How I Averted a Medical Billing Disaster in 3 Steps

Even if you never get a medical bill, failure to pay for care has repercussions.

ByABC News
December 6, 2014, 6:47 AM

— -- Over Labor Day weekend, I fell and broke my hand. Seeing my finger dangling at an odd angle was alarming, not to mention painful, but I’ll confess the first words out of my mouth when I arrived at the ER were, “I want to confirm that you are a participating provider in my insurance.”

I have decent health insurance, but I’ll admit I border on paranoid when it comes to medical bills. I have heard numerous horror stories on the blog from consumers whose medical bill nightmares have ruined their credit, often through no fault of their own. In fact, about half of all collection accounts on credit reports are due to medical bills, and medical debt often has a significant impact on credit scores.

I wasn’t about to take that chance.

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Sure enough, a few weeks later bills started rolling in from various providers. Although I spent only a few hours in the emergency room, I received bills from five different providers. And that doesn’t count the doctor and physical therapy bills from the services provided later.

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Worse, the largest bill — the one from the ER — did not arrive until two months after my visit and after a lot of effort to hunt it down.

Although I was hampered by having my right hand in a cast (not ideal for a right-handed writer!) I was determined to stay on top of the bills as best as I could. I did three things:

  1. 1. I reviewed my Explanations of Benefits from my insurance company online as they came in. EOBs explain which companies have billed the insurance company and how much the patient is responsible for.
  2. 2. I did not assume that because I didn’t get a bill, all was OK. Three weeks after my visit to the emergency room, I still hadn’t heard a word from them. The EOB for the hospital visit was listed as “pending.” So I called the ER billing department to find out what was going on. They assured me it was in process.
  3. 3. I kept good records. I started a file where I kept copies of bills, notes from phone calls, receipts etc.

Nevertheless, despite my careful efforts, I suspect I narrowly averted a potential disaster with the ER bill. Fifty-two days after the ER billed my insurance company, the claim was processed. But a week later, I still hadn’t received a bill. I called the ER’s billing department (it was surprisingly difficult to find the right phone number without a bill) and they could not find me in their system.

They asked me to fax the EOB to them, which I did. Two days later I called again, and my bill couldn’t be located. I sent the EOB to them again, this time by email, and finally, that afternoon, I was told that they found my account and a bill was on its way.

Although it would have been nice to not have to pay for that visit, I know better. Even if they never sent me a bill, there was a distinct possibility I could hear from a collection agency down the road.

PHOTO: Gerri Detweiler
Gerri Detweiler

Medical Billing Frustration

The experience still leaves me with a bad taste. Our medical billing system is far too complicated and convoluted. For all the talk of putting patients more in charge of their care, there is little opportunity to make informed decisions. One of the main things that irked me was my complete inability to confirm whether I received the services my insurance company and I paid for.

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I was billed, and paid separately, for the doctor, the X-rays, a sling and a splint. That didn’t leave a whole lot besides the painkiller and warm blanket the nurse gave me when I started shivering. Yet the ER bill alone — not counting all those other services billed separately — totaled nearly $3,000. I requested an itemized statement of charges, but it was incomprehensible. For example, there are two charges of $264 each for “3 MCLSD TX FX PHALENGEAL W/M.” What the heck is that? I haven't a clue.

Fortunately, insurance discounted the total significantly, but still, between my insurance company’s payment and mine, we did pay a large chunk of change and I'd like to know it's accurate. I understand the ER must be prepared to treat all kinds of emergencies, and perhaps this is a toll to get through the door, but it is still hard to fathom how the bill can be that large. (Note: I know where the urgent care facilities in my area are and would have chosen one of them for less expensive care if the accident didn’t occur late on a Sunday evening.)

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Besides the ER bill, some bills were mysterious, and I could not find anyone to explain them to me. For example, I received two separate bills for what appeared to be the splint provided in the ER (the same one my doctor later told me was a piece of junk and advised me not to use). When I tried to clarify it, I was bounced back and forth between the two companies. In frustration, I paid the bills to protect my credit.

I had no way of knowing — and still don’t — which companies would be billing me for what. I know I have paid all the bills that were submitted to insurance, but if there are others floating out there, I can only hope they reach me. That’s one reason why I use free credit monitoring tools to keep close tabs on my credit. If a bill does slip through the cracks and wind up in collections, I want to know about it right away.

In a month I was out of my cast and on to physical therapy. My hand will probably never be quite the same, but I consider myself lucky when I think of what patients and their families must go through when they are dealing with serious extended illnesses or accidents. How do they stay on top of all of this?

Given that a single collection account can drop your credit scores by 50, 75 or even 100 points, it's worth trying to make the effort to get organized, stay organized and ask lots of questions. If you can't handle it yourself, consider asking a trusted friend or relative to help, or consider hiring a patient billing advocate. Doing so may just save your credit.

Any opinions expressed in this column are solely those of the author.