Linda Michelson once whittled a $3,400 health-care patient bill down to $75 after she discovered a medical billing services error.
Steven Corn brought a $9,000 medical bill down to $15 once he discovered a coding error.
Health-care patient advocates like Michelson and Corn contend with nightmares such as these on an almost-daily basis. While extreme examples, they show how much worse a medical billing services error can make an already stressful situation.
“There was a study a few years ago that estimated 80 percent of medical bills have a mistake in them,” says Corn, founder of Los Angeles-based Metis Advocacy and a board-certified patient advocate. “In my personal experience, my number’s more like half. If you think your medical bill is wrong, it probably is.”
What is a patient advocate?
According to the National Cancer Institute, a patient advocate is “a person who helps guide a patient through the health-care system. This includes help going through the screening, diagnosis, treatment and follow-up of a medical condition.”
Not all health-care needs require a patient advocate, but patients should consider asking for outside help if confused about insurance coverage, wrongly charged or denied coverage for a service or procedure, or simply buried by expensive medical bills that keep piling up.
What can patients do to advocate for themselves?
Michelson, president of The Medical Bill Advocate in Englewood, N.J., and Corn encourage patients to prepare before entering a doctor’s office or operating room so they can advocate for their own health care or assist with a loved one’s medical care.
Check out these 7 suggestions to help you get ready for your next appointment:
1. Understand your insurance benefits. “[Know] how much they pay, what percentages, what your deductible is, what your maximum is,” Corn says. “That’s easy to do on your own. There’s always a declarations page of some sort.”
Michelson suggests patients visit Medicare’s web page that explains common health care and medical billing services terms.
2. Know where you stand on your deductible. “If you’re told you need to get a procedure, check where you are so you don’t get a surprise bill,” Corn says. “This is probably the No. 1 task that people forget to do. They think they know how much they’ve spent, but they’re often wrong.”
3. Use in-network providers whenever possible. “If you are facing a major surgery, it’s best to have it done at an in-network hospital and performed by an in-network surgeon,” Michelson says. “If the surgery was done at an out-of-network hospital or by an out-of-network surgeon, depending on your policy, it won’t be covered or it will be covered at a higher coinsurance level.”
4. Before you pay, request an itemized bill. Read it carefully to ensure all of the services you’re being billed for were actually rendered. “Maybe 25% of people do that,” Corn says. “That’s the first thing I always ask for when I have a new client.”
5. Familiarize yourself with your plan’s free preventive services. Thanks to the Affordable Care Act, Medicare provides complete coverage for some services, such as bone mass measurements, breast cancer screening, cardiovascular screening and some immunizations.
Be sure to check your insurance plan and benefit package for this preventive health-care coverage, as many items are age-dependent (e.g. age 50 or older) and/or frequency-dependent (e.g. every two years).
6. You can price shop. Corn suggests patients check healthcarebluebook.com to compare pricing against local and national averages.
“Health care is the only product we generally buy without asking [about pricing] ahead of time,” he says. “Can you imagine buying a car without knowing how much it’s going to cost until the first payment? [The blue book] won’t give you ammo to negotiate your price, but it’ll give you information.”
7. Expect the unexpected. “No matter how much you prepare, there are a lot of smart people … who still end up in a bad situation,” Corn said.
The bottom line
Invest and save money wisely now, so you won’t be left sick with worry over unexpected medical charges you can’t afford. If you find yourself drowning in medical debt or lost in today’s health-care system maze, reach out to an experienced patient advocate for guidance.