A cursory internet search revealed a world of theories and testimonials on how to negotiate medical bills, but all of the articles and listicles and forums effectively boiled down to two distinct approaches. The first and most obvious was to simply claim I couldn’t pay. So long as I could credibly explain the nature of my hardship, chances were good that the hospital would offer me a discount. The second approach was more aggressive and involved obtaining copies of the hospital’s billing forms. I would have more leverage if I could find a billing mistake or could pick at one of the more extreme charges. Just be warned, one website cautioned, hospitals won’t be very friendly about this.
I opted for the former strategy, dialing the 800 number on my bill. This connected me with a pleasant-sounding woman in what I realized was not a hospital office but a call center. Before I could say anything, she politely reiterated the active balance on my account.
“I’d like to discuss my options,” I said. “This surgery resulted in complications that prevented me from working for six weeks, and that’s been very difficult financially.”
“We’d be happy to help, Mr. Fischer. What we can offer you is an installment plan.”
“That’s great,” I said, trying to smile through the phone. “But I hoped we might be able to talk about a discount for prompt payment.”
“I’m sorry, I’m not authorized to offer that,” she said.
“Not a problem. Could I speak to your supervisor about the matter?”
“He’s not available, sir,” she said.
I asked her when he might be and she suggested I call back next week. So I did. And although I reached a different operator, I had the exact same conversation. This time I also asked for an itemized list of charges, which was a buzz-term I’d picked up from the medical negotiation how-tos.
“That should be what’s on your bill,” the second operator said.
“My bill only has category charges. I’m trying to get an itemized breakdown of what those are for.”
The operator said he’d send one out. What reached me several days later was an identical copy of my bill.
Additional research produced mention of a form called the UB-04. Evidently, this document was used by hospitals as the central manifest for billing my insurance provider. Get the UB-04 form—said the patients’ rights message boards—and you’ll get the true dollar amounts associated with your treatment.
A call to the hospital’s medical records department redirected me to their billing office. After a few minutes of hold music, an operator informed me in no uncertain terms that UB-04 forms were not given to patients.
“For insurance only,” she said, and hustled me off the line.
My insurance company said that they didn’t have access to it either, but that the hospital should give it to me.
Technically speaking, the UB-04 form is part of something called the HIPAA Designated Records Set. HIPAA (the Healthcare Insurance Portability and Accountability Act) is an enormous piece of Clinton-era legislation that has a lot to do with patient privacy. You sign a HIPAA disclosure every time you visit a new doctor, allowing them to legally share your medical records with your insurer. But the “P” in the acronym also has more specific consumer-protection benefits. It legally establishes patients’ rights to access any document used to make decisions about their treatment, billing, or insurance payments.
Armed with this information, I again called the billing department. I reached another operator. When she told me that the UB-04 form was off-limits, I hit her with the HIPAA statue and code.
“I don’t know what you’re talking about,” she said, audibly annoyed. “Can you fax me whatever you’re reading from?”
“I’m legally entitled to this form,” I said. “This is my right as a patient. May I speak to your supervisor?” By this point I was keeping a record of every phone call, every response, everyone’s name.
“He’s on special assignment and not available,” the woman said.
“Can I have your name?”
She offered her first name as Ariel, but wouldn’t give a last name.
“Can I have your supervisor’s name and contact information, then?”
Ariel asked me to hold while she transferred me to someone who could better assist with my request. It took me a moment to realize that the transfer was actually just her hanging up.
I opted for the former strategy, dialing the 800 number on my bill. This connected me with a pleasant-sounding woman in what I realized was not a hospital office but a call center. Before I could say anything, she politely reiterated the active balance on my account.“I’d like to discuss my options,” I said. “This surgery resulted in complications that prevented me from working for six weeks, and that’s been very difficult financially.”
“We’d be happy to help, Mr. Fischer. What we can offer you is an installment plan.”
“That’s great,” I said, trying to smile through the phone. “But I hoped we might be able to talk about a discount for prompt payment.”
“I’m sorry, I’m not authorized to offer that,” she said.
“Not a problem. Could I speak to your supervisor about the matter?”
“He’s not available, sir,” she said.
I asked her when he might be and she suggested I call back next week. So I did. And although I reached a different operator, I had the exact same conversation. This time I also asked for an itemized list of charges, which was a buzz-term I’d picked up from the medical negotiation how-tos.
“That should be what’s on your bill,” the second operator said.
“My bill only has category charges. I’m trying to get an itemized breakdown of what those are for.”
The operator said he’d send one out. What reached me several days later was an identical copy of my bill.
Additional research produced mention of a form called the UB-04. Evidently, this document was used by hospitals as the central manifest for billing my insurance provider. Get the UB-04 form—said the patients’ rights message boards—and you’ll get the true dollar amounts associated with your treatment.
A call to the hospital’s medical records department redirected me to their billing office. After a few minutes of hold music, an operator informed me in no uncertain terms that UB-04 forms were not given to patients.
“For insurance only,” she said, and hustled me off the line.
My insurance company said that they didn’t have access to it either, but that the hospital should give it to me.
Technically speaking, the UB-04 form is part of something called the HIPAA Designated Records Set. HIPAA (the Healthcare Insurance Portability and Accountability Act) is an enormous piece of Clinton-era legislation that has a lot to do with patient privacy. You sign a HIPAA disclosure every time you visit a new doctor, allowing them to legally share your medical records with your insurer. But the “P” in the acronym also has more specific consumer-protection benefits. It legally establishes patients’ rights to access any document used to make decisions about their treatment, billing, or insurance payments.
Armed with this information, I again called the billing department. I reached another operator. When she told me that the UB-04 form was off-limits, I hit her with the HIPAA statue and code.
“I don’t know what you’re talking about,” she said, audibly annoyed. “Can you fax me whatever you’re reading from?”
“I’m legally entitled to this form,” I said. “This is my right as a patient. May I speak to your supervisor?” By this point I was keeping a record of every phone call, every response, everyone’s name.
“He’s on special assignment and not available,” the woman said.
“Can I have your name?”
She offered her first name as Ariel, but wouldn’t give a last name.
“Can I have your supervisor’s name and contact information, then?”
Ariel asked me to hold while she transferred me to someone who could better assist with my request. It took me a moment to realize that the transfer was actually just her hanging up.
by John Fischer, TMN | Read more:
Image: Martin Mull
