Author Topic: Disputing a Medical Bill?  (Read 2027 times)

jsloan

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Disputing a Medical Bill?
« on: April 20, 2015, 10:21:26 AM »
Hi Everyone,

My wife requires an MRI each year for a medical issue.  We currently have a high deductible HSA medical plan  through my work (5000.00).  Last year we went to a local, in network hospital and the cost for us was 900.00 for the MRI, there were also other costs associated with the doctor's visit, etc which made it around 1300.00 total.  This year my wife chose to go to a different, in network hospital because of their reputation.  We recently got a bill for our portion of the costs from our insurance company and the cost this year is $2800.00 for the MRI alone (around 4200.00 total cost)!  So I guess my questions are:

1.) Is there anyway to reduce/dispute this current charge?  If we would have known it was so expensive to switch hospitals we would have probably questioned the decision upfront.
2.) In the future, is it even possible to shop around since this will be a yearly cost for us?  I don't know what all is being charged except for the MRI seems to be the largest portion.
3.) Since we know we will have this cost each year, does it even make sense to go high deductible?  I can't imagine that any plan I would get through work would 5000.00 each year?
4.) Can my wife have the MRI done at the local hospital, but the results interpreted by the doctors at the reputable hospital? 

If anyone has been in this situation before any help would be greatly appreciated.  Thanks in advance!     

NCGal

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Re: Disputing a Medical Bill?
« Reply #1 on: April 20, 2015, 11:05:58 AM »
Medical providers seem to have different rates for different circumstances. I went through a long drawn out appeal process for a lab bill. When I told the lab I was in dispute with my insurance company they reduced a $1,000+ fee to $500 and told me that was the rate they charge the uninsured. Recently I also asked a dermatologist's office for an out of pocket quote for my husband, who's on a high deductible plan. They would charge him as someone who is uninsured, with a lower rate than what they put on the claim to my insurance company, for the same exam. My insurer covers it all but a co-pay. 

You might call the billing office and tell them you're wrestling with perhaps initiating an appeal process with your insurance company since they covered only a small portion of the bill. Tell them you know the process takes a long time, but you don't have that kind of money right now. Then ask if there's a way they can reduce your portion of the bill so that you can take care of it now.


NumberCruncher

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Re: Disputing a Medical Bill?
« Reply #2 on: April 20, 2015, 11:33:03 AM »
Ugh medical bills and dealing with medical billing people. I had to go through something similar recently, though it was on a much smaller scale.

(1) Possibly. I'd probably start by calling your insurance company. Try to understand what is different this time from last time, etc. Sometimes things are coded wrong, and you may need to call the hospital to get codes changed to lower the cost. Compile a big list of questions (and have all the codes handy) and just go line by line on the phone. If you don't have a line-by-line from the hospital with billing codes, get that first. Always document everything - date, person you talked to, what they said.
(2) Hmmmm...The hospitals may be able to run a quote for you, through the insurance. I had this done with a dentist on the cost of a procedure when they weren't sure how much it would cost me. This could take a bit of time, but sounds like it would be worth it. They might not even need to run a sample claim to give you a quote. You don't know if you don't ask! Like NCGal said, you could also see about an out of pocket quote.
(3) Quite possibly. Figure out why the cost was so different this year, and what you'd have to pay with the HDHP vs. a different one. Factor in tax savings with the HSA, etc.
(4) I'm thinking yes, though it might cost a few hundred more (I'm guessing anyway - you'll get a better idea once you start understanding each line item). She should have access to all medical files, including MRI scans, and at the very least she could request these files, then go to the other hospital. The hospitals would likely share the files, too, if requested.

Sorry you have to deal with this. :-/  If all else fails, you might want to contact a medical billing advocate - someone who regularly deals with this kind of stuff. That would be some fee, though, either up front or some portion of what they save you on your bill. I'm all for do-it-yourself, but in some cases, with the mental exhaustion something like this entails...might be worth it.

Good news is you now know better and will likely be able to reduce your costs in the future one way or another! This kind of stuff is always easier to deal with before the procedure or test has been completed.