Easy Money: Empowered Mom Saves $21,000 on a Bogus Medical Bill

Lauren Caston had read my book, Never Pay the First Bill, so she knew how to defeat an overpriced hospital bill.

When you contest a bogus medical bill, the customer service reps for your hospital or insurance company may act like you don’t know what you’re talking about.

That’s what Lauren Caston found when she got a $21,826 hospital bill in April after a routine hernia surgery. She knew something was off when she got the bill. She had insurance and had only been at the facility for about four hours and went home the same day.

Thankfully, Lauren was ready. About a year earlier, the 35-year-old Tennessee mom of three had dealt with a different outrageous medical bill. Her daughter had slipped in the tub after hours, requiring a trip to the emergency room. That bill came to more than $4,400 – for four stitches!

A friend recommended my book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. Lauren read the book – which some call “The Art of War for health care” – and got equipped and empowered. She fought the bill until she realized the same daughter needed a surgery that year. That put them over their out-of-pocket max whether she got it reduced, or not, so she let it go.

But it left a bad taste in her mouth.  

An educated patient is an empowered patient

Getting educated empowered Lauren to scrutinize the $21,826 hernia bill. She called her surgeon’s billing department. They suggested calling her insurer, Aetna, to get more details.

The Aetna representative sounded like he was reading from a script, Lauren said. He acted like she had done something wrong by failing to get the operation pre-authorized. Thus, she had to pay the bill, she was told.

This is typical. Don’t be surprised when the customer service reps for billing departments and insurance companies act dismissive when you question a medical bill. They’re usually reading from a script and don’t know themselves how to check a bill for accuracy or fair pricing. To put it bluntly: if you’re following my methods, you likely know more than they do.

Lauren isn’t the type of person to lean into conflict, but she didn’t back down – especially after she started getting calls from a bill collector working for the hospital. What!? The bill collector also didn’t care when she said she disputed the bill. They just wanted her to pay up.

Lauren called her surgeon’s office again to see if the operation had been pre-authorized or required pre-authorization – the pre-approval by an insurance company that’s sometimes required before a procedure. The surgeon’s biller said she would reach out to the insurance company to find out the problem. The biller called Lauren the next day to explain the issue. The insurance company had been using old billing codes and had misread them.

The surgeon’s office re-coded the claim and resubmitted it to Aetna.

It worked! The hospital got paid and adjusted Lauren’s bill. The amount she owed got reduced to $825.

BAM! Lauren saved more than $21,000!

“I love how little work I actually had to do…”

Several things stand out to Lauren about the experience. Foremost: patients must be on guard. “No one is looking out for the patient to make sure the patient isn’t overcharged,” she said. “You have to look out for yourself.”

That underscores the need for patients to get educated so they know how to protect themselves. My book and health literacy videos are a good place to start.

Lauren marvels about another takeaway from the experience.

“I love how little work I actually had to do to fix it,” she told me.

Easy money!

I love Lauren’s story because it illustrates my vision for teaching working Americans to become savvy health care consumers. Lauren read my book and got educated. She got equipped. She got empowered. She knew to question the bill – even though the so-called experts told her not to – and she got it corrected. Huge congratulations to her!

Get educated!

Now what about you? If you’re a patient, get educated so you and your loved ones don’t overpay for medical care or end up in debt. My book and health literacy videos are the starting point. Becoming a savvy health care consumer pays off!

Are you an employer, broker or HR person? You also need to get educated, and you need to educate your employees and clients.

If you’re a member of NABIP, the association for health benefits brokers, you can earn continuing education credit for watching my health literacy videos. Sign up here.

If you’re a member of SHRM, the association for HR people, you can also earn continuing education credit for watching my health literacy videos. Sign up here.

And if you’re an employer, or a broker or HR person, let’s work together to educate and empower your employees. They will save money and so will your health plan. My health literacy videos are an affordable and scalable solution. Email me at neverpay@marshallallen.com and let’s join forces!

Takeaways:

1. Lauren got educated so she knew what to do when she got her massive medical bill.

2. Lauren didn’t take no for an answer when she talked to the customer service reps for the hospital and insurance company.

3. Lauren found someone who would help – in her surgeon’s office – and that got the problem resolved.

4. It can be easier than you expect to win a medical billing battle.

5. Have you won a health care battle? Share your Victory Story with me so we can use it to inform and inspire others!

I’m looking for forward-thinking employers to equip their employees with my Never Pay Pathway health literacy videos. They’re based on my book, Never Pay the First Bill, and the knowledge will transform the way your employees engage the health care system.

The videos are an ENGAGING and AFFORDABLE resource that will save money for your employees, their families - and your health plan. Let’s stop overpaying for our health care, shall we? Email me at neverpay@marshallallen.com for more information.