Medical Bills - How to Deal With

I've no special expertise, but this is how I have dealt with them lately.

  1. Wait at least two months for all the bills and insurance statements to come through. (Generally there's no penalty so long as you pay within 90 days, but check and make sure.)
  2. Take the time to figure out, as much as you can, exactly what the bills and statements say. This can be nearly impossible.
    All the people you will talk to are reasonable people trying to do their jobs to the best of their ability. Treat them well. Their job is confusing and difficult and you need their help. Document all conversations including the name of each person you contact and the time of the call. Remember that they are doing their best but their job is to maximize payment to the hospital or minimize expenses for the insurer.
  3. Call the hospital and confirm that you understand what the bills say.
  4. Call the insurance company and confirm that you understand what they are willing to pay.
  5. Study your insurance plan documents. Keep in mind that the summary which you may have is not an official document. You may have to get the original. You will probably have to contact the insurance company to get clarification. Their interpretation will favor them as much as possible, but it isn't necessarily correct.
  6. If it makes sense at this point, go ahead and pay the remainder. If it doesn't make sense, get on the phone again and ask them to explain. Be respectful and as nice as you can, but be insistent. Don't get put in the position of relaying information from the provider to the insurance company. Insist that they contact each other. Provide the names of the people you have talked to so they can talk to the same people. If the people you talk to aren't forthcoming or reasonable, ask to speak to their supervisors.
  7. If it makes sense now, pay the remainder. If it doesn't make sense, go to the person who negotiated the policy with the insurance company. That will usually be the benefits person at your employer or the person who sold you the policy. Ask for their help in understanding the situation and ask them to advocate for you with their contacts. Be nice but insistent all the way through the process. Document everything.
I've had to do this twice in the last year. It took a lot of my time and frustration and it took a lot of their time and frustration, but I got a reasonable solution each time. (Actually one is still in process, but I think it will be solved.)

(No political message here, but keep in mind that in most other modern countries none of this is necessary.)