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How to avoid getting gouged by hospital bills

After our last post looking at why hospital “sticker prices” are so ridiculously high. Some readers were wondering if there were ways to avoid getting gouged by hospitals.

Unfortunately hospitals charge these outrageous prices to the uninsured because they usually can get away with it. Patients don’t have a lot of leverage– it’s not like you can shop around, since finding accurate price information from hospitals is nearly impossible. And if you’re rushed to the emergency room with a life-threatening condition you can’t exactly threaten to take your business elsewhere.

Still there are a few things you can do that can help reduce your health care bills.  

Avoid the hospital, when possible

Hospitals, and in particular hospital emergency rooms, are the most expensive places to get care. If you need preventative care or treatment for a non-life threatening illness, there are other options:

Community Health Centers: These are federally funded health care clinics where no one is turned away due to lack of insurance or inability to pay. Patients pay what they can afford, on a sliding scale based on income. Most community health centers provide a wide range of services:

  • checkups and preventative care;
  • treatment for illnesses;
  • complete pregnancy care;
  • immunizations and checkups for kids;
  • dental care and prescription drugs; and
  • mental health and substance abuse care.

One drawback is that due to high demand, it can be a long wait for new patients to get an appointment at many centers– sometimes it can take months for a first appointment (once you become a patient, wait times for appointments usually aren’t as long). It depends on the center though- some are able to provide same or next day appointments even for new patients.

To find a community health center near you, simply enter your address, county, or state here, on the HRSA website.

Retail Care Clinics: Also known as “Convenient Care Clinics” or “Walk-In Clinics,” these are health care clinics located in retail stores, supermarkets, or pharmacies that provide preventative services and treat minor illness. Unlike community health centers, they don’t charge based on a sliding scale, but they are cheap and usually have very short wait times (like 15 minutes).

A study in the journal Annals of Internal Medicine looked at the costs and quality of care provided for patients with ear, throat, and urinary infections. Here’s how the average costs stacked up:

  • $110 for retail clinics, versus
  • $166 at a doctor’s office,
  • $156 at an urgent care clinic, and
  • $570(!) at the emergency room

The study also found that retail clinics, urgent care clinics, and doctors offices all provided roughly the same quality of care, while emergency rooms’ quality scores were significantly lower.

One downside to retail clinics is that they’re usually staffed by non-physician providers (physician assistants and nurse practitioners), so they can only treat a limited number of minor illnesses.

Urgent Care Clinics: These are similar to retail clinics, but differ in a couple important ways. For starters, retail clinics are usually located in another store or shopping center, while urgent care clinics tend to be freestanding.

But a more important difference is that urgent care clinics always have a physician on site, which means they can treat more serious conditions like sprains, strains, lacerations, contusions, back pain, fractures and even minor surgeries. And while retail clinics treat children only 18 months and older, urgent care clinics can treat all ages.

Unfortunately having a physician on site means that the cost is usually only slightly cheaper than going to a doctor’s office (but still much, much cheaper than the emergency room). Also, unlike many physicians offices, urgent care clinics are usually open late, and you can walk in without an appointment.

Health Care Hacks has a helpful suggestion for deciding whether a retail care or urgent care clinic would be right for you:

If you have a major but non-life threatening condition, you are better off at the urgent care center. However, if you only have a minor thing, and have the choice, you can be seen much faster [and more cheaply] at a retail clinic where average wait times are 15 minutes, whereas average waiting time at urgent care ones can be anywhere between 15 and 45 minutes.

Find out if the hospital has a charity care program

For serious illnesses, you have to go the hospital. If you have the choice, nonprofit hospitals are your best bet, because they have to provide “community benefits” as a condition of their not-for-profit status. Often this means free or reduced priced care to patients without insurance who demonstrate financial need and who don’t qualify for other programs. It’s usually on some type of sliding scale– for example at UPMC in Pittsburgh:

  • If your income and assets falls below 200% of the federal poverty line (FPL), they’ll wave all fees
  • If it’s between 201% and 300% of the FPL, they’ll reduce the bill by 80%
  • If it’s between 301% and 400% of the FPL, they’ll reduce the bill by 70%

Before health reform, often hospitals wouldn’t publicize these lower rates, but the new law requires them to inform patients about charity care options. Still it’s important to ask.

Also it’s worth noting that not all hospitals provide their community benefits in the form of charity care, as the Progressive States Network explains:

In return for their non-profit status and $12.6 billion in federal, state, and local tax exemptions, these hospitals must provide a “community benefit.”  Many people assume this means charity care, or free care for the uninsured and indigent, but the term is so loosely defined that some non-profits have been reporting the wages they pay to employees as a community benefit.

Negotiate

Remember that the “sticker price” for care is often three or four times the cost of providing that care, and several times what hospitals will charge insurance companies. Unfortunately hospitals have no problem threatening you with collections and ruining your credit if you don’t pay– no matter how unfair the bill is. Still, often it’s easier for hospitals to accept a lower payment than going through the collections process, so if you’re uninsured, it’s always worth trying to negotiate for a lower bill.

Look out for balance billing

Our last post mentioned balance billing- a practice where doctors and hospitals who want to get paid more than the insurance company’s rate will charge patients for the difference. The New York Times has a great list of ways to avoid being balance billed.  Here’s a sample:

NEGOTIATE AFTERWARD, TOO When confronted with a balance bill, do not hesitate to call the doctor and discuss payment. Ask why he or she feels the insurance payment is not sufficient and why you were not informed of the excess fees ahead of time.

Often, a provider will compromise, Ms. Cooper said. At the very least you can work out a payment plan and keep the bill out of collections.

Definitely check out the entire article here.

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