How Long Do I Have Before My Bill Is Sent to Collections?
June 13, 2010 10:51 PM   Subscribe

I've just been sent a ridiculous medical bill that my insurance has denied. Anyone out there who's fought the insurance company and won who has any helpful advice for this poor grad student?

$800 for one blood test!? They claim it wasn't necessary, and my benefit has been exceeded. I disagree. Like most matters of this sort, it's a mess-- I'm obviously appealing to the insurance company, and I'm going to call the doctor and see if there's anything I can work out/clarify there but this, realistically, is a lot of people's fault (my HR, for duplicating me in the computer system and thus making it appear I had twice the benefits I actually did, the doctor, for not telling me how much the test would cost, and me, for taking them at their word it was covered), and I have a feeling that, as the only party without corporate lawyers, I'm going to be the one left holding the bag.

I can pay the bill, but it's half my monthly income and so this one-time failure to badger my doctor about cost will pretty much wipe out a year's worth of savings. Ouch: lesson learned. Assuming my appeal fails, I'm not trying to dodge it, I'm just looking for ways to minimize the financial pain.

One idea I had would be to use my Health Savings Account, but I won't have enough funds until the new year. So, I know YANML or my financial advisor, but, ballpark, how long can one put off paying a bill before it gets sent to collections? Do I have until January? I have no desire to destroy my credit on top of reducing myself to penury. If I don't have until then, would I have any success setting up some kind of payment plan to buy myself some time until then? Any insurance battle techniques also welcome.
posted by neko75 to Work & Money (16 answers total) 5 users marked this as a favorite
Most medical providers are happy to set up a payment plan.

They also have billing staff who would be overjoyed to speak to a responsible person who wants to fulfill their payment obligations, and could arrange to give that person not only an extended payment plan, but a discount on the service being paid for itself.
posted by treehorn+bunny at 10:54 PM on June 13, 2010 [1 favorite]

would I have any success setting up some kind of payment plan to buy myself some time until then?

You never know till you call and ask. In my experience, most doctors/hospitals/etc. would prefer to set up a payment plan rather than send it to collections (which usually takes about 90 days, but really, don't wait till then).
posted by scody at 10:57 PM on June 13, 2010

I'm just looking for ways to minimize the financial pain.

I spent most of the last four years in your situation. While biking home one night, I was hit-and-run by a car and left on the road with a broken elbow.

I was paying for my own pathetic "catastrophic" insurance, and the bill was outrageous -- over a few thousand bucks, not enough to make insurance pay. When I called the hospital and explained the situation, they dropped about a thousand bucks off the price and set up a payment plan... I think the minimum was like $80/month.

I found this both infuriating and mildly helpful. Insurance is obviously unaffordable in part because the hospital is fucking gouging for whatever they can get. Call billing, be calm, logical, and factual, and you will probably get a similar discount.
posted by fake at 11:05 PM on June 13, 2010

Lean on your insurer for as long as possible, and stay in touch with the doctor and tell them you're appealing to your insurance company. I put off an ER bill for 9 months before I finally got the insurer to pay.
posted by Lukenlogs at 11:55 PM on June 13, 2010

A letter from the doctor explaining that the test was a "medical necessity" may be all that's necessary.
posted by Obscure Reference at 4:43 AM on June 14, 2010 [1 favorite]

If the insurance coverage really hinges on whether the test was necessary, then it makes sense to appeal, and to get your doctor's help with that appeal.

If you really have exceeded your benefit limits, for whatever reason (e.g. HR's mistake), then there's not much point in appealing to the insurance company.

If the problem really hinges on HR's mistake, you might ask your employer for help with this. My guess is that they won't be eager to shell out $800, but the HR dept. might be willing to go to bat for you when you have to deal with the insurance company or lab.

If you end up on the hook for this bill, then negotiate the price down. If your insurance company isn't involved then you're being billed the sticker price for the service, which is far more than the lab actually needs to make on this transaction. Look at some of your old EOB's for services that were covered. Notice that the amounts the insurance company paid were actually far less than the service providers billed. The lab is billing $800 but the insurance company, if it had paid the claim, might have only paid $500. You may be able to negotiate a price similar to what insurers actually pay instead of the fantasy rate that service providers ask for.

Finally (or maybe firstly), try and get emotionally centered. I know that it seems as if your employer, the big, scary docs and insurance company have all sorts of power because they have "corporate lawyers," but they don't. Nobody is suing anybody over $800 (or, more likely, $500), because the lawyers' time is too expensive to be worth it. You have quite a bit of power here, because you have the checkbook. You exercise that power by dragging your feet and being insistent. Insist on talking with people who actually have the authority to make decisions and negotiate with you. Insist on a resolution that makes sense for you.
posted by jon1270 at 4:47 AM on June 14, 2010

Couple of things:
1) Sadly, you pay a lot more to the hospital yourself than the insurance company pays. I had a similar bill of around $1k and I think the insurance company ended up paying $300 or something. Insurance companies have different rates than self pay, usually a lot less.

I'd consider that if negotiating with the hospital.

2) Is your insurance through the school? I would bring this up with whatever office handles insurance for you. Tell them you feel you are getting ripped off by the insurance they set up.

3) My usual strategy is to be polite for as long as possible, and when I feel like I'm not getting anywhere (and not just getting a little something, but having my general complain answered), I do a little freak out on the phone, telling the person I'm talking to that I know this is not your fault but that I'm, this very moment, writing a letter to all my representatives, going to send it to them individually, regarding the insert travesty of american governmental lack of regulations and that I'm going to have to put their name on it as the person I was last speaking with.

I hate doing this, but I have to say that it's consistently provided results to me. I really hate giving any pee-on a hard time, but it's worked out for me pretty well. My basic feeling is that I'm going to do you more damage than you've done to me.

And if they don't send you up to some sort of customer service guru, you have to write that letter.
posted by sully75 at 5:31 AM on June 14, 2010

Tone down the anger and outrage, ramp up the "I'm sure there's been a mistake"--not because you shouldn't be angry but because having an emotional response isn't going to help you. It's easy to feel very emotional and vulnerable (not to mention righteously angry) when you encounter problems with your medical care and/or financial stability, but the more you can act calm and businesslike, the better off you'll be.

Call your insurance and find out what you would need to do in order to prove the test was medically necessary--not "How dare you?" but "Obviously this is a mistake, how can we solve it together?"

Call the billing office at your hospital and ask if there's any way they could re-bill insurance using a different code, or if there's any other way they might get a different result from the insurance. I once got a bill reduced from, oh, about $1200 to $0 because of the way the billing office coded the procedure. Again, your tone is, "Something went wrong, can you help me fix it?" not "I'm ruined!" During this conversation, mention that you want to get this cleared up before the bill ends up in collections, and ask what their timeframe for that process is.

Contact your HR department and ask who you can discuss this with. Same thing as above: you're approaching them with a request to work together to solve a problem, and if one person can't help you ask him/her to direct you to someone who can.
posted by Meg_Murry at 6:12 AM on June 14, 2010 [3 favorites]

While you work on various options--sometimes a doctor's office can make the case for necessity, or an error can be corrected--call whoever the bill is coming from and say, "I'm not dodging this bill; I believe there's been an error and I'm trying to get it worked out. I'll be in touch by X day." I did this recently and they were perfectly happy to not send the bill to collections while I got it worked out, because this kind of thing happens all the time.

Whatever portion of the bill you end up paying, yes they will set up a payment plan with you. I do this all the time, too. Usually when I call, they ask, "How much can you afford per month?" Only once--and I've probably had these kinds of payment plans a dozen times or more over the last few years--have they said, "OK, you have to pay it off in 6 months so here's your minimum payment." In every other case they've allowed me to set my own monthly payment.

They do send things off to collections lickety-split if you miss a payment. But up until then, they are helpful and just glad you're keeping in touch and willing to work it out. I actually got a letter to that effect from one doctor's office when I called to set up a payment plan, thanking me.
posted by not that girl at 6:37 AM on June 14, 2010

Since you said the insurance denied it because it 'wasn't medically necessary,' the medical office / needs to fix it by communicating with the lab the correct diagnosis code, and from there to billing.

To me it sounds like a coding problem. Certain insurances - for example, Medicare - only allow certain tests to be scheduled with a particular diagnostic code. Sometimes the list of allowed codes doesn't include ones that it should (like requiring a diagnosis that would only be proven after the test is done) but sometimes the office doesn't realize the test/the insurance needed a particular code written on the lab order.
posted by cobaltnine at 6:55 AM on June 14, 2010

Definitely call them and talk to them.

Don't be afraid to get creative in scraping the funds together, though. I have a friend who was in a bike accident, and has almost paid the medical, dental, and ambulance bills (which I believe were somewhere around $8,000) through doing drawings for people at $30 a piece. After six months or so at it, he's within $100 of his goal.
posted by PhoBWanKenobi at 6:56 AM on June 14, 2010

After you've talked to everyone and their brother about trying to fix the mistake, if it still turns out that insurance won't pay, you might be able to find out how much the insurance WOULD pay if it were covered, ie - their negotiated rate with the lab if they have one. If that lab is not part of your network, this might not work, but if it is, then you have a very good case in your negotiation with the lab to reduce the bill down to that negotiated rate even if you are paying out of pocket for it.
posted by CathyG at 7:05 AM on June 14, 2010

the medical office / needs to fix it by communicating with the lab the correct diagnosis code, and from there to billing.

This. So much hinges on the right diagnosis code being used, when it comes to insurance approval. We've gone through this dance a few times with doctor's bills that were initially refused.

Another thing to think about is to call the insurance company and talk with a representative. We've had an occasion where a claim was denied, even though we were positive it was a covered procedure. When we spoke directly with a rep, they looked through our benefits and agreed that tit should have been covered and corrected the error.
posted by Thorzdad at 8:15 AM on June 14, 2010

One idea I had would be to use my Health Savings Account, but I won't have enough funds until the new year.

this doesn't make a different with my flexible spending account. i can use it up front & they continue to deduct from my paycheck. (i.e., if i have a bill for $100 but i've only got $50 in there, they'll still cover the $100.) your plan may differ, but definitely look into it. and definitely call the doc & the insurance company & see if you can't get it covered.
posted by msconduct at 8:37 AM on June 14, 2010

1) Call your doctor and tell them what happened. Ask if they can help with a 'more accurate' diagnosis code.
2) Have HR call the insurer and have it documented that HR screwed up.
3) Call your insurance company and CALMLY talk to them about it. Write everything down - date, time, who you talked to. If the person can't help you, say, "Well, I appreciate what you've done, and I don't have any problems with the service you provided me, but I need to talk to the person who can help me," and have them escalate. It's important that you state it in that fashion so they don't get dinged for not helping you 'properly' for their CSR numbers.
4) If you go through all of this and you still owe the money, then *tell them what you can afford* and that you have to pay them in installments because you're a poor grad student. I wouldn't empty out my FSA for this (see msconduct above about how they work), but I would pay them off monthly until the debt is paid off. If they take you to collections, you can repeat the story, but I doubt that they will if they are getting money from you monthly and if they don't have to pester you to get the money.

I had this happen once. It was my fault for trusting the doctor when they said it was covered (ultimately it is your responsibility), and when everything else failed, I called to talk about a payment plan. I got a sharp "we can't possibly do that, just borrow the money" and so I just started sending them $25 a month. They called once, I told them that I had already talked to them about this and that this was what I could afford. They said they'd take me to collections, I told them that I'd just be sending the $25 to the collection agency then, that I had just finished grad school and wasn't going to be applying for a credit card or buying a house or a car soon. I documented it in writing and sent it to the doctor's office and I never heard from them again. I paid it off, it took me about 4 years, but I paid it off.

That was 12 years ago. I get everything in writing now about how much it will cost. I have walked out of doctors' and dentists' office if they can't give that to me. And even as recently as last year, when an incompetent dentist's office kept revising their written statements to me about work, when I got a bill I wasn't expecting, I just started my own payment plan (and have taken my custom to another dentist who can provide competent estimates). Everyone would rather have your money than not.
posted by micawber at 10:59 AM on June 14, 2010

Response by poster: Thanks for you help, everyone! I asked both my insurance company, and the doctor, to review the claim. Both still denied it (benefit exceeded, etc.), but somehow behind the scenes a "preferred provider discount" appeared that brought the bill down to $32.50! That I can pay. The American health care system is messed up, but for the moment, I'm grateful.
posted by neko75 at 12:39 PM on August 23, 2010

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