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How a Real-life David Beat a Health Care Giant
A project engineer in Utah used my book to battle a prominent health system. He calls his win a blueprint for working Americans and employers.
We all love an underdog who defeats a bully.
But it’s especially delightful when a savvy underdog puts on a master class in overcoming the abuse of power.
When Dave, a project manager in Salt Lake City, Utah, found himself getting bullied by an overpriced medical bill, he didn’t roll over. He followed my guidance in Never Pay the First Bill. He summoned state regulators then sued to protect himself in small claims court. Then he jousted in legal filings with a hospital’s high-priced attorneys before ultimately having the medical bill waived.
Dave allowed me to use his full name to verify the details of his billing battle, but he didn’t want his full name used in this story, to protect his privacy. His victory is a guide to other working Americans that he hopes will light a fire under employers, including his own. Dave estimates his company could save millions of dollars a year if it challenged unreasonable health care costs like he did.
It all started when Dave visited a University of Utah Health allergy specialist in October to get help with a chronic case of hives. The doctor performed an allergy test, which took about 25 minutes, then sent him home with the instruction to take an over-the-counter medicine.
The staff at the front desk told him they would bill his Blue Cross insurance plan. Dave didn’t receive any upfront estimate of the total cost and didn’t sign any paperwork.
A month later, a bill arrived for $1,329. After insurance, Dave’s portion came to $163. Dave called the hospital, and they told him this was the final bill. It seemed fair so he paid it.
It turns out that bill only covered the physician services.
Weeks later Dave received a $1,552 bill, this one for the hospital charges. After insurance, his share came to $585. That seemed odd and unreasonable to Dave. He couldn’t figure out how a 25-minute allergy test could lead to more than $2,800 in medical bills. He didn’t realize it then, but he was already taking step one to defeat a bogus medical bill.
Step One – Question the bogus medical bill
Dave’s skepticism toward the medical bill was his first step down what I refer to as The Never Pay Pathway. It’s the roadmap I show patients to help them overcome bogus medical bills and other unreasonable health care costs. Let’s go through the steps Dave took. If you’re fighting a medical bill you can follow similar steps, though there will be variations. Step one is to question the health care billing status quo.
Step two – Get educated
Dave searched online and watched my appearance on the Self-Funded with Spencer podcast. He said it felt like I was speaking directly to him. “It’s rare you find someone who is exactly showing you the way to deal with bogus bills,” he said. That led him to my book, which he purchased and devoured in two days and then applied step-by-step. “Your book was the main motivator that kept me going,” Dave told me.
Step three – Determine how much you’ve been overcharged
Dave followed the guidance in my book (the steps are also laid out in my health literacy videos) and used the site FairHealthConsumer.org to research the billing codes on the hospital’s claims. He found that a fair price for the services he received is about $350.
Step four – Contest the bogus bill
Dave called the hospital billing department to fix the problem but didn’t have any luck. The hospital’s customer service department investigated the bill and verified that the charges would remain. No surprise there! But Dave didn’t take “no” for an answer. He kept pushing.
Dave waived his HIPAA privacy rights so University of Utah Health officials could speak to me for this article. The health system declined to comment.
Step five – Complain to regulators
Dave filed a complaint with the Utah Division of Consumer Protection, which opened an investigation. The state investigator contacted Dave and the hospital to inquire. This certainly stirred things up and is likely what Dave calls “the magic” that eventually got the bill waived. But Dave didn’t know right away how the state investigation would turn out. He kept pushing.
Step six – Threaten to sue the hospital
My book and videos include a template of a demand letter that patients can use to warn bogus billers that they will be sued in small claims court if they don’t correct the problem. Small claims court is an effective venue for these disputes because it’s low cost for patients and creates a high cost and hassle for the billing entity. It also takes the dispute to an independent forum, instead of one where the health care providers make up the rules to favor themselves.
Step seven – Sue the hospital, and don’t get bullied by its attorneys
University of Utah Health ignored Dave’s demand letter, so he followed through, suing them in small claims court for $585 plus the $60 filing fee. The hospital’s attorneys filed a motion to dismiss the case, and Dave responded with well-reasoned counter-arguments.
Step eight – Continue pursuing other remedies
The state investigator wanted a copy of Dave’s financial agreement with the hospital, and recommended that Dave obtain a copy. But when Dave called the hospital, they said that they didn’t have one on file. He hadn’t signed anything.
A week before his small claims court trial date, Dave got a crusty phone call from a higher-up in the billing department who said that they would waive the bill. Dave said the higher-up also seemed aware of the looming trial date, but it didn’t come up in the conversation. The case clearly put pressure on the hospital, he said.
Dave still had his court appearance. But on the day of the hearing, the bill no longer existed. The judge simply dismissed the case.
It took a lot of work, but Dave said in the end it almost seemed easy to get the victory. He put the heat on the hospital system and it had to relent.
But isn’t that a lot of work to save $585? Dave didn’t think so. The situation affected him personally and engaged his mind, Dave explained, and its egregious circumstances made him furious and motivated.
Plus, as I’ve said before, many Americans can’t afford a medical bill that’s over a few hundred dollars. Taking the time to fight beats overpaying or getting saddled by unreasonable medical debt.
Dave also had his eyes on the big picture. He wanted to use his medical billing battle as a case study to help his coworkers and his employer, a global company with about 2,000 U.S. employees.
Fighting overpriced medical bills “will save jobs and layoffs,” Dave said. “We are wasting money in the hospitals for no reason.”
Dave led a presentation about his billing battle for his company’s executive management team. By his analysis his company could save millions of dollars a year by being savvy about its health benefits.
Will it lead to lasting change in Dave’s company? He’s hopeful — and he’s on the right track to push for change.
We need more working Americans like Dave to rise up. These same conversations should be happening at every company in the United States. There’s no justifiable reason for us to continue to overpay for health care. Let’s follow Dave’s example and demand a fair deal!
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