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Why It Pays to Complain About Your High Medical Bills

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • jackie5275
    4 years ago

    Go get ’em Kim! I just embarked on a similar episode 2 days ago when I got an EOB for a claim for alleged services rendered while recently in the hospital for a cardiac episode. It was claimed a cardiologist examined, interviewed, & did observation of me. She asked me 2 questions, nothing else, but decided to say she had done the rest & billed my insurance $473, of which I had to pay $28. For me, yeah, $28 isn’t that big of a deal. However, that’s if I actually had such services rendered. I called & complained to my ins co & biller who has agreed to credit me the charge. You have to fight them when you think you need to. You can’t be meek & give your money away.

  • MsMyers
    4 years ago

    Yes! I am currently disputing $70 Medicare refuses to pay for an HPV test performed as part of my yearly PAP test. But, my doctor very helpfully provided the very decision memo that was issued saying is *is* covered now. I hadn’t really been very energized to follow up on this problem, but now you’ve got me all riled up and ready to fight some more 😉

    On a similar note: I am lucky enough to pay less than $150/yr. copay for literally $70,000 worth of MS medication each year. This is not due to accident or luck or religion! My low-cost medicine is the result of hours and hours on the phone with drug companies, patient assistance plans, doctors, nurses, customer advocates, and charities. Because having MS isn’t already enough of a fight.

  • katea
    4 years ago

    Good story. Thanks for sharing. I’ve also been on the receiving end of those charges for “no-cost” health exams. What a pain to have to do anything to take care of a problem that should not exist in the first place. Maybe warnings need to be issued before exams and tests to unsuspecting consumers. “Before we begin your colonoscopy, let’s make sure you understand that even though you’ve been told there is no charge for this procedure, you will indeed receive a bill. So, should we continue?” So crazy. I would like to add, however, that while “acting like a holy terror” may work for you, it is not necessarily helpful or healthy for many others. Certainly, anger is justified and can serve as a motivator to take action. For me, the next step is to calm down, do a bit of research, and then start the phone calls. There have been times in my life when the cognitive issues have made it impossible for me to take care of these things myself. I have a trusted and persistent friend who steps in on my behalf during those times and deals with the necessary people and agencies for me. The bottom line is not to let it go, not to let ourselves be cheated by these bait and switch tactics. Again, thanks for bringing this to our attention.

  • Mags325
    4 years ago

    Am so glad you shared this story. Have you also seen increases in the cost of MS medications? Have spent the last three months trying to get an answer as to why my medication has increased over $1500 in 1 year, not to mention 75%+ since starting it! From the manufacturer, pharmacy to insurance co. No one can explain why! Couple that with my insurance telling me they will no longer cover this specific med at my local pharmacy, which is cheaper, and in network, but must purchase from a specialty pharmacy whose price is higher.
    None of these entities care that I am disabled on a limited fixed budget and $1500 is close to my total monthly income!
    Where can you find answers, and better yet, where do the unsubstantiated increases stop!

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