Have you noticed something odd about your medical bill? Don’t overlook it.
A study published Friday in JAMA Health Forum found that filing an appeal often uncovers errors and can make bills more affordable.
“If you get a bill that seems strange or that’s an amount you can’t afford, pick up the phone and contact the billing office,” said Erin Duffy, director of research training at the University of Southern California’s Schaefer Center for Health Policy and Economics and lead author of the study. “Most people have good outcomes when they do that.”
The survey results showed that about one in five people said they’d received a medical bill in the past year that they didn’t understand or couldn’t pay, and of those, 61.5% said they’d contacted a billing office to address their concerns. Most of those who didn’t contact a billing office didn’t think doing so would make any difference, Duffy said.
“In most cases, the charges were corrected,” she says, “and many who felt it was unfair were able to negotiate a lower price, even if they could have afforded it.”
The survey found that of those who contacted the agency about a billing error, nearly three-quarters said the mistake was corrected. About 62% of those who contacted the agency about a bill they couldn’t pay said they received a payment plan or a reduction in the price, and about 76% of those who asked to negotiate said they received financial assistance or had the bill canceled.
More than half of U.S. adults have incurred medical debt in the past five years, according to a 2022 survey from KFF, a nonprofit that studies health policy issues. Another KFF report said Americans owe at least $220 billion in medical debt.
Dr. Adam Gaffney, an intensive care physician at Cambridge Health Alliance in Massachusetts, said medical debt can “ruin people’s financial futures” by impairing their ability to get loans or mortgages, and some people have had their wages garnished or been sued by hospitals over unpaid medical bills.
Duffy noted that certain groups in the study were more likely to dispute medical bills because they were extroverts and people who tended to be skeptical, competitive and outspoken.
Those without a college degree, those with low financial literacy and those without insurance are the least likely to dispute bills, she added.
The study is based on responses from a survey of more than 1,100 U.S. adults conducted between August 14 and October 14 of last year.
How to Dispute a Medical Bill
If you notice something strange on a medical bill, you should first check to see if it’s yours, says Michelle Johnson, executive director of the Tennessee Justice Center, a law firm and nonprofit advocacy group. “This is especially important if you have a common last name,” she adds.
“I’ve received bills before that aren’t my own,” she said. “My husband’s name is Hill, and I’m Johnson, and it’s happened a number of times. So is it your bill? Ask that first.”
Johnson also proposed requiring hospitals to provide itemized bills, which would include a detailed list of all the services, treatments and procedures a patient received during their visit, and requiring hospitals to send itemized bills within 30 days of billing.
“I’ve seen cases where people were charged for pregnancy tests for baby boys,” she says. “When you’re given an itemized bill, make sure it’s a service you actually used or could have used,” and if something seems odd, call the billing office.
Johnson said the No Surprises Act, passed in 2020, protects people from surprise medical bills when they get services from an out-of-network provider at an in-network facility. (In-network means the provider has a contract with the health plan to accept a discounted rate; out-of-network means there is no contract.)
“If you’re insured at a hospital and you see an in-network doctor, you can’t see an out-of-network anesthesiologist,” Johnson said.
People who don’t have insurance or don’t use it can get a “good faith” estimate of the cost of care before their visit, she added, and anyone who receives a bill that’s more than $400 more than the estimate can file a dispute.
Many hospitals also offer financial assistance, also known as charity care, Johnson said. Nonprofit hospitals are required to have charity care policies and make them available on their websites. If you qualify, you can get reduced or free care, even after you’ve already been billed, Johnson said.
Johnson also advised avoiding using credit cards to pay bills, if at all possible, because proposed Consumer Financial Protection Bureau rules set to go into effect next year would remove medical debt from credit reports.
Johnson recommended asking for a payment plan instead.
“Medical expenses are treated differently than credit card debt,” she says. “No one wants to pay medical expenses on top of basic necessities like housing and food. Our elderly clients often end up paying medical expenses on bills they don’t actually need to pay.”
Johnson said patients should remember that they can and should dispute a charge if they feel something isn’t right.
“We think of medical billing as something completely separate, like a black box that we don’t have access to, because the American health care system has dynamics that make patients feel really powerless and helpless,” she said, “but the truth is, if they’re charging you money, there are certain rules that protect you as a consumer and allow you to fight back.”
