In WFAE's series The Price We Pay, reporter Dana Miller Ervin took us on a deep dive into the U.S. health care system, looking at why Americans spend more on health care than those in other wealthy countries but are a lot sicker. She found reasons and some solutions. To continue offering solutions, WFAE is sharing some resources to aid you in cutting your costs for health care.
"Morning Edition" host Marshall Terry spoke with Jeanne Pinder, CEO and founder of Clear Health Costs. Pinder has written a series of columns about what you can do to fight or reduce health care costs.
Marshall Terry: So, I'm going to go out on a limb and say most of us have received a medical bill that surprised us. Perhaps you thought that you paid a bill off or that there was an extra charge you didn't expect. Whatever the case, this interview is for you.
So, we are going to talk about what people can do in advance to keep costs low and what people can do when they feel like they're being told to pay too much. First, though, just how common are mistakes made by insurance companies and medical providers?
Jeanne Pinder: You know, they're shockingly common. I've actually seen estimates that as many as 80% of hospital bills contain at least one mistake.
Terry: Eighty percent. What kinds of mistakes are made?
Pinder: Well, there are things like billing you for something that you didn't get, an add-on at the hospital's billing system thought you should have had, even if you didn't have it. The stories are crazy.
Terry: Just why is that number so high?
Pinder: Well, there isn't a lot of oversight, shockingly, in this system. It's a highly regulated system, but it's sort of ineffectively regulated if you can imagine that. There are barriers, things like the privacy laws. It's difficult, actually, for people quite often to receive a copy of a hospital bill if you call and ask for a copy. Sometimes you'll be told that privacy laws preclude you from getting a copy of your very own hospital bill.
Terry: And when they say that privacy laws preclude you from getting it, I mean, is that true?
Pinder: No.
Terry: So what do you do then?
Pinder: Ask again, ask up the line. I usually suggest that people write letters more than getting on the phone. I think writing letters, getting in writing. I myself have written letters where I CC'd everybody in the billing department of the hospital, the CEO, the CFO. Make a ruckus. I've seen people have great success by tweeting at people or by speaking with a legislator. We hope that it will get solved at a lower level before you have to go and talk to your congressman. But you know there is always that possibility.
Terry: Now, one thing that you recommend people do is ask providers what the cost of a procedure is in advance. Now is there a big difference if paying in cash for a procedure?
Pinder: There can be. I myself, for example, once bought an MRI on cash for a family member. It was towards the end of the year. We hadn't met our deductible. I knew that an MRI could be $2,400 or more, and I needed the MRI and I was determined to pay cash because I knew that I could get it for much less. So I called the provider first and I gave them the procedure code. You have to have the special number. Told them I was a cash customer. They said, "What? You're uninsured?" And I said, "No, I'm a cash customer." They said, "Oh, OK, that'll be $900." I called the second one, went through the same thing. "Here's the procedure code." '"Oh, you're uninsured?""No, I'm a cash customer.'" They said $600. And then before I called the third one, the first one called me back and said, "If you can be here at 7 tonight, that'll be $450."
Terry: This is just amazing. Why such discrepancies?
Pinder: Well, because it's sort of a marketplace that's got a lot of secrecy attached to it. You can be pretty sure if the marketplace has a lot of secrecy attached to it, Marshall, somebody is making a ton of money.
Terry: Now, what difference does it make if the cash cost is still more expensive than your deductible?
Pinder: Well, quite often these days with the high deductibles, it's not true. But if you can imagine the standard hospital bill or a medical bill. In the upper left-hand corner, there's a really big number with lots and lots of zeros. And then when you get down to the bottom right, which is what you owe, it's generally a much smaller number. And in the middle, there are a bunch of other numbers that you don't quite understand.
That sticker price, the price in the top left, is a vastly inflated notional price, sort of like a manufacturer's suggested retail price or the sticker price on a car. It's never what the provider actually would expect to get paid by an insurer. And quite often, the provider will in fact accept a cash price from you as a way of they can avoid dealing with the insurance company. They get cash in hand. They might get more cash from you than they would get from the insurance company.
Terry: Let's move to the back end now. Let's move on to fighting a bill that you get. What should a consumer do before making that first call to an insurance company or a medical provider, and who should you call first?
Pinder: Well, the first thing that I would recommend is that you look at your paperwork to see if there is an appeals procedure for both the insurance company, if applicable, and the hospital or doctor. And who to call first? It kind of depends on the situation. If you think the hospital charged too much, you might start there. If you think the insurance company denied you wrongly, you might start there. The chances are that you might have to get the two of them on the phone together in a three-way call to make sure that everybody understands what happened
Terry: In these situations, I'm sure it's easy for people to get angry. I mean, does being nice get you anywhere?
Pinder: Always. You catch more flies with honey.
Terry: How do you make your case if you're convinced that you're being charged too much? What do you say to them?
Pinder: Well, that also depends on the situation. There's a lot of advice on our website, ClearHealthCosts.com. If you go to the search bar and type in, "How much does an MRI cost?" or "How much does a colonoscopy cost?" You can see what other people have done.
Terry: Now, will health care providers or insurance companies readily admit that they made mistakes?
Pinder: They will. If you're dogged enough and well-informed enough, you can often get them to admit mistakes, which could be hours and hours and hours on the phone or hours of writing letters.
Terry: So let's say you've done all these things that you recommend. What's next if you're still not happy with the way things turn out?
Pinder: Well, you have the state insurance commissioner that you can report to. There are usually state agencies that relate to hospital performance and quality. There is the Consumer Financial Protection Bureau on the national level. They have a database where they collect complaints about medical billing. There's the National Consumer Law Center, and you can always take to Twitter. As I mentioned before, I have seen occasions in which people really have a lot of success by tweeting at somebody and shaming them into submission.
I think it's so important for people to know that they don't just have to accept what's sent to them by the insurance company or by the hospital. Write me if you to — Jeanne@ClearHealthCosts.com — and I'll see if I can give you a hand.
