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Hospital Bill Secret Exposed! How I Easily Saved $3000 in 10 Minutes

Home/DIY Healthcare Savings/Hospital Bill Secret Exposed! How I Easily Saved $3000 in 10 Minutes

Hospital Bill Secret Exposed! How I Easily Saved $3000 in 10 Minutes

Hospital Bill Secret Exposed! How I Easily Saved $3000 in 10 Minutes

Would you like to save money on hospital bills? I bet you do. I mean, that’s why you’re here, right? Headlines oftentimes work as lures, but I promise you that I’m not just fishing here. I need a bigger net anyway and some beer. But really, I have something you can use quite easily to save big.

What I have to offer you today no doubt could save you much more than what this little secret applied to a hospital bill saved me—yes, I did save $3000 in 10 minutes. Little effort was required. There is a bit of a backstory before we get to the crucial details and, of course, the useful infographic I will give to you that, if followed, will secure to you potentially a whole lot of money. So without further ado, let’s get to my story.

Twas a dark, dreary night…

Dark, dreary night in a lit public park

Dark, dreary nights usually don’t foretell a good ending to a story. Mine is different

Weeellll, probably not; I would remember if that were the case. I actually don’t remember the sort of weather that night, but the story does start with a night at any rate.

I ended up, for the first time in my life, in a life-threatening state, inside [oh, the horrors!] a hospital room. And horrible it was—perhaps I shall regale you with more details in a video sometime, because, quite frankly, there are some extremely useful tips to take away from the whole experience.

Anyway, the hospital experience sucked, pure and simple.

Hospital Stays: Modern Day Horror Stories

You may have been there. Certainly you probably know somebody close who was, and you were compelled to visit. Without going into too much detail, I was in critical condition rather unexpectedly and such was not due to a sudden accident. Rather, my condition sort of crept upon me.

And then it savagely went for the figurative jugular.

The good news certainly is that I am alive. I also am totally healthy and in absolutely no need of medication or any sort of treatment. Such good fortune–there must be a double rainbow somewhere. And you know what that means: double the leprechauns and double the gold. Forget the breakfast cereal creature: marshmallows are for losers;)

Seriously though, so instead of being dead in the ground or in some sort of urn or scattered as dust in some field or whatever, I am using my corporeal status [I’m not playing harps upon some cloud quite yet] to benefit you. Surely this is a remarkable thing.

Post Hospital

So now we fast-forward to the future and not exactly in a cool ride like the one Dr. Smith had in Back to the Future.

No, my ride is a Pinto and there is the stench of a mixture of BO and smoke—hey, I got a good deal on this time-machine posing as a vehicle.

Oh, I should be more exact about what the future means.

I mean we will fast forward to the past’s future. The past that was my excruciating pain and miserable customer-service experience [but, admittedly and thankfully, successful by way of preserving my life and assisting me in regaining a healthful state], and since the past is not something we ought to agonize over, I hint towards an awesomely relevant movie so as to mosey along to something more consequential and that being the future…or maybe that’s still the past or something. Anyway, we all know time travelling is trippy, so forgive me for being a bit loopy.

So now, in this part of my story’s timeline, post hospital, and hopefully in a way so as to not disrupt the space-time continuum, we see a lively, hopeful, convalescing version of me. It’s great to be alive, and I am moving ahead with some important things in my life, preparing for some big changes. All is going well, and then…stuff.

Stuff Happens

Nail through a gauged hand

Stuff happens. An inaccurate and illegitimate hospital bill…and, yup, even incidents involving nails can happen, though luckily not to me

Stuff happens, right? Exactly, we should expect stuff. Stuff, unexpected stuff at that, particularly such in the mail. Such stuff can alter things. Stuff in the mail is not usually good, right?

So I receive a bill in the mail. And not just any bill, mind you. Nope. I receive an unexpected hospital bill a few months after the incident.

I recoil in horror at a bill, not just a form that says “this is not a bill,” but a real, live bill, a hospital bill.

Well, not live—and a good thing, too, because that hospital bill would not have been alive for long.

Remember how I said this was unexpected “stuff?”

You see, I am an exceptionally detailed person. Painfully so some may say.

But who cares what those people say? Who is offering you something very valuable for free? Oh, yeah.

Soooooo…oh I am very detailed, and I knew what I would owe the hospital organization for its services:

ZIP, NADA. 

That hospital bill, to me, was merely a mockery or a frank and stupid way to extort money. I would have none of it.

Health Insurance with a red stamped. Your hospital bill will be much higher if you are counting on health insurance that does not deliver for one reason or another.

My health insurance may not have been denied, but the hospital bill did not reflect fully what I was entitled to: NO COST. Balanced billing happens more than you would like to know…

You see, at that time in my life, I had a health insurance policy. I knew the fundamentals of it backwards and forwards. I knew enough anyways, to realize that this bill was an illegitimate claim on a portion of my wealth.

I’ll speak more of this in future posts and videos, but let me add here that at this point in time I worked for a very large health insurance company. Yes, my health insurance policy was an offering from my very employer. I think you can see, in addition to my attention to details, how and why I would know that the hospital bill I had in my hand was illegitimate.

So, here I must ask you a question. What do you do when you receive a bill unexpectedly but perceive that it IS legitimate? One of three things is likely:

1) You pay it

2) You pretend it is not there because it is difficult or impossible to pay it

3) You do any number of things to satisfy it by working with the institution or person. This may entail paying installment payments over time and/or paying a reduced sum

Let me say this about that little list in concerns to the hospital bill secret that I am exposing:

MANY people first of all and most importantly ASSUME that the hospital bill is legitimate [HUGE mistake] AND they do # 1 or #2. Time in a relevant industry, as well as common sense and a general perception of human behavior, informs me of this truth.

Well, now. Don’t get glum. I am here to help, not to get you sounding like the donkey from a certain classical story book and cartoon.

Let’s get back on track to my story. As you may have very well assumed, I have a happy ending, and, in turn, you can, too, if you should find yourself in the same pickle.

I have that very real hospital bill. And I know that it is not legitimate. I simply know it.

But knowing is not enough. Even in G.I. Joe, at the end of those old cartoon episodes, the audience is advised that knowing is half the battle. Knowledge applied through action brings wisdom. Knowledge by itself is next to worthlessness.

Don’t you want to be a wise man? What I am offering, due to my actions, is true wisdom. Learn from my experience and act!

Cry Babies Don’t Win…EVER

Ouch. Well, the truth is not always pleasant to hear, but it always helpful.

Whining and complaining to my friends and family may help me feel vindicated but such accomplishes nothing. I’ve seen it again and again—many of us have valid concerns and can very well appeal and win what is fair and appropriate. Sometimes this can be done quite easily and with really no actual resistance but what is in our heads. However, all too often, we simply commiserate.

Child covering face with hand while crying

Crying over a hospital bill or spilled milk won’t help you. Take action!

 

This phenomenon will be a topic of another post, but suffice it to say right here and now: DON’T DO THIS.

Winners Take Action

Determined runner at start of sprint

Do you suspect that you have an inaccurate hospital bill? TAKE ACTION! That determined look in the runner’s face is what you need to have. It takes action to get what you want

It is kind of funny. If you want something and have the knowledge to get it, then quite naturally you must then take action. Cause and effect rules this world, not any of the victimization horse dung paraded about. And boy, there is A LOT OF THAT these days! Simply said, nobody is going to swoop in and save you. To the extent that such is true, there is always a cost.

Do you want to save yourself some money, to not get taken advantage of?

Yes?

GREAT!

Well, then…DO something. I DID something.

This is what I did, and I will summarize with the most important details in an infographic for this post near the end:

I MADE A PHONE CALL.

Whoop de doo! How remarkable! It is sort of epic, right? I can see a major motion film being produced to celebrate this tremendous feat of courage. If you can’t tell, I’m being facetious.

Seriously though, sometimes picking up that phone and going about challenging an “official” decision can be nerve racking.

Before you go along thinking that I am some huge, egomaniac, hear me out.

I get it; I’ve been there. Who has not succumbed to that negative filter we all have in our head? But come on! Put this in its proper perspective. Making a phone call and challenging those little nagging shards of doubt and fear of confrontation in your mind does not have to be this big monster.

This truism is free of charge… Mark Twain once said that he “(…) had a lot of worries in [his] life, most of which never happened.” We worry about things that we simply do not need to be worrying about! Taking action eliminates fear and reveals it to be largely a fraud.

Back to the story…so I made that phone call, and no, celebratory trumpets did not blare. However, my heroism did not and could not end there! I did something beyond making that phone call.

I proceeded to use my words to communicate the exact problem, confirm some things that I already knew, and comfortably and confidently prove that the hospital bill I had in my hand was not legitimate and would not be paid.

Holy crap! This ain’t hard, huh? Now, there is a bit more detail than that, but I summarize that for you in the aforementioned infographic.

What was the result you ask? It was this:

The hospital bill was no more. This simple process took 10 minutes. And I saved myself $3000. It was like I rubbed a lamp and a magical genie transformed my problem into a key psychological victory. Something bad turned into something positive.

It worked for me, and it will work for you, should your circumstances be similar to mine.

END OF STORY

POST MORTEM OF THE BILL: AFTERWORD TO THE STORY

So that hospital bill I had lost its potential legitimacy. That did not happen, however, automatically. I had to do something!

It is important to examine these sorts of things. I know you really may just at least initially want the goods in this post, [and if you hadn’t thought of it, just skip ahead already ;)] much like how as a child we all want that dessert BEFORE the main course, but as with that meal, it is in the real meat and potatoes of the lesson that true nourishment or benefit is had.

You see, the details ARE important, and that is what I am about and what Sovereign Liberty Solutions is about. It is simply foolish and irresponsible of me not to do this post mortem.

Insurance claim form

A simple little claim form. BUT it is in the DETAILS in which the devil lurks. BE DETAILED!

That bill I had—I NEVER perceived it as being legitimate. I simply knew better. You can know better, too. This post will help.

However, let it be known that even if you perceive that something is not legitimate, that does not mean it simply resolves itself. No. I guarantee you that if I had not done anything, if I had not done anything with my knowledge and perception, I would have ended up getting collections notices and all that comes with that—in a sense, what was not legitimate, that bill, would have had very real consequences for me without my action!

Just what was that bill all about? THAT is the question most important for us.

First of all, as the infographic will demonstrate, we need to know, if we have insurance. [posts in the future will also discuss circumstances for those without insurance] We also need to know what our deductible, coinsurance, co-payments are as well as the standings in regards to such. Finally, we need to know the status of physician/facility [in or out of “network”] is, and then we proceed to verify that such, with the explanation of benefits from the insurance company, checks out in accordance to the benefits to which you are entitled under the insurance policy. Oh, and do not forget about the out-of-pocket maximum—this is just the way it sounds—you cannot be held responsible for anything at all over this stated figure in your health insurance plan.

Phew! That’s a lot of…crap. No, really, it is. I have empathy with you, really.

I know this stuff backwards and forwards for good reason. God knows that it IS boring. But you have to know this stuff and what it means.

I will create an infographic in the future that will assist you in defining the myriad of elements one may find in a health insurance policy. Until then, check out this little cartoon, which does a good job of doing this.

As tedious as that all was, in my story I did know all of these very important things. It turned out, after considering all of these things, that I should have owed $0—I had no deductible to satisfy as well as no coinsurance; I also had no copayment or any other fee to render under the authority of the insurance policy. However, I still had that big, bad hospital bill.

THE BILL HAD A NAME

Well, Bill is a terrible name. So let’s call that hospital bill I had BALANCED BILLING.

Yes, BALANCED BILLING is a terrible name, if we are thinking of naming a child. But in terms of identifying a common phenomenon in the wacky world of healthcare billing, such a name is exceptional.

You see, balanced billing is an actual practice. Now, without going too far into this, let me say that balanced billing happens with enough frequency, and prevails sometimes with certain “players” often enough, that I will not hesitate to say that it IS a practice. So this must lead to the inevitable: just what is this practice?

BALANCED BILLING: OR HOW YOU MAY BE BEING SCREWED

Ouch! Yup, that is some powerful language on my part. And I will not tone it down. To be honest, I am surprised that at this point more people, competitive business organizations included, are not more hostile to wrongs, misdoings, and the like. There’s actually a lot worse than balanced billing!

Now, don’t get me wrong, mistakes do happen. Of course; and this practice, which will be detailed in all its chicanery-filled horror, does happen, I am certain, by accident a good deal of the time. However, my experience, and common sense really, suggests that balanced billing is an intended and established PRACTICE.

Insurance Torture

Now is time to get down and dirty.

No, that was not an invitation. Get your head back in the game;) I know that this may amount to Chinese water torture [also going by other names these days] for you, but I promise that it is to your benefit.

Here is what it is, this thing called balanced billing:

You have an insurance policy, and it offers reimbursement schedules [to provider, hospital, etc.] and reimbursement allowances and shares of cost [to member/owner of policy] separated usually by “out of network” and “in-network” classifications, greater stated benefits to the member/owner/YOU contractually being in the “in” camp. We will focus on the share of costs, as it is the most relevant for us here.

In-network simply includes providers that have signed up to terms and conditions that are agreeable enough for both the insurance company as well as that provider. Out of network simply includes the rest.

To be in or to be out: that is the question

Why would a provider/hospital sign up to be “in” you ask? Well, I know you really didn’t ask this, but I will pretend you did. 🙂

By agreeing to the terms and conditions, said in-network providers gain access to a horde of individuals [including YOU; yes, YOU; YOU are part of the horde now] under that policy, a horde of individuals that come with, particularly, a group policy, which is what employers oftentimes offer to their employees.

Providers would do this to be assured of a certain likely quantity of patients, which means volume and a significant amount of money to be earned with patient visits; the other side to this agreement for the provider, the more negative side, is a contracted discount [among other conditions, restrictions, etc.] to be reimbursed by a combination of the patient/insurance member and insurance company. That combination payment and its percentage shares can be discerned by going through that mind-numbing terminology alluded to earlier. And, as always, remember that mistakes and illegal practices abound on all sides [not just with providers/hospitals, as is with my case and that typical of balanced billing]. Always be aware of what you are entitled to under contract and even statute!

Now we know that:

  1. A) Out-of-network providers and hospitals do not charge the patient/insurance member AND/OR insurance company a stated discount rate
  2. B) Being in-network constitutes a sort of advantage [only sometimes, as future posts will reveal] to the member/patient

FUSING STORY WITH INSURANCE STUFF: A TERRIBLE BUT NECESSARY CHIMERA

Statute of minotaur being slayed, a half man, a half bull chimerical creature

Half bull and half man creatures: just as chimerical as my story and health care insurance details. You DO have to know this stuff. Unless losing big money on a hospital bill is your thing

You may very well remember my story. The hospital that provided my services was in-network per the insurance policy I had at the time. This was VERY IMPORTANT in my analysis at the time. You see, you have to have a case to present. Whining or complaining and saying something is not fair will not work to your advantage in these sorts of cases; at least, it will not out of merit and as certainly as my way does at any rate!

Balanced billing can now be properly defined for you I think. Balanced billing is the occurrence in which the provider or hospital engaged in billing practices with the member/patient that is not in accordance with the contractual agreement established between the insurance company and that organization or provider.

More neatly and specifically for you:

Balanced billing is when the insurance company has paid less than what the provider has charged, which is usual and customary practice I have found [Innocently, it probably just saves time and resources for the provider/hospital, BUT, cynically, it also fetches some extra money due to insurance company or patient/member mistake or oversight] Balanced billing occurs when the remainder, or balance, is billed to you, the patient/member/customer.

So I was at an in-network hospital, and, as it turned out, the insurance company had reimbursed appropriately, per the contract between the insurer and hospital. I verified this with my three-way phone call that I had with my insurance company contact and hospital billing manager contact. That difference or balance between what was initially billed and actually paid is the $3000 I was being charged. BINGO.

Pst, I Have a Secret to Share with You

A young girl sharing a secret to her smiling girl friend

I have a secret…read on to find out what it is!

That’s right. Remember, I put in some time in the health insurance industry, several years. I realized that some providers/hospitals engaged in a whole lot of balanced billing, more than others. Now, if a provider/hospital is not following rules and abiding by restrictions and so forth as set in the contract with the insurance company, it is possible for the insurance company to terminate the provider’s status and dissolve the contractual arrangement. That would be a sort of consequence for mistreating the paying insurance company’s member [always remember, even if you do not pay out of pocket or only through paycheck deduction very little or none at all per month for the premium, that your employer pays for all else and that this adds up to a significant amount, an amount that no doubt reduces other benefits you receive as an employee!].

Well, as it turns out, I verified during my time in the industry, with one of the largest health insurers, that consequences often times were avoided. In other words, a violator, a provider that has at least the appearance of making balance billing an established practice, is able to continue the practice without consequence. The lesson here is obvious:

You need to be your own advocate with healthcare billing! You need to look at your bills from hospitals and providers as well as explanation of benefits forms [EOB’S] from third party payers such as insurance companies!

Here is Some Good News!

So that last section may have you a bit down or angry. Hopefully it hasn’t left you defeated, because you shouldn’t be. The thing is you have quite a bit on your side to stop this practice and prevent being looted!

Remember, balanced billing involves a difference between what was initially billed and what was paid by the insurance company, the difference, or balance, being billed to YOU. Now, EVEN if the insurer was wrong and should have paid what was being charged, the fact of the matter is that the insurance contract more than likely forbids the hospital from engaging in the balanced billing practice! This is NOT your problem at this point—it is a problem between the insurer and provider; and YOU must realize this and state it if need be!

Regarding balanced billing, health insurance companies submit plenty of letters advising participating [in-network; just another name for the same thing] providers and hospitals to NOT balance bill their members. They do this when the error or practice of balanced billing GOES NOTICED anyway. Not everything goes noticed—not such a subtle hint for you I hope.

ADDITIONALLY, strengthening your hand as customer/patient, nearly all states in the United States have state statutes on record that make this practice in most cases illegal!

So the private contract makes the balanced billing practice a no-no. The likely state statute makes it a double no-no. So you see, it is entirely in your favor to challenge ANY bill! That is GREAT NEWS! You have EVERY reason to challenge your bills and explore every angle, quite frankly.

So much is in your favor. Never, ever feel as if you are overstepping your ground or are “out of line” when working on these matters. I would advise strongly, though, to not be belligerent with anybody you may be communicating with in regards to your hospital bill or any other sort of bill—as always, be tactful while also being firm.

WHAT YOU HAVE BEEN WAITING FOR: THE BALANCED BILLING INFOGRAPHIC!

Balanced Billing Secret Resolution Cheat Sheet

Balanced Billing Secret Resolution Cheat Sheet

1) KNOW WHAT BALANCED BILLING IS:

Balanced billing is when the insurance company has paid less than what the provider has charged. That remainder, or balance, is billed to you. If the provider or hospital is “in network” this is likely not allowed and/or is even illegal

2) FIGURE OUT WHETHER YOUR PROVIDER OR HOSPITAL IS “IN” OR “OUT” OF NETWORK FOR YOUR INSURANCE PLAN

Be sure to know the proper designation. Also figure out the percentage share for “in” and “out” so as to calculate accordingly against the billing and explanation of benefit (EOB) information. 80-20 and 60-40 are most frequently used

3) DETERMINE WHAT THE INSURANCE FEES AND SHARES DO TO THE COSTS OF THE HOSPITAL BILL

DEDUCTIBLE: Any amount of healthcare charges billed to the insurance company below this amount is your sole responsibility. No coverage benefits are afforded to you until you exceed this amount

CO-INSURANCE: This is a percentage share between the patient/member and insurance company with regards to paying for healthcare bill. Betters terms usually exists for you when “in-network.” Coinsurance shares do not start until after the deductible is satisfied

CO-PAY: These flat fees are levied on a per visit/occurrence basis according to type of visit/occurrence

OUT-OF-POCKET MAXIMUM: You will not pay a cent over this amount. This comes when the sum of the deductible as well as your co-insurance share amount meets the out-of-pocket figure

4) COMPARE PROVIDER OR HOSPITAL BILLING WITH INSURANCE EOB

You may notice that the amount you are being billed PERFECTLY mirrors the difference [subtract the allowed amount from the billed] between the hospital billed amount and the explanation of benefits “allowed amount” [allowed amount per the contract between the insurance company and hospital]. If this is the case then you most likely are being “balanced billed.”

5) CONTACT THE INSURANCE COMPANY AND HAVE ALL FORMS AND INFORMATION READY

Make your case. Have the hospital bill as well as the insurance EOB in front of you. It is likely that the insurance representative will ask for contact information found on your hospital bill and set up a three way phone call. State your case for the hospital/provider billing manager as well if need be

6) FOLLOW-UP AT LEAST ONE MONTH LATER WITH THE HOSPITAL OR PROVIDER IF THEY DO RESCIND THE BALANCE BILLING CHARGES. ENSURE THAT THERE IS NO SNAFU

YOU ARE AWESOME

That’s right. You are awesome. Your neighbor may disagree and maybe even the postman, but that’s not something a stiff drink and a good dose of “I don’t care” won’t take care of right away.

It may be a real hassle, but knowing some insurance terminology and reviewing two billing related documents, while also being able and willing to make a phone call, can save you lots of money and even headaches and stress.

Just bear in mind that the healthcare related industries do a lackluster job in the billing and reimbursement departments for you, the customer. The last line of defense in these regards, in YOUR regards, is YOU. So this means that YOU need to take action once armed with information and a solid case—I hope I have helped you in these regards.

I admit that it is not a preferable thing, to have balanced billing and other healthcare related issues to pose such risks to your wallet—but the truth has to be confronted. Fortunately, if you spot these sorts of problems, it is very likely that between an insurance company service representative and hospital/provider billing manager you can settle potentially huge bills quickly and to your satisfaction.

WHAT DO YOU THINK?

Do you have any objections, thoughts, concerns, or contributions? I REALLY WANT TO KNOW. Help me to make this a conversation!

Together we can map out better solutions and truly navigate clearer paths towards quality services, low prices, and better lives.

Oh! And as always, if you find this post useful, do me and so many others a huge favor. When it comes to this kind of information: share and share alike! Information is meant to be disseminated wide and far.

Sovereign Liberty Solutions

Your Home for Liberty Bias in News, Opinion, & Solutions
By | 2017-03-28T17:00:45+00:00 September 2nd, 2015|Categories: DIY Healthcare Savings|Tags: , |0 Comments

About the Author:

My name is Matthew. I am founder of and manage Sovereign Liberty Solutions.

I am a proponent of free, voluntary association and expression. I understand that there is no single exception or excuse to violate this with the initiation of force, fraud, and coercion.

I welcome a genuine dialogue & seek information, news, analysis, and, of course, solutions, whether it be on the individual level or a more voluntary association [group] or even “national” one.

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