Why It Pays to Complain About Your High Medical Bills

It was the last straw. I’d opened a medical bill for 83 dollars--for a free PAP/pelvic exam. I felt my face grow hot and my blood pressure blow out of the top of my head.

You’ve seen the commercials. It’s been a national marketing campaign for a year or more. Your medical insurance will now charge you zippo for annual routine health screenings: A physical for men and a PAP/pelvic (cervical cancer screening) and mammography for women. Since I have Medicare, it will only pay for a PAP every other year but will cover mammograms annually. I followed the rules and waited two years to get this exam. The last exam in 2014 produced a bill for only $14. But this bill for the same procedure was $83. My morality meter spun out of control. I started making phone calls.

First I called Medicare. The policy for these free screenings states that doctors can legally tack on an office visit charge. I made a mental note that though they can, they don’t necessarily.

Next I called the health system biller who sent me the statement. The more explanations I received, the madder I got. The biller said the reason why one bill was $14 and the other was $83 was because they had been coded differently—but she couldn’t tell me why. I would have to call the biller at my doctor’s office.

Now I’m fuming and indignant. Anger serves me well. While it might make someone else tongue-tied, it makes me very articulate. Before I hung up, I stridently informed her that I am poor and disabled with MS, and this kind of expense causes hardship for people like me. She began to explain the patient assistance program and how I could get a discount on the bill and set up a payment plan. I told her that I know all about their patient assistance program and have used it several times as well as many others; that, in fact, you could say I am the poster child of patient assistance programs, and that she is missing the point. I am taking issue with the core problem, the reason why patient assistance programs exist in the first place. The rising cost of health care against stagnant incomes is squeezing people until they explode, and not just the poor. And if a doctor doesn’t get adequately reimbursed by Medicare, it is, in my book, outrageous to automatically bill the patient to make up the difference. Squeezing the poor has long been the desirable solution to this systemic problem. It continues because there is no Washington lobby representing the poor and disabled. All I have is my mouth and cognitive ability to self-advocate. I finished my spiel by presenting a scenario: What if I were a 90-year-old woman with not great cognitive function and no one in my life to go to bat for me? What would happen is that I would not make phone calls and protest, I would write a check for $83 and not eat enough or buy meds for the rest of the month. The biller was sympathetic, but is as helpless as I am in this maelstrom of too-high medical fees and insurance company greed. I finished the call by stating that I am officially disputing the bill and she told me it would be sent to the examiner for a determination and to call back in three weeks.

Finally I called the doctor’s office biller. The higher bill was the result of charging for an office visit. It was charged because I brought up some problems that amounted to reporting symptoms of a yeast infection. I flippantly remarked that I’ll simply report no problems on my next exam to avoid getting the higher bill. And besides, I have a $20 co-pay for office visits, so getting billed $83 for that still doesn’t make sense. Can’t she appeal to the doctor to re-code and reissue this bill?

She tried, but he refused and said it would be fraudulent to change anything since the charges were legal and followed the guidelines. Then she told me she’d look into it further and call me back.

The next day, fortune shone down on me. She reviewed the doctor’s notes and saw that one issue we discussed didn’t make it into my record—and therefore she would recode and re-bill me for $14.

The biller had found a loophole and used it to my advantage. I thanked her profusely for digging into the issue and going to bat for me. I also used the opportunity to ask some rhetorical questions. When you make a billing and see the patient’s name, can you envision that person? Do you know their financial situation? Probably not. And this is why I will call and be a pain in the backside every time I get a high bill. It’s the only way of putting a human “face” on these statements. She told me that she attached a note to my record about my case for future reference. She knows me now! And I feel like I have an ally in her, someone in that office who will be in my corner.

And that, my friends, is why it pays to act like a holy terror whenever you receive a medical bill that sticks in your throat like a big pill. Service providers need to know the real-life impact of medical bills, and it’s up to us to tell them. Self-advocacy is often the only path to having peace of mind whatever the outcome. We might not have an ideal resolution each time, but fighting for ourselves feels a whole lot better than helplessness.

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