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Here's what you can do about big medical bills in North Carolina and elsewhere

One in five Americans has a medical bill they can’t pay. Getting a huge bill can be overwhelming, but there are some things people can do to protect themrselves.

Shaunna Burns knows alot about that. She’s known as the "TikTok mom" because she creates how-to videos for 20-somethings who might need a little help learning how to live on their own. She records videos with advice, like what to do about carpet stains.

Shaunna Burns
Joan Malloch
Dana Ervin
Shaunna Burns is seen in an undated photo.

But it’s her videos on handling big medical bills that have really gotten attention. Burns knows a thing or two about dealing with those bills. She’s a former debt collector and the mother of a seriously ill child.

“Here’s how to handle it anytime a collection agency calls you," Burns tells her TikTok viewers. “What you need to do, you need to say, 'I would like to request an itemized bill with every single charge.'”

The Charlotte mom says she started making those videos after she got a call about a bill for one of her daughter’s many hospital visits.

“One day I was sick. I was really sick,” she said. “And I got a call from a debt collector and they were really rude to me, and it made me mad. I thought what if people don’t know they have rights when it comes to debt collecting.”

The videos got millions of views, and several people posted testimonials about how they saved money. She even appeared on national TV. But Burns says her advice is pretty straightforward. She learned a lot after her daughter got a $67,000 emergency room bill.

“First of all, they just give you a bill with a bunch of codes — doesn’t say what it is,” Burns said. “So I was like, 'I want it broken down with every single charge.' So when I got it, I started going through it.”

Burns says she found a $37 charge for a Band-Aid, a charge for a diagnosis that was never made and another for a referral that never happened. So she started to cut the bill down to size.

Getting an itemized bill is the first step, says Lisa Berry Blackstock, a member of the National Association of Healthcare Advocacy.

“I have always found errors on itemized medical bills — always," Blackstock said. "So first you have to make sure the bill is correct and then look up the codes.”

You make sure the bill is correct by looking up the codes. They’ll be labeled "CPT" on your bill, for “current procedural terminology.” Google them to find out what they mean. For example, the code 36415 means the hospital took some blood so it could perform a test.

Then request your medical records from that hospital visit so you can compare the charges to the treatment you actually received. The hospital is legally required to give them to you, so don’t be deterred if you have to call several times. If the treatment isn’t listed in your medical records, the hospital can’t bill for it.

And make sure to check the bill for what’s known as the “level of care.” Emergency room visits are classified from 1 to 5, depending on whether the visit is life-threatening and needs immediate surgical care or is less urgent. The more serious visits cost a lot more.

“All of them are guilty of what's called upcoding, which means that they will charge a level higher than the level legitimately warrants,” Blackstock said.

So if the level of care on your bill is higher than the one in your medical records, demand that the hospital fix the bill. Burns says she saved $11,000 when the hospital adjusted the level of care on her daughter’s bill.

Another thing: If you have insurance, make sure to review the estimate of benefits. Did the hospital get paid by your insurance company? If it hasn’t been, it may be because the hospital never submitted the bill in the first place for reimbursement, and it’s not supposed to bill you first.

But Blackstock says it’s best to avoid getting high bills in the first place. Start by knowing your coverage.

If you have a high deductible plan and don’t think your annual medical bill will be that high, ask the doctor, hospital or lab how much it would charge if you paid cash. Sometimes you can save a lot.

“Medical providers and facilities love cash pay because it reduces the paperwork and the labor hours that person has to submit a claim to insurance,” Blackstock said. “The discounts are substantial.”

Being a savvy health care consumer also means going to an in-network hospital or doctor and never going to an emergency room when urgentcare will do. (That will cost you thousands more).

And don’t take an ambulance unless it’s necessary. That could run over $1,000, and your insurance may not cover it.

“It’s so important to help people understand that they really need to be proactive before they need health care,” Blackstock said. “The health care system does not look out for you.”

And if you do need emergency room care, you can try to keep the cost down by paying attention to the hospital paperwork. You’ll be asked to sign a document saying you agree to pay the charges. Marshall Allen, author of the book “Never Pay the First Bill, says you should scratch that out and write in:

“I consent to appropriate treatment and (including applicable insurance payments) to be responsible for reasonable charges up to two times the Medicare rate.” 

And take a picture of that for your own documentation.

On average, hospitals charge those with private insurance 2 and 1/2 times what they charge Medicare, so it’s worth trying to set that limit. As WFAE reportedin its series The Price We Pay, North Carolina hospitals charge those with private insurance an average of 273% of the Medicare rate, and South Carolinians pay over 300%.

But if you do get a call from that debt collector, Burns has one last piece of advice:

“Be nice to debt collectors. Believe it or not. It’s counterintuitive because most of them are jerks. But if you’re nice to them, they’re more likely to want to work with you and help you."

Still need help? If you have a large bill and want some advice, send it to us. Several patient advocates have offered to review a few bills for a future story.

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Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.