Understanding the bill can be one of the biggest issues.
The incident I referenced with the $66K bill that netted the hospital $8.6K was a classic example. This was a surgery that was done a total of three times, in a short time frame, due to a truly talented, and competent surgeon who admitted that he flat out screwed up. The first time there were no billing issues for the actual surgery. The second time an office employee of the surgical group used a wrong code, and it was rejected as "experimental" by the insurer. The following few months we so bizarre that it was laughable. The surgical group was owned by he hospital, who did the billing. They sent me a bill for $8K for the surgeon, since the insurer refused to pay. I then contacted the insurer, who very cleanly detailed the situation for me. The provider used an odd code, it wasn't legitimate and was in fact a claim for an experimental procedure, and they would be happy to pay when it was corrected. The insurer was in total agreement that they were responsible for the charge, but rules are rules, and when you bill for experimental procedures, you don't get paid. They helpfully offered all the proper code info. based on the same surgery they had done a few weeks prior, and paid in full. As expected, the hospital was arrogant and unwilling to deal with the problem. First, I was told that I was wrong, and didn't have the correct info. I responded that I was reporting exactly what the insurer told me that they needed, which was, oddly enough, how you got promptly paid the last time. The next few weeks were wasted waiting for the hospital to "review the situation", as they did absolutely nothing. The billing continued, and by this point the anesthesiologist is getting stiffed for his fantasy $4k bill, since the insurer won't pay that either. Their office is trying to tell me that the coding error isn't their problem, and that they expect me to cut them a check. I then have to break the news that it is their problem. They did business with the surgeon, not my wife, and the surgeons office is incapable of billing correctly, so they will get paid, some day, when the hospital decides to correct the problem.
The hospital absolutely refuses to address the issue, and even goes so far as to claim that asking the surgeon to correct his error would be illegal, since it would be fraud to correct it. After four months of this bullshit, I grow tired of the game, and lay out the fact to a senior employee of the billing department. I calmly tell her that, first, I will NEVER pay the $8K they are billing, nor will my insurer. Second, if they continue acting this stupid, we will end up in front of a judge, and I will be a very unpleasant experience, as I have extremely detailed documentation on everything. Finally, I recommended that she take a moment to reflect on exactly how it's going to look when I lay out the case..................Specifically, the fact that, at this point they had done the exact same procedure three times in less than eight months. Two of three times the surgeon was paid promptly, due to the use of proper coding, and paid less than 25% of the fantasy bill. Instead of engaging in rational behavior and sound business conduct, they refuse to address the issue, refuse to correct an obvious and indisputable error, and are attempting to damage my wife's credit, and steal six thousand dollars is excess profit from her. I then asked if they REALLY wanted to continue with this battle?
I get the usual, "let me look into it, and I'll get back to you" bullshit. A few weeks later the EOB comes, the insurer pays roughly a quarter of the surgeon's and anesthesiologist's bills. Everybody is paid in full, and we wait for the next screwing.