Kellie Brown had rarely suffered from an ailment worse than a runny nose when she let her health insurance lapse last August. Brown, 23, had always been covered by her father's plan. But when he retired in July 2007, she lost her coverage, and "it just seemed like an expense that I didn't really need."
Big mistake. Less than two months later, Brown ended up making two financially devastating trips to the hospital: one to have her appendix removed and another, a few days later, to be treated at a different hospital for an infection resulting from the surgery. Altogether, her tab came to $40,000.
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A visit to the emergency room, for yourself or a loved one, is no time to be haggling over prices or shopping around for a good deal. On the other hand, even if you're uninsured, huge medical bills don't have to bury you in debt, wreck your credit or banish you to collection hell.
When she got sick, Brown was a junior at Virginia Commonwealth University, in Richmond. She had few assets to speak of, and her parents were living overseas. When she told the hospitals about her financial situation, the hospital that had removed her appendix slashed her bill from $32,000 to less than $10,000; the hospital that treated her infection wouldn't budge on her $8,000 balance because it was below the $10,000 level that qualified for charity.
After an extended recovery, Brown had missed too much school to complete her semester at VCU. Last October she picked up an office job with a local catering company to begin paying down the remaining $18,000 of her debt. Then, in February, a group of friends organized a fund-raiser to lend a hand. The event, called "Show Some Love for Kellie Brown," brought together bands, dance groups and an art auction, and raised $6,000.
Armed with that lump sum (plus $2,000 from her parents), Brown was able to bargain with the first hospital, which agreed to settle her outstanding $10,000 balance for $8,000. She's still paying $50 a month toward the remaining $5,000 she owes the second hospital. But her monthly installments won't break the bank. And in September she'll head back to VCU to resume work on her dual degree in sociology and psychology. "It pays to have good friends," says Brown.
But you don't need a fund-raiser in your honor to slash your medical bills. There are plenty of other options if you know how the system works.
Read Your Bill
If your balance from the hospital appears out of line, give it a reality check by requesting and reading an itemized bill. Pat Pane, a specialist in medical-claims assistance in Wilmington, N.C., who helps patients interpret their bills and appeal them if necessary, says she once worked with a woman who had been billed for four hernia surgeries when she had had only one.
If you don't find any errors but your bill still seems questionable, call your insurer to make sure a paperwork snafu isn't gumming up the works. A claim filed under, say, your maiden name instead of your married name could throw a wrench into the process. So could a medical procedure or diagnosis that was coded improperly. "Say you've got bronchitis, but the doctor codes your condition as chronic fatigue," says Pane. "Chronic fatigue is an ongoing condition, so your insurance may not pay for your tests." If you find an error, "contact the provider and ask for a corrected claim to be filed," Pane says.
Know Your Insurance
If your treatment falls into a gray area that your insurance may not cover, bolster your case by submitting letters from your doctors that explain why the treatment you received was necessary. And verify that you provided the insurance company with any required referrals from your primary-care physician.
Mark Rukavina, of the Access Project, a nonprofit group that works to improve access to health care, recommends that you submit official paperwork whenever possible. "Often people call their insurer's customer-service department and get discouraged," says Rukavina. "But sometimes you just need to file an official grievance to clarify whether something should have been covered."
Similarly, if you used an out-of-network service because of a medical emergency, make sure your insurance company is treating the episode as an emergency. If that's the case, you'll more likely be charged as you would for an in-network service and the insurer will pay more of the bill. If not, file an official appeal, or submit a letter from the doctor who treated you explaining the urgent nature of your illness.
HMO participants generally have to walk a thinner line in terms of hospital care. "You may have to notify your primary-care physician within a certain time period of going to the hospital," says Tom Bridenstine, managed-care ombudsman for the state of Virginia. Or if your situation isn't immediately life-threatening, you may need to speak with a registered nurse at your HMO before heading to the hospital. Bridenstine's advice: Study up on the ins and outs of your policy.