What is the best way to dispute an emergency room medical bill?

What is the best way to dispute an emergency room medical bill?
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#1

My son was 19 and had a cycle accident. He went to the emergency room at a local hospital. They did not have his insurance information, and went ahead and ran three MRI tests totaling $3,600. When we gave them our insurance information our company later approved all 3 tests but as our deductible was not met, I am being billed for them. I want to argue that two of these tests were not urgent or needed that evening, and as they admitted him without insurance should not have run up unnecessary bills without checking the patient’s ability to pay. I’d like to settle for a portion. How do I approach this without accepting their bill? Will my son’s credit score be affected if we just walk away?


#2

I’m very sorry to hear about your son’s accident and hope he makes an easy and speedy recovery.
Physicians in hospital emergency departments don’t typically run tests if they don’t view them as necessary. As I’m sure you understand, MRIs and other scans are run in order to rule out potentially serious, if unlikely, complications. Therefore, in my opinion, arguing that the tests were not urgent or needed that evening is not going to help you make your case unless you have a strong, written medical opinion to back you up.
Physicians in the ED and elsewhere order procedures without consideration of a patient’s ability to pay. This is a fact of life that causes patients and their families immense frustration and distress. I am truly sorry for yours.
Imagine, though, if something serious had shown up on one or more of the MRIs. In retrospect, the scans might have seemed a good deal more urgent than they appear to be in retrospect.
The question, then, is, what will help you make your case since the $3,600 charge is billed against your deductible? One option would be to apply for financial assistance from the hospital and go through the process of determining whether you are eligible for a partial or full write-off due to financial need. If you aren’t eligible, then ask the hospital for a monthly payment plan that you can afford.
Alternatively, you are free to dispute the medical necessity of the tests but unless you have a medical opinion to back up your claim, I don’t think you’ll get very far.
If you “just walk away,” the hospital will send you repeated statements and eventually send the account to collections, which will not only affect your son’s credit score but make his life miserable. You are wise to dispatch this matter swiftly.
Wishing you and your son the very best,
R. Ruth Linden, Ph.D., President, Tree of Life Health Advocates, San Francisco, CA


#3

As healthcare started to become more complex and cost of care continues to rise, it places more financial burden on consumers with high deductibles, increased out of pocket expenses and soaring premiums. Your situation is not unheard of and I would suggest the following options:

  1. Financial assistance: You can normally find the charitycare/financial assistance application online at the hospitals website and their policy guidelines. Financial assistance is based on household income and size. Some hospitals base the income guidelines at 250% of the Federal Poverty Level and some hospitals will go as high as 450% on average and in NYC some hospitals go as high as 700%.
  2. Uninsured discount: if insurance did not pay on the claim but applied all towards the deductible ask for uninsured discounted amount.
  3. You can negotiate with the hospital offering to pay a lump some payment upfront for reduced bill.
  4. If none of the above suggestions work out for you my last suggestion would be to hire a medical bill advocate to assist you with reducing this bill. Medical bill advocates normally work on a contingency basis and charge anywhere from 25-35% of what they save you and only if they save you money. They have the ability to audit the medical records for errors in coding, compliance and pricing. They can research what other hospitals in the area are charging for the same service etc.
    Tip: I would also suggest having an advocate check the Emergency room bill and the emergency room physician bill for errors, for additional savings on out of pocket liability.
    Chances are pretty good that your son’s credit score will be affected if he just walks away from this bill.
    If you need assistance do not hesitate to reach out!
    Cheryl Welch, MBA
    Hudson Valley Medical Bill Advocate

#4

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