Preying on Grandma
A Medicare patient gets a surprise bill for almost $15,000. Two phone calls cleared it up.
My friend Val Engle’s mom got a scary surprise after receiving a routine steroid injection at a surgery center: a medical bill for almost $15,000.
Val’s mom is a sweet, conscientious, 87-year-old grandmother who doesn’t understand the predatory ways of the health care system. She took the bill at face value and panicked. “I always pay my bills. I’m never late on a bill,” she said to her daughter. “Am I going to have to sell my investments to pay for this?”
This bill was ludicrous. The steroid shot had been a routine outpatient procedure that took a few minutes. The statement showed that the surgery center charged $15,000!
Val’s mom is covered by Medicare, the government’s insurance for people who are disabled or over age 65. The bill from the surgery center showed the bill had been sent to Medicare, but the plan hadn’t paid anything. The bill showed that her secondary insurance plan paid $20.99 for the shot.
The facility billed Val’s mom for the balance: $14,979.01.
Val called me to talk about it. It was clearly a bogus bill. Medicare prohibits sending patients “balance bills” – aka “surprise” bills — for the amount of the charge that it does not cover. Private insurance plans now prohibit surprise bills in many cases, thanks to the No Surprises Act. I’ve written here about how the new law can protect working Americans on private insurance plans.
This looked like an obvious billing mistake – or a predatory biller going on a fishing expedition. Perhaps the bogus biller was sending a naive and vulnerable elderly woman a massive bill to see if she would pay up.
It almost worked!
My book Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win shows how employers and working Americans are being preyed upon financially by our health care system, and what they can do about it. I have not focused on bills related to Medicaid and Medicare, the government’s insurance plans for people who are low-income, disabled or over 65, because they aren’t the hardest hit by unreasonable and unjust health care costs. But this case got me thinking about how easy it would be to rip off Medicare patients by sending them bogus medical bills.
Val asked me not to name her mom or the surgery center in this story. Val’s mom is a heart patient and the situation had already caused her a tremendous amount of stress. caused Val’s mom a tremendous amount of stress.
I gave Val two suggestions that will help any Medicare patient beat back a bogus medical bill.
Call Medicare and confirm that balance billing is not allowed.
Val called the Medicare customer service number and confirmed that balance billing is prohibited. Then she asked the representative whether it was common for medical providers to try and extract more money from patients than what Medicare had allowed. “Without hesitation, the Medicare rep said ‘yes,’” Val told me.
That’s terrible! Have you heard of Medicare patients getting balance bills? If so, let’s do some crowdsourcing. Please share what you’ve seen or heard with me. Leave a comment here, email me at neverpay@marshallallen.com, message me on LinkedIn, or via my website marshallallen.com. Just let me know!
Call the bogus biller and press them to drop the bill
I gave Val some basic suggestions to help her successfully challenge the surgery center’s billing department. You want to signal in a non-confrontational manner that you know your stuff. The goal is to get them to back off with their bogus bill.
Val called the billing department and explained that there must be a mistake on the bill. She informed the billing representative that SHE CALLED MEDICARE and learned that MEDICARE ONLY ALLOWED a payment of about $300 for the procedure. Thus, a BALANCE BILL or ANY TYPE OF BILL to Val’s mom had to be a mistake.
“After I told them, ‘I called Medicare and they told me,’ they backed down,” Val told me.
The bogus bill got dropped.
Val’s mom ended up paying $226 - the amount of her deductible that had not been met.
Way to go, Val!
Sometimes battles over bogus bills can be prolonged. Other times, like this one, you can save thousands of dollars with just a couple of phone calls. The key is to know your rights and push back. Either way, it’s worth the fight to stand up for what’s right and save your money.
Val’s mom felt grateful and relieved to have the bill disappear. Val felt unsettled by the experience. It’s great to win a billing battle, but troubling to think of how common the problem might be. Val said she felt like she had been violated secondhand. “It just made me feel yucky that these people were trying to extract so much from these elderly patients,” she said.
Employers - let’s do a webinar to empower your employees
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Here’s what people are saying about my webinars:
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“Marshall's webinar helped my client and their employees better understand how to advocate for themselves when seeking medical care and save money on their healthcare. This particular client has an already aggressive cost containment strategy in place, and this webinar was instrumental in helping the team members understand why the employer does this and how to leverage those savings for themselves - before they meet their deductible. It was an hour very well spent.” Benefits advisor
My webinars demystify the health care system and show employees practical tips to save BIG MONEY on health care. Interested? Contact me at neverpay@marshallallen.com.
Employers - let’s equip your staff to save money on health care
I’m looking for bold 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 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.
I know there has been a move to identify providers that charge a "fair price". But there needs to be a movement to identify medical providers that still have a moral compass.