The US healthcare system is deeply flawed. Each year, millions of Americans are overcharged or underserved while healthcare companies rake in record profits. We know something is wrong, but the bureaucratic red tape discourages people from speaking up. Healthcare companies want you to think you’re powerless against them.
But there are ways to fight back and get the care you need. In his book “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win”, investigative journalist Marshall Allen draws on 15 years of health industry reporting to show how individuals and employers have beaten the system.
Allen reveals the pressure points of the US healthcare complex and how regular people have battled overbilling, price gouging, claim denials, and more. He lays out practical strategies anyone can use to protect themselves against predatory practices and get the care they deserve.
Here are some of the key takeaways from Allen’s indispensable book:
Know Your Rights as a Healthcare Consumer
You have more power than you realize when it comes to interacting with doctors hospitals and insurance companies. But you need to educate yourself on your rights under the law.
For instance, did you know that you can appeal any insurance claim denial? Federal law guarantees your right to an appeal. Most denials are overturned on the first appeal when properly contested. Don’t take no for an answer.
Analyze and Contest Medical Bills
Never just pay a medical bill without scrutinizing it first. Bills often contain errors and overcharges. Go through each item carefully and check it against the insurance company’s explanation of benefits. Verify the dates, procedures, diagnoses, fees, and more.
If you find discrepancies, contest the bill. Call the billing office and push back on unreasonable charges. Ask detailed questions and demand answers. Often the provider will back down and reduce the bill.
Obtain Billing Codes in Advance
The medical industry uses standardized billing codes to charge for procedures and services. Get a complete list of codes before undergoing any significant treatment.
Compare the codes you receive beforehand to the ones on the final bill. This allows you to contest any tacked-on or inflated codes that don’t match the initial list.
Add Patient Protection Clauses
Before signing any hospital admissions forms or financial documents, write in clauses to protect yourself from overbilling.
For example: “This admission form is not a contract to pay excessive fees. Charges will be paid once reconciled with insurance company allowable amounts.”
Use Small Claims Court
If a hospital or doctor refuses to budge on an unjust bill, take them to small claims court. The cost to file is minimal, yet hospitals often settle rather than send legal representation.
Prepare documentation showing billing errors and discrepancies. Bring medical experts who can explain how you were overcharged.
File Complaints
If you experience negligence, overcharging, or denial of care, file formal complaints with regulators.
For doctors, contact your state medical board. For hospitals contact the state department of health. For insurance denials, contact your state department of insurance. Filing a complaint creates a paper trail of wrongdoing.
Report Fraud
If you encounter particularly egregious wrongdoing such as fraudulent billing or falsified records, don’t hesitate to report it. Federal law provides financial incentives for whistleblowers who expose fraud against the government.
You can file a “qui tam” lawsuit and receive 15-30% of the amount the government recoups This has resulted in many mega settlements against healthcare corporations.
Negotiate With Cash
If you have the ability to pay cash for treatment, use this as leverage to negotiate better deals. Many providers charge insured patients exorbitant amounts but will offer deep discounts for cash payment.
Ask questions like: “How much if I pay cash today?” Cash puts you in a stronger bargaining position.
Shop Around
The healthcare marketplace is opaque by design. Providers know it’s extremely difficult for patients to compare prices beforehand.
Turn the tables by doing comparison shopping. Get cost estimates from multiple providers for expensive treatments and procedures. Go with the best value.
Scrutinize Ambulance Bills
Ambulance transportation can be vital during emergencies. But ambulance companies often exploit patients through predatory billing practices like balance billing and add-on fees.
Thoroughly review any ambulance bill and contest inflated charges. Check if the company is in-network or out-of-network. Negotiate the bill and report wrongdoing.
Maintain Good Records
Save all paperwork related to medical treatment, especially bills, insurance statements, and communications with healthcare providers. These records enable you to fight billing errors and unjust charges.
Create a file folder or binder for each medical incident and keep every document together. Thorough documentation strengthens your case if a dispute arises.
Know Your Insurance Plan
Read your health insurance policy closely so you fully understand covered benefits, exclusions, out-of-network rules, and the appeals process. Far too many patients realize too late that expensive care wasn’t covered.
Stay up to date as insurers frequently make changes. Use your detailed knowledge of the plan to push back against unwarranted claim denials.
Talk to Former Employees
Current healthcare company employees are often afraid to criticize their employer. But former employees who no longer work there can provide inside information about shady practices.
Try contacting ex-staff on LinkedIn. Ask about billing fraud, unneeded care, internal policies, and more. Their insider perspective can bolster your case against the company.
Report to Regulators
Government regulators like state insurance departments rely on consumer complaints to identify patterns of wrongdoing within healthcare companies.
File detailed, documented complaints about any mistreatment by insurers, hospitals, doctors, and ambulance services. Your complaint helps regulators take action against unethical behavior.
Partner With Employers
If your employer-provided health plan has denied coverage or claims, ask your company for help pushing back. Employers have clout since they pay insurance premiums for many covered lives.
Rally your coworkers if they’ve experienced similar issues. Have the company’s benefits manager intervene on your behalf.
Crowdsource Information
Websites like Reddit and Quora contain a treasure trove of advice on battling the healthcare industry written by people who’ve done it successfully.
Search the sites for details on fighting denials by your specific insurer, negotiating bills from your local hospital, and more. Their real-world tips can help strengthen your case.
The deck is stacked against ordinary Americans by this unfair system. But we can educate and empower ourselves to get the medical care we need without financial ruin. Through persistence and calling out injustice, we can gradually help reform healthcare for the benefit of all.
One Nation Under GunsDominic ErdozainHardcover$200
Listen to a sample from Never Pay the First Bill
Marshall Allen is a reporter for ProPublica, where he covers the health care industry. He is a Pulitzer Prize finalist and recipient of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting. He teaches investigative reporting at the Newmark Graduate… More about Marshall Allen
Marshall Allen is a reporter for ProPublica, where he covers the health care industry. He is a Pulitzer Prize finalist and recipient of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting. He teaches investigative reporting at the Newmark Graduate… More about Marshall Allen
Marshall Allen is a reporter for ProPublica, where he covers the health care industry. He is a Pulitzer Prize finalist and recipient of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting. He teaches investigative reporting at the Newmark Graduate… More about Marshall Allen
Never Pay The First Bill – Fight the Healthcare System and Win
FAQ
What happens if you don’t pay medical bills in America?
Can medical debt be forgiven?
What happens if you don’t pay a hospital bill in Texas?
What happens if you don’t pay medical bills in California?
What is never pay the first bill?
Never Pay the First Bill is the guerilla guide to health care the American people and employers need. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen shows how companies and individuals have managed to force medical providers to play fair, and shows how you can, too.
Are You struggling to pay medical bills?
But then the bills come – hundreds, maybe thousands, maybe hundreds of thousands of dollars. So many Americans are struggling to pay medical bills – unexpected debt that for some leads to financial ruin. Marshall Allen is an investigative reporter, and he’s been digging through medical bills for years.
What if I’ve struggled to pay a hospital bill?
If you’ve struggled to pay a hospital bill to the point you’ve been threatened with collections, fill out the form on the page and tell us about it. It’s possible you were overbilled and may be able to take legal action to have the bill thrown out.
When should you pay your first medical bill?
But the principle that we have in the title is never pay the first bill until you have checked it to make sure that it’s accurate and to make sure that it’s fairly priced. And so those are two things that every patient should examine because most medical bills, according to people who review them for a living, contain some kind of an error.