Health care providers almost always bundle the bill. Some of them have caught on that patients want an itemized bill, so the bundled bill may be a mock itemized bill. For example, instead of crutches, it might say "supplies;" instead of Motrin, "pharmacy;" and so on. Do not be fooled. If the bill comes in the mail, call immediately and request an itemized bill. Do not have any other conversation yet. You cannot begin to evaluate the bill until you see the itemization.
8. After you get the itemized bill, call immediately and request an audit of the bill. Again, it is not necessary to start a conversation. You want to see what the providers put forth as an accurate bill before you begin evaluating the individual charges. Hospital bills routinely double every physician order. An audit, which they must do if asked, compares the chart to the bill and eliminates any discrepancies, or at least eliminates discrepancies the hospital feels it cannot defend. Those doubled orders will be removed an the bill will go down. Naturally hospitals do not like to audit bills, but do not take no for an answer. At the same time you ask for the audit, ask that the "past due" clock be stopped.
9. You may have to request an itemized bill again. Sometimes after the audit, the provider will send you a new, lower bundled bill. Call immediately and request an itemized bill. If they send you the original bill with a notation that they have reviewed the bill and found it to be correct, you might need some outside help in parsing the bill. Health providers have found that patients will accept the result of an audit as definitive. Sometimes it is a nothing but a ploy. At this point you will need some good reason to reject the audit result and you might need a knowledgeable person who can ask you the right questions to find out if there is a good reason to request another audit.
For info on Medicare's payments to doctors. See this diary.