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Avoiding hospital over-charging

Whether you have health insurance or not, if you have an emergency and seek treatment at an emergency facility in the United States, you are at risk of being billed a huge amount of money for services that you may or may not have needed, and may or may not have been performed, at rates that many other people would not pay. Most people unknowingly sign away their rights to fair treatment when they show up at the emergency room. This page collects resources around how this happens and how to reduce your risks.

I’m at the hospital, it’s an emergency, what do I do?

• FIRST: DO NOT SIGN ANYTHING.
  • Many “Consent to Treatment” forms also include language where you agree to be billed for anything anyone does, “in-network” or “out of network” at any rate they choose to bill. You will be signing away your rights to contest invalid charges and over charges.
• Download this PDF of consent to treatment cards Print it out, and sign one, and present that at check-in. (original source)
• If you can’t print the card, get a piece of paper (anything with a blank side), write the words from the card on paper, and sign that.
• If they refuse to take your consent card:
  • Take a picture, if possible, of your signed card at the reception desk.
  • If you feel comfortable reading legalese, demand a paper form, cross out anything related to billing, and sign that form.
  • If they insist on you signing an electronic form (for example on an ipad) which does not allow you to cross out billing language, tell them that you do not consent, and sign the form on the ipad with “DID NOT READ.”
  • Make sure you document who you spoke with (send yourself a text message if that’s all you’ve got, or write it on the back of any paper form you can find).
• If they try to not treat you, let them know that a law called EMTALA requires them to provide you treatment in an emergency, regardless of your ability to pay. Raise hell.

Resources about medical over-billing and how to protect your rights

This page is the distillation of information found in a number of places about how people, with and without insurance, end up frequently being billed exhorbitant rates for procedures, can be billed out-of-network rates at in-network hospitals, can be billed for unnecessary procedures, can be billed for procedures that were never performed, etc. There are some strategies you can employ to help protect your rights in these situations.

First, there is a doctor named Marty Makary, who is also a NYT best-selling author, who has focused on this area for years now. Digging in a bit into the work he’s doing in this area:

• He wrote an article, “How hospitals overcharge patients, and what you can do to fight back” that’s a great overview of what we’re talking about here.
• He is a speaker in a video, Is there a CURE for Employees’ Surprise Medical Bills? (youtube) where he goes into some more detail on these issues, and discusses a “battlefield consent” form – i.e., a card you can carry to consent to treatment and to limit your risk of inappropriate billing later. That video also has examples of how to use this (see around minute 40 for the latter matterial).
• This video is summarized briefly in “Webinar Recap: Is there a CURE for Employees’ Surprise Medical Bills?”
• An actual “battlefield consent” card was made available after that talk at Quizzify: Emergency Consent, and you can download the PDF (as listed above). I also have the PDF mirrored here in case the original site should change or be offline.
• Additionally, Dr. Makary’s most recent book The Price We Pay: What Broke American Health Care–and How to Fix It digs deeper.
• The site Healthcare Blue Book makes it possible to find the cost, at various providers, of medical procedures and tests. If you’re not in an emergency situation, this sort of pricing information can be key in negotiating and choosing where to get elective or necessary but not time-sensitive procedures done. It’s also one way to determine what the fair cost for a procedure actually is.

Advice

Distilling down some of my personal take-aways:

• Print out, sign, laminate (ideally), and carry (and stash in various places: wallet, purse, car glovebox, at home, etc.) the emergency consent (“battlefield consent”) card(s) from above.
• Use HealthCare Blue Book to find reasonable prices and providers for upcoming medical tests and procedures. Shop around, talk to your providers.
• Talk to friends and family about how to deal with an emergency medical event, including this information and especially the checklist at the top of the page. DON’T SIGN ANYTHING, and use your battlefield consent card.
• Note that standalone emergency rooms (separate building emergency rooms that are beginning to pop up in more places), if they are part of a hospital, are covered by EMTALA, but if they are not (and many are not) they may not be covered by EMTALA. They often have high rates and you have fewer rights. Similarly, urgent care facilities that are part of a hospital organization will typically be covered by EMTALA, but others may not, and it helps to know, and it helps to ask, if you can, when you show up.
• You can negotiate down bills before, during, and after. If you didn’t consent to pay for unnecessary procedures, if procedures are incorrectly coded, not coded, and so on, you have a lot of room to dispute. If you were treated under your battlefield consent terms, or in a situation where you refused to consent to the hospital’s billing legalese, you have a lot more negotiating leverage, and your bill may not even be collectible if sent to collections.
• When in doubt, talk to the doctor(s) who performed your procedure(s), they are likely unaware if you’re being over-billed and may even go to bat for you.

Disclaimers

I am not a lawyer, medical professional, or anything like that. This is not legal advice. Do your own research, consult with your own legal professionals.

I put this page together to aggregate information that I found, via the prompting of my own physician, who suggested certain books and websites to look into. I’m making this available so that if I have an emergency I and my friends/family know what to do; and I can provide this to my friends and family so that they can protect their own rights when emergencies happen.