Surprise Medical Bill? Here’s How to Fight It, and Avoid One Next Time

By K Health
November 10, 2021

As much as we may hate it, surprise medical bills are pretty common in the U.S. Even if it ends up being a mistake or ultimately covered by your insurance, hearing you owe money for something you didn’t account for can be nerve wracking.

Unfortunately, errors in medical bills are also alarmingly common. A 2017 study showed that 4 out of 5 had at least minor mistakes, and from our internal research, we found nearly 30% of people didn’t know medical bills could be negotiated. 

It’s important to know what to do if you receive a surprise medical bill, how to avoid them altogether, and how to make sure you never overpay again. Danielle Eddleston, K Health’s VP of Marketing, shares what she’s learned from successfully negotiating a nearly $1,300 bill for COVID-19 tests for her daughter.

Tip 1: Understand if you need to be the middlemen  

Some doctor’s offices don’t submit claims directly to insurance. This means it becomes the patient’s responsibility to communicate between the clinician and their insurance provider to get a bill paid. 

If the office submits the claim directly, they often will not adjust the claim once submitted—even if there are errors. This means the patient has to negotiate directly with their insurance company. 

When Danielle was worried her three-year-old daughter might have been exposed to COVID, Danielle was told a test would be covered by her in-network pediatrician under her insurance plan. So she did not hesitate to get her daughter tested on two separate occasions.

However, the next month the pediatrician’s office sent a $1,300 bill to her home. After much confusion and back-and-forth with all involved, it became clear that her insurance company did not negotiate correctly with her doctor’s office and also did not appropriately cover the full amount.

After connecting with her insurance provider through multiple emails and and having them do a manual review of the claim, it was confirmed that the insurance company would pay for the COVID test in full.

She knew she had to be more upfront with the pediatrician’s office about how future bills would be submitted, to hopefully prevent another surprise.

Tip 2: Don’t be afraid to ask questions  

When you receive a medical bill that looks “off”, it’s essential to spend the time to understand why.

While time consuming, contacting your physician and insurance company to have them explain the charges is the first step. Almost all physician practices and insurers have an online message center, which is the easiest way to submit pointed questions about your bill and the best way to avoid hold music.

It’s also a good idea to ask questions prior to any test or procedure being performed. 

Common questions you can ask your doctor or insurer before a test include:

  • What’s the estimated cost of the test?
  • Is it covered under my insurance plan? 
  • Are any other services related to this test that I have to pay for? 
  • Will anything else be billed to me?
  • Would this test qualify for any government programs? 
  • Do you charge extra for certain appointment times (such as weekends, after hours)?

This way, even if there is an amount you’ll have to pay, you can expect it and be prepared.

Tip 3: Review every detail, regardless of how small

Medical bills don’t just include the test itself—they often include every service, supply, or personnel involved in your visit, plus added charges depending on the date or time.

Always make sure each line item on your bill makes sense to you, and that your appointment details are accurate. 

A doctor could use the wrong billing code which could mean a higher price from your insurance provider. Wrong codes need to be updated to reflect accurate billing. 

Danielle’s bill for example, had an extra $115 for a weekend visit, even though the visit was on a Thursday. After checking with her insurance, she learned that the doctor’s office submitted the wrong date.

Reviewing the bill closely is important for spotting any discrepancies and human errors, which ultimately may save you from overpaying.

Tip 4: Keep calm! Resolve can take time

Even if you successfully challenge a medical bill, late payment reminders could still be sent to you in the mail. 

This is because there is often a lag in communication between a doctor’s office and your insurance. 

When an insurer is due to cover a bill, there could be a delay in the actual payment to the doctor, too. In Danielle’s case, she got reminders in the mail to pay her $1,300 bill for months after settling with her insurance company. 

If you have already spoken with your doctor or provider about your bill and received documentation or have a paper trail of your conversation, remain calm. 

Tip 5: Cost-savings solutions exist for everyone, insurance or not

Laws and resources are available to help avoid unexpected medical bills and help you advocate for yourself. 

The No Surprises Act, which will take effect on January 1, 2022, is designed to protect people from many unexpected medical bills resulting from out-of-network emergency care. With this new law, there will be fewer surprise bills and more protection for those who have limited options when in need. 

Additionally, under the federal law, if your provider suddenly leaves your network your insurer must provide you with at least 90 days of coverage at the previous in-network rate.  

If you don’t have insurance coverage and are affected by COVID-19, the federal government also has established a provider relief fund to reimburse clinicians for services provided to those without coverage. 

Healthcare options like K Health, which offers $73 remote visits with board-certified clinicians regardless of insurance, can help people save a lot of money on urgent care visits. For everything from a UTI to a headache to pink eye, savings compared to in-person care with or without insurance can be immense. Plus the free K Health app is a good way to see if you need emergency or in-person care, or can get treatment from home. 

Danielle’s biggest takeaway was using her voice to ask questions and learn, and not blindly accept the bill she received. The current healthcare system isn’t perfect, and although surprise bills can happen to everyone, there are ways to challenge them and protect your wallet. 

K Health

Reliable, relatable medical information written by hundreds of board-certified clinicians, updated regularly to ensure accuracy.

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