Insist On "Appropriate" Medical Prices By Revising Your Financial Forms

Let's lay the groundwork to get a FAIR deal on health care.

The receptionist handed me a clipboard and told me to sign the dreaded "financial responsibility" document. 

Clearly, she expected me to simply sign the thing and hand it back to her. 

Yeah, right. 

Doctors and hospitals hand us these financial CONTRACTS and expect us to blindly sign them. Then they can bill us for whatever amount they want. But I just wrote a book called, "Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win." So I wasn't going to sign a boilerplate financial contract that's giving the doctor’s billing department the equivalent of a blank check.  

Here are some of the proposed terms in the "Financial Responsibility" agreement I held in my hands:

• I accept the charge determination of my insurer as the "full charge." But what if my insurer hasn’t negotiated a fair price?

• I agree to accept "full responsibility" for the difference between what my insurer pays and the doctor's charges. What if that’s not an amount that’s fair to me?

• "I accept responsibility of all charges for services furnished to me..." What if the treatment was unnecessary?

• If I don't fulfill my financial obligation, I may be sent to collections, AND get a $100 fee added to my bill! I’m gonna agree to be sent to collections before I’ve even been treated or told the price?

That's a lot of unfair contract language to take in at 7:30 in the morning. But it's typical stuff for a health care financial agreement. So, I altered the contract to make it fair to me. And why not? We patients are the ones who pay for the care we receive, either directly or indirectly. So we should absolutely negotiate to make sure we pay a fair price.  

Everywhere the proposed contract put me on the hook for "charges," I inserted the word "appropriate," so the revised version said I agreed to "appropriate charges." (See the photo above).

It was a quick fix but I figured it would be fair enough and something I could use in my favor if we had a billing dispute down the road. I love to share Victory Stories, where patients win a battle against an insurance company denial or bogus medical bill. But sometimes the greatest victory is the one where you don't have to fight - you avert the problem before it shows up. 

I am happy to pay appropriate charges. But it's not wise to open myself up to the jacked-up price gouging that too often happens to working Americans who undergo medical treatment. How would I determine what charge is "appropriate?" I go through that in my book, but the short answer is to compare it to Medicare prices or what's posted on FairHealthConsumer.org or other sites. 

As I scribbled my revisions, the thought crossed my mind: "What if the doctor refuses to accept my altered agreement?" Then I will walk out. I was there for an annual physical. This was not an emergency. Why would I go to a doctor that wouldn't agree to ensure the charges billed to me are appropriate?

I told the receptionist I had altered the financial agreement and she froze, almost as if she had been Tased. "You'll have to take that up with the doctor," she gasped. 

I set the financial agreement on the table in the exam room and the doctor took my medical history and checked me out. This was my first visit with him and he was excellent. He took his time and answered my questions. I was impressed.

Near the end of the visit, I told him what I did for a living and about my book. Like other clinicians who know their stuff and care about patients, he was interested, not concerned. The good doctors know the health care system is a mess and are eager to talk to me about it.

When I asked the doctor about his financial responsibility document, he surprised me. 

"I haven't read it in years," he said, waving his hand dismissively. "I just got it from some other doctor." 

I told him it needed to be revised. Signing it as presented would be like him signing an agreement at a car dealership that obligated him to pay whatever amount the dealer billed him weeks after he drove his new wheels off the lot. We laughed at the idea. It's absurd.  

Then I asked him why he included a clause about taking patients to collections. He said he wrote off bills that couldn't be paid and had never sent a patient to collections. I told him he should remove the collections clause because it made him look like a jerk.

In the end, we never even closed the loop on my revisions to his financial responsibility agreement. No one asked me to turn it in and I walked out the door without signing the document. The bills haven’t arrived yet, and while I don’t anticipate a problem, you can be sure I’ll be looking closely at them.  

So are the takeaways?

1. Do not agree to a financial agreement with a health care provider that's unfair to you. It’s easier if the care you’re receiving is elective. If it’s an emergency, I wrote about the Quizzify Battlefield Consent in my book - the language you should insert into your emergency room financial agreements. You can revise your contracts with all medical providers. We need to be having these conversations about fairness in medical billing.

2. Reward the clinicians who are fair with your business. Shun the price gougers. The good clinicians aren't out to exploit us. And the reality of price variation, which I also write a lot about in my book, means there are providers who have fair prices and those who do not. If someone's trying to extract more money from you than they should, give them a stiff arm to the melon.

I go into much detail about these type of tactics in my book. I've been thrilled to see how "Never Pay the First Bill," is helping people stand up for themselves against the predatory practices of our money-gobbling health care machine. Order it for yourself, or buy it for your loved ones. And as always, if you have a Victory Story, please share it with me!