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How To Challenge Medical Bills

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We owe immense gratitude to those who are caring for the sick, and to those who support those workers. At the same time, we should be skeptical of bills we may be presented for that care.

The struggle to contain health-care costs in this country is now a fixture in the national policy debate. Our health-care expense does not lead to good results. The United States spends more on health care as a share of the economy – nearly twice as other developed nations – yet has the lowest life expectancy and the highest rates for suicide, chronic disease, and obesity. See:

https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

If that expense has landed in the middle of your household budget, here are some home truths that may help you monitor what you’re being charged. In many cases, the bills are fair. But they may not be.

For example, in the case of coronavirus testing, many providers charge between zero and $200 – yet one Texas lab charged insurance companies as much as $2,315.

Or, a hospital may have charged you exorbitant fees for medication you could have obtained over the counter. A patient was billed $238 for eyedrops obtainable in a retail pharmacy for between $15 and $50. Sometimes the worst excesses are due to “surprise medical bills.” You can be treated in a hospital that is in your insurer’s network, but if the particular physician has rejected the insurer’s rates as too low, the physician will be treated as out-of-network, the costs can go through the roof, and your insurance company will refuse to pay.

If you are willing to put in the time and effort, it may be that you can negotiate to have your bills reduced. If the charges are big enough, it may be worthwhile to embark on an effort to get them reconsidered.

Health care reporter Sarah Kliff, formerly of Vox and now with the New York Times, has written a primer on how to proceed.

The steps she outlines are:

*     Obtain an itemized bill. The first bill you receive may give you no idea of what the charges are for.

*     It is common practice for emergency rooms to bill for simply walking in the door. Hospitals often use a point system depending on their assessment of the emergency, with higher fees for more complicated conditions. You may be able to challenge the assessment down to a lower grade.

*     You may be able to obtain a discount for paying promptly. Sarah Kliff advises persistence until you connect with a person who has authority to permit this.

For especially big bills, please call us. We can assist in advocating for you.  And if you are outside of Florida, please contact an experienced Elder Law Attorney (preferably one that is Board Certified in Elder Law) to assist you.

Jason A. Penrod is only the 20th attorney to be Board Certified as an Elder Law Expert by the Florida Bar and the National Elder Law Foundation.  He is the founder of Family Elder Law (www.familyelderlaw.com) which has offices in Lakeland, Lake Wales, and Sebring, Florida.

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