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Know your rights when it comes to shocking medical bills

Everyone knows a horror story about a mammoth hospital bill that came as a total shock. 

But what people may not know is that they have legal rights that could affect how much they are obligated to pay. 

There are processes in place to help avoid getting those nightmarish bills and ways to negotiate or fight them, experts say. And lawyers qualified in this specialized area can offer advice.

Doing your homework in advance might be the number one way to avoid unexpected surprises. The internet has  several sites that do the shopping for you to determine what it will cost where for specific procedures, said Gerri Detweiler, director of consumer education for Credit.com and co-author of the book Debt Collection Answers: How to Use Debt Collection Laws to Protect Your Rights.

Gerri Detweiler

Detweiler suggests doing plenty of research up front and even downloading the clearhealthcosts.org app to your smart phone for times when you are traveling. She even suggests reviewing the cost of various emergency procedures and printing them out to have in the glove box, should the need arise.

But if you still get a big bill, you definitely don’t want to ignore it, she said.

“You want to find out what your options are,” she said. “Is there a billing mistake? Is it accurate? You can hire someone to audit the bill or if you have questions, your insurance company may be able to help because they don’t want to overpay, either. You definitely want to find out why certain procedures were not covered by insurance. If you don’t have insurance, you want to see if you are eligible for a discount.”

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Another thing to consider is whether you will ever be able to pay the bill off, she said. Even with a payment plan, if you are paying only a small amount each month, it could take decades to make it go away.

“And if you miss a payment, very often, it gets turned over to collections,” Detweiler said. “But collections aren’t always a horrible thing when it comes to medical bills.”

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Collections will affect your credit, but if you can’t pay off a medical bill within three to five years, a collection agency may give you a severely reduced amount to settle, just to get the debt off the books, she said.

“It’s a very common problem,” Detweiler said, noting that a huge percentage of collections are for hospital and other medical bills.

If a provider chooses to sue, it can get nasty.  A judgment against you could mean your wages can be garnished and your bank accounts emptied. Before that happens, consider bankruptcy and contact a consumer bankruptcy attorney.

Duke University Professor Barak Richman said there are other options, too, including fighting what you consider an astronomical bill.

“It really sets off an awful cascade of events,” once that surprise bill arrives, he said.

Professor Barak Richman

Richman believes that in many instances, the bills you receive – many for out of network care — are not even legal, because they are not supported by contract law.

“I recommend patients be very proactive and know if what they are getting billed for is unreasonable,’’ he said. “They can negotiate for something much more reasonable. They can also sue the provider as a defensive mechanism, so they don’t have to pay these crazy amounts. But it can also be used as an offense because of unfair business practices.”

The Kaiser Family Foundation has been preaching self-advocacy for years, Richman said.

“The cost of health care has long been a concern in the U.S., on both a national and a personal level,” according to The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey. “For individuals, this concern plays out most prominently among those who face difficulty paying medical bills or who are unable to pay such bills at all.”

A lack of insurance hinders access to care and leaves people vulnerable to bills they cannot pay. 

Patients need to be savvy consumers, the report states. Find the best price and work out a payment plan once services have been received.
‘’The survey finds that some of those who faced medical bill problems found healthcare providers willing to cooperate with them in setting up payment plans or reducing the amount they owed, while others attempted to engage in cost-conscious healthcare shopping behaviors and met with little success.”

Not enough people know they need to be their own advocate, Richman said. “Very few do. They don’t know. Some do go to court” to fight the bills, but not many, he said.

“State attorneys general should be stopping this practice” of charging outrageous amounts for out of network procedures, Richman said. He said state attorneys general should be issuing cease and desist orders “because this is not the way we view our contract law and that it is an unfair business practice and contrary to consumer protection laws.”