Dollars and No Sense: Protecting Yourself Against the Mysteries of Medical Bills

If you're expecting a healthcare bill in the mail, I have one critical piece of advice: sit down before you open the envelope. 

Not only will the total cost most likely shock you, the sheer confusion of why you're being charged whatever they're asking will probably give you a headache and the utter lack of transparency will  make you dizzy.

Steve Lopez wrote a great piece in the Los Angeles Times on March 31, 2012, "The Bizarre Calculus of Emergency Room Charges." The article actually focused on more than just the emergency room, looking at the absurdity of all kinds of medical invoices, including hospital bills, colonoscopies and outpatient surgery. 

Lamenting the fact that patients are often surprised to go in for surgery and end up with separate bills from the hospital, the anesthesiologist, the surgeon and and an assistant surgeon, Lopez says, "It's like going to a Laker game, paying $150 for a ticket, and later getting an additional $75 bill in the mail from Kobe Bryant." Or make that $15,000 for a ticket and an extra $7,500 bill from Kobe.

My hair stylist, who has health insurance, got a $600 bill for a screening mammogram, and when she questioned the cost, she found out that if she had just  told the clerk she was uninsured, her bill would have been about $60. 


Our friend tripped going down a set of concrete stairs outside his apartment in the dark and landed on his knee, couldn't walk, and required emergency surgery a couple of days later. In all the commotion, although he checked to be certain the orthopedic surgeon was a participating provider under his insurance coverage , he didn't think to find out about the hospital, assuming the surgeon and the hospital were linked somehow. He now owes about $10,000 more than if he had had the surgery at a hospital down the street.


A couple of years ago I had a "free" physical, allegedly covered under my health insurance, and then got a bill for $300 from my physician. Why? She said that during the physical I had asked a question about whether I should consider taking hormone replacement therapy, and asking a question costs extra. Honestly.  I disputed the bill and the physician fired me. 


I could go on and on about the challenges of reviewing, understanding and disputing healthcare bills, but here are a few simple things you can do now:

• Don't review the bill until you're in a relaxed, calm setting with a cup of coffee and some nice music playing in the background. Don't expect it to make sense. Think of it as a  difficult calculus exam question or a foreign language quiz.
• Use a highlighter to help you focus on items you don't understand or think are high.
• Pull out your "Explanation of Benefits" from your insurance company to compare your coverage to the charges. Knowledge is power.
• Check each line item carefully and be sure it accurately reflects services, procedures and tests that you actually received. If you're not sure, you can ask for a copy of your medical record to help you link charges to services.You may need a translator, perhaps a friend who is a healthcare provider or office assistant.
• Be sure you know whether a healthcare provider or facility is a participating provider with your insurance coverage. If it's not, your bill will most likely be significantly higher. If the surgeon is a participating provider but his or her preferred hospital is not, ask if the covered hospital might be an option. (The surgeon will need to have "privileges" to perform surgery here, i.e. be approved by the hospital medical staff). If that's not a possibility, consider finding a new surgeon. Ask, too, if the anesthesiologist who will be in surgery with you is a participating provider in your plan.
• If you have a high deductible plan, before you get a procedure or test, you can call and compare the cost if you don't have insurance to what it would cost if you have your plan. Often the "uninsured" rate will cost you much less than what you would be charged with high-deductible insurance. Based on what you hear, you might be better off telling the healthcare center that you don't have insurance and just pay the lower rate.
• If you receive a complex bill, typically after a hospital stay, call and ask for a detailed itemization of the bill and tell them you will need additional time to audit the bill for accuracy.  Such a review could save you literally thousands of dollars.
• A S K. Assume nothing. Before a healthcare encounter, sometimes during, and frequently afterwards, don't hesitate to ask questions about coverage and cost. 

Good luck! Let me know what happens.