How to save money as a self-pay patient in the emergency room

Self-pay patients can, with a little advanced planning and conscious effort, wind up saving a lot of money. Whether it’s finding a cash-only doctor, visiting hospitals and surgical facilities in the U.S. that offer up-front and real prices, signing up for a telemedicine serviceusing generics and shopping for the best price on prescription drugstraveling overseas as a medical tourist, or any of the many other options available, self-pay patients are often in a position to save substantially over what those with standard health insurance pay.

And then there’s the emergency room, where by its very nature it’s just not possible to shop for prices in advance and it can be difficult or even impossible to make appropriate judgments about what care is needed and what is not. For self-pay patients, dealing with an emergency room visit can be a big financial challenge, on top of whatever medical issue brought them into the ER in the first place.

That said, self-pay patients don’t have to just take what the ER billing process gives them. Michelle Katz, who runs the blog Health Care for Less, appeared last night on ABC News to discuss how to save money when going to the emergency room. The video isn’t up on her or ABC’s site yet, but Michelle does have some advice up on her blog drawn from her appearance that I thought I’d share here is somewhat abbreviated form. 

Watch Out, High Emergency Room Bills Can Cause Heart Attacks!

…When Suzanne came to me after receiving her $8, 000 bill for 30 minutes in the ER almost 1 year later, she could not recall some of the events that occurred in the ER or know why her insurance was not kicking in.  Who would?  On the other hand, what she could recall, was helpful enough to get that bill down to about $1, 500 and this is what we did:

1.  Get an itemized copy of your bill from the hospital:  This is key to helping you recall events and navigate through that horrifying day.  Suzanne called the billing department and made that request via the phone and email… She also told them to put her bill on hold while she was investigating the charges… This ultimately “stops the clock” on any collections, and gets the hospital involved.  By doing this, you are letting them know, you are serious.

2.  Get a copy of your medical chart:  This is legally yours and it will not only help you recall some of the finer details of the event, but it also might help uncover some of the mysterious charges on your bill.   When Suzanne and I compared this with the itemized bill we uncovered the following: wrong dates, wrong times, wrong amounts, double charges, unnecessary tests and even a wrong diagnosis.

3.  Call up the insurance company to double check the information:  In this process, we discovered that one of the main reasons her insurance company did NOT kick in was somewhere in between filing the claim and capturing it, her birthdate was transcribed wrong…

4.  Don’t wait for the billing department to call you:  As soon as you get all of the above information and highlight what seems like an obvious mistake to you and write down your questions, pick up that phone AND contact the billing department in writing and make that appointment to go over your bill…  Any delay on your part may throw your bill back onto the track to collections…

5.  What you don’t understand, be sure to ask:  Remember that many of the people in the billing department do not have a medical background, so they might refer you to the doctor.  Ask them for help if you do not know the doctor…

6.  Document: After the mistakes are found get a reprint of the bill.  Be sure your insurance company has a correct copy and if the balance is correct, pay for it immediately and be sure to get the zero balance in writing and keep this is your file for at LEAST a year…

7.  Negotiate:  If you have a high deductible like Suzanne, there may be a balance even after insurance kicks in that is a tough amount to swallow.  Take the time to sit down with this billing person to talk about your situation and ask for a discount.  If that amount is too high, work out a payment plan that works for YOU and get your final agreement in writing.  You might be surprised what you can work out if you just ask.  Sometimes hospitals will accept a low cash amount to settle out your bill since setting up a payment plan can be time consuming and cost more for the hospital depending on the situation.

8.  Say thank you:  I cannot emphasize this enough.  It is rare the billing department gets a thank you.  So one up your game!  A simple thank you may get you an ally in the billing department that may “have your back” if something goes amiss in the future.

In the end we were able to get Suzanne bill down to about $1, 500 and work out a payment plan that is comfortable to her that she can afford to keep up with her other bills without going into cardiac arrest at the end of every month…

The person Michelle was working with here had a high-deductible insurance policy, which undoubtedly made things easier here because they presumably were able to get negotiated rates instead of the dreaded ‘chargemaster’ prices that many of the uninsured get hit with, as well as picking up some portion of the bill for this patient.

For self-pay patients that don’t have insurance, one additional suggestion would be to find a medical billing negotiator that can help to at least get the ‘chargemaster’ rates down to something approaching a real price (discussed earlier in “Hospital billing negotiators can save patients big money.”

There may also be charity care programs at the hospital that can help to defray some of the costs in the event the bill is just too high even after a negotiator has gotten the bill down. One of the more helpful parts of Obamacare is that it requires nonprofit hospitals to have written charity care policies, although it doesn’t specify what those policies should be.

Ultimately, self-pay patients who lack high-deductible health insurance are probably going to better off if they have at least some form of alternate coverage, such as a fixed benefit or accident insurance policyAFLAC is probably the best known of all companies offering these sorts of policies, but others include AssurantReserve National, and United Healthcare. These policies provide cash that can be used to pay for care in the event of an accident or traumatic injury, typically at a fraction of the cost of standard health insurance. Membership in a health sharing ministry is also an excellent option for many as well.

Any trip to the emergency room is likely to be a stressful enough event without having to worry about the financial implications. For self-pay patients, the opportunity to prepare in advance for such a trip is limited, but there are things you can do after the fact to avoid sky-high bills. If nothing else, that can provide some peace of mind during an otherwise stressful time.

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One Response to How to save money as a self-pay patient in the emergency room

  1. Hello sir,
    Thank you for your nice posting.There may also be charity care programs at the hospital that can help to defray some of the costs in the event the bill is just too high even after a negotiator has gotten the bill down.

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