Introduction

A confession up front: I don’t like how insurance companies work. 

Their main goal is to avoid paying you, not to help you. They want to get paid for taking risks, for covering losses, and even when they don’t manage their money own well. 

Some hospitals, even though they give great care, also let their finance teams use unfair business tricks. Don’t fall for them.

The first step is to read this post; don’t pay the bill quite yet.

In short, I’m not your lawyer, and this isn’t legal advice. I just want to give you helpful information you can use.  

The Problem

After a hospital visit, you’ll get a lot of bills from different people and places. This can happen while you’re still recovering from surgery or getting treatments like chemo or radiation. Expect bills from:

• The hospital
• The surgeon
• The anesthesiologist
• The lab
• The radiologist
• The hospitalist group
• The ER doctor (if you went to the ER)
• The ambulance (if you used one)

You might wonder if you’ve gotten the last bill, but sadly, you probably haven’t.  

Step One: Don’t Pay Right Away

When you get these bills, don’t pay any of them at first. Put them all in one place (like a shoebox) and wait about 30 to 90 days.  

Now, ask yourself: Are you insured or uninsured?

If You Have Insurance

Many times, hospitals and doctors will send you bills and try to get you to pay before they even check with your insurance. They might call or send letters, making you feel like you have to pay right away. Sometimes, they even say you could lose your home if you don’t pay quickly. These bills are often much higher than what you really owe because insurance usually pays a lower price. If you pay too much, it can take a long time to get your money back.  

You Have Rights – How to Respond

There are laws to protect you, like the Fair Debt Collection Practices Act and EMTALA. Your state might also have laws against unfair business practices. You can look these up online for your state. Some laws even make the bill collector pay your lawyer if they break the rules. 

If you get a call, email, or letter about a bill, you should:

• Tell them you think there’s a mistake in the bill, and mention the Fair Debt Collection Practices Act, EMTALA, and your state’s unfair trade practices law if you have one.
• Say that if they hurt your credit score, you’ll take legal action right away.
• Remind them they might have to pay your lawyer if they break the law.
• You MUST send them a letter with the same information.

Usually, after you do this, they stop bothering you for a few months.  

Wait for Your Insurance

Don’t pay any bills until your insurance company sends an Explanation of Benefits (EOB) to both you and the provider. This is smart because:

• It makes sure the provider actually billed your insurance.
• You get the insurance discount, which means you pay less.
• You pay the correct amount, not an inflated price.  

If Your Insurance Says No

If your insurance company says they won’t pay, you can appeal their decision. Most insurance companies have a process for this. Sometimes, a simple form and some paperwork can turn a “no” into a “yes.” Appeals are common, and you can ask the billing company to wait until your appeal is finished. Appeals can take 30 to 120 days or more, but don’t give up if you get a “no” at first. No isn’t no; it’s just the start of an interesting conversation (omage to movie Boss Baby). Also, watch out for duplicate bills—they happen a lot.