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The Long Road To Erasing a $224,000 Medical Bill
It took know-how, endurance and an advocate funded by you, the readers of this newsletter. But we made a medical bill the size of a house disappear.
Sometimes the breakthrough that leads to victory happens when you’ve almost given up.
In this battle against a hospital bill, the stakes were unusually high. The balance came to $224,762.
My involvement began in October 2021. A woman named Diane - I’m only using her first name to protect the identity of the patient, who is her sister – heard me interviewed on GMA 3. She sent me a message, as many people do, through my website. It’s fun for me to help people hack the health care system, so I responded right away.
Diane told me a complicated story. Her sister, who was disabled and unable to work, had peripheral vascular disease and in April 2021 had to be taken to AdventHealth Orlando, where she underwent surgery and treatment over the course of 12 days. She had an individual insurance plan through Cigna, but it was based in a different state, where she was a resident.
Cigna denied payment because the hospital was out-of-network, leaving the sister with a massive bill.
When I talked to Diane the first time we discussed two options: appealing to Cigna to get the insurer to pay the bill, or getting financial assistance through the hospital. Sometimes you have to try multiple angles to overcome these challenges, and in this case, applying for financial assistance seemed like the easiest route. I write about the policies in my book, Never Pay the First Bill, and feature them in my video curriculum, The Never Pay Pathway.
Nonprofit hospitals are required by the IRS to provide financial assistance to low income patients. In this case, the sister had a meager income from Social Security and a small monthly stipend from a trust fund that could only be applied to her living expenses. So in November 2021 Diane applied for financial assistance on her sister’s behalf.
It didn’t seem like it should take too long. Little did we know then that it was only the start of the journey.
Sometimes hospitals try to avoid granting financial assistance, even to patients who clearly qualify. Often they keep the financial assistance option hush-hush, as I wrote about recently. Patients and their loved ones must be prepared to press their case.
In January 2022, the hospital responded to the application with an odd denial. “The insurance has determined that the services for the balance were not medically necessary. Therefore, Advent Health charity is not an option.”
Not medically necessary? Diane and I discussed the strange response and decided on a logical response. “If it wasn't medically necessary then why would the doctor have done the surgery?” Diane responded.
The hospital never claimed again that the services were not medically necessary.
But it still sat on the financial assistance application.
Around this time I started raising money from the readers of this newsletter, to hire patient advocates in complicated cases like this one. You all have been generous. I previously shared how an advocate funded by this newsletter’s subscribers helped a patient whose insurer had denied 273 of her claims at once. In this case, I used some of the donated funds to hire Gayle Byck. She worked on it on and off for about a year to bring about its resolution.
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Gayle decided to appeal Cigna’s decision to deny payment for the treatment. She succeeded! Cigna approved payment, but then later backtracked. The situation between the insurer and hospital got messy - with the patient in the middle. The case languished for months with Gayle and Diane checking in periodically with the hospital.
On January 16 of this year, Gayle tried a method that’s always worked for her in the past: she overnighted a letter to the hospital CFO. The letter explained that the sister’s taxable income for 2021 was zero. Her projected income for 2023 is about $12,000 in Social Security payments - below the Federal Poverty Level.
She sent emails and left voicemails to follow up, but never got a response.
I kept tabs on this via email and with occasional updates from Gayle and Diane. AdventHealth wasn’t sending bills to the patient, but it also was not responding to the application for financial assistance.
In March, Diane decided to apply another tip from the playbook I lay out in my book and videos. In my chapter and video about winning insurance company appeals, I feature the advice of Laurie Todd, aka The Insurance Warrior. When Laurie sends her appeal memos to insurance companies, she sends a copy to all the top executives at the company and any other big name influencers that might be able to add to the perception that the appeal memo is a BIG DEAL. The goal is to get the request in the hands of a decisionmaker - and elevate its urgency so the decisionmaker takes action.
Diane emailed Gayle and suggested that they try the tactic. They put together an email list of the top executives at AdventHealth and Gayle sent them an email blast, with the same request to respond to the financial assistance application.
The next morning, Diane’s sister received an email from AdventHealth. “You have qualified for Charity Assistance,” the letter said, “your balance is now $0.00.”
POOF! The $224,762 bill disappeared. Sitting at her kitchen table, Diane put her head down and cried. Now her sister’s limited income could be applied to her living expenses. “What a relief,” Diane said. “It was just such a relief.”
Diane expressed appreciation for the donors to this newsletter who were able to fund Gayle’s work. Without Gayle, Diane said she’d still be spinning her wheels, with the stress continuing to mount.
“There was no money they could get from [the patient] anyway,” Gayle added. “Once it went to the right person it was taken care of in less than 24 hours.”
Hopefully you won’t ever face a medical bill for $224,000. But this case has important lessons that we can all apply in all of our medical billing battles.
Don’t give up. You may need to persist and take more than one route to victory.
Go to the top. Find out who the decision makers are and contact them directly. “I tell people all the time that you’re not going to get anywhere by calling the number on your billing statement,” Gayle said to me.
Reach out for help. You may not be able to afford a professional patient advocate. But reach out to me and I can help you or try and find someone who can.
Be patient. Sometimes cases are resolved easily, but they may take months. Try not to feel stressed and keep pushing it forward.
And of course - it goes without saying that people need to get educated. The information in my book and health literacy videos can save people from medical debt and bankruptcy. Please help spread the word!
I love to see working Americans have their mindset flipped by effective health literacy education. Our health care system isn’t broken. It was designed this way. It’s no accident that employers and working Americans keep paying more than they should for health care. But employees are not powerless.
Does your organization sponsor health benefits for your employees?
Want to see them get equipped to be savvy health care consumers?
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 email@example.com for more information.