Frequently Asked Questions
Below you will find a list of some of the most asked questions we find ourselves answering for our clients. Do you have a question you don’t see below? Contact us and we’ll be happy to answer it for you.
- What does an “adjustment” on my bill mean?
- I don’t have insurance, but there’s still an “adjustment” on my bill. What is it?
- How do I know if my bill is fair?
- I think my bill is fair, but I still want to dispute it. Can I?
- Why isn’t there any detail on my bill?
- If I dispute my bill, will it prevent it from going to collections?
- If I dispute my bill, will it go on my credit report?
- If a bill goes on my credit report as disputed, will it affect my credit?
- Can a collections agency garnish my wages?
- If a bill is reported on my credit report, can I have it removed?
- I disputed the bill, but the collections agency doesn’t seem to know that. Now what?
- Should I send my dispute to the collections agency?
- The collections agency said it validated my bill. What now?
- Why is is important to dispute my bill?
- Why did my insurance company deny a bill that, to me, obviously should be covered?
- I appealed a denied claim, but my insurance company denied my appeal. What should I do?
- How do I get a copy of my medical records?
- Why would I want/need a copy of my medical records?
- Why should I take the risk and dispute my bill if there are no guarantees?
1. What does an “adjustment” on my bill mean?
An adjustment on your bill reflects the fact that your insurance company has negotiated some kind of reduction to the biller’s price list (sometimes called the chargemaster, particularly in the case of a hospital). This negotiated price might be a fixed price your insurance company has agreed to provide for the service, or it might be a percentage reduction to the biller’s price list. In almost all cases, the agreement between the provider and in the insurance company is considered a confidential agreement. We think this is wrong and we look forward to challenging it in court. The idea that an insurance company and a medical provider have agreed to a secret price list, yet one is providing a service to you (the medical provider) and the other is supposedly acting on your behalf (the insurance company) defines any notion of logic or fairness.
The “adjustment” does not generally represent an amount paid by your insurance company.
2. I don’t have insurance, but there’s still an “adjustment” on my bill. What is it?
Many states have rules regarding how much an uninsured patient can be charged. The rules vary by state. The adjustment is most likely the amount that your bill was discounted.
3. How do I know if my bill is fair?
There are many ways to check if the amount you are being charged is a reasonable price. One of the best resources is www.healthcarebluebook.com. Additionally, many states have started to create what’s known as “all payer claims databases.” If you search for that phrase and your state, you might find it. Finally, if you have insurance, you can check your insurer’s website or call them. At BrokenHealthcare.org, we don’t believe you should have to wonder if you are being billed fairly. There is no reason we cannot have ALL of the information about a providers pricing in advance. Excuses provided by the provider and insurance industries are just that—excuses.
4. I think my bill is fair, but I still want to dispute it. Can I?
YES! Until we know without a doubt, quickly, easily and transparently that each and every bill is fair, you can use our method to dispute your bill. You shouldn’t have to do research to determine whether or not your bill is fair and we shouldn’t be purchasing and negotiating for healthcare like we’re buying a used car. Many people don’t have the time, the experience or the resources to do so. Many don’t even know that it’s necessary. Every procedure, every service and exactly how you are charged given your particular insurance plan should be at your fingertips. There is no rational explanation as to why that is too difficult. Even if you think the cost is fair, we encourage you to join join the fight to make the system transparent, fair and understandable for everyone by disputing your bill.
5. Why isn’t there any detail on my bill?
It’s amazing, isn’t it? Because as soon as you ask for it, you will receive a bill with what’s generally called, “line item detail.” Unfortunately, the line items are not things that actually show up in your medical record and in many cases you will not be given the information that is sent to your insurance company. The excuse used by medical billers is that it’s too complicated for us to understand. Unfortunately for them, we are now demanding that very explanation.
6. If I dispute my bill, will it prevent it from going to collections?
Probably not. Sometimes with smaller labs and physicians’ practices, it will, but not with bigger practices or hospitals. That’s okay. If you have a legitimate dispute created, they have to acknowledge that. When a bill goes to collections and the collections agency finds out you have a dispute with the biller, they have an obligation to conduct due diligence on the bill. Generally, they do an inadequate job and merely get another copy of the bill from the medical provider. At that point, you need to let them know there is a serious dispute and that you need much more than the simple line item detail. Refer to the dispute process for more on this.
7. If I dispute my bill, will it go on my credit report?
Not always, but it is possible. What’s most important is that when it goes to a collections agency, you ensure they mark the bill “disputed.” Disputed medical bills have a much lesser impact on credit ratings.
This is when things get contentious. Thus far, each time this has happened, on the advice of BrokenHealthcare.org the patient has either sued or let the collections agency know they intend to sue both the bill collector and the original medical provider. Then it’s up to the bill collector to either remove the negative mark and settle the account or proceed to court.
This is when we want you to call us. We have many volunteer attorneys and we have prepared the legal arguments. While a court will very likely order you to pay a fair and reasonable price in the end, the goal is to force everything out in the open and to have the court affirm our right to information. Thus far, no bill collector has proceeded to court. They have walked away 100 percent of the time because it’s not worth their time and effort, and they know they cannot win without providing reasonable information.
8. If a bill goes on my credit report as disputed, will it affect my credit?
It’s possible but probably not. Generally speaking, disputed medical bills have little to no effect on your credit rating. However, that doesn’t mean a lender (for example) won’t factor it in. Also, you can almost always have it removed by paying the bill, so you really have little to lose by putting up a fight in the first place.
9. Can a collections agency garnish my wages?
It’s possible but they need a judgment first. This is something generally misunderstood. If you’re disputing the bill, it’ll be harder for them to get that judgment and those are the fights we’re looking for. Many people fear words like, “garnished wages” but that’s only a major risk if you ignore your bills and make it easy for the bill collector to get a judgment against you. If you are disputing your bill and fighting back, it’s going to be much harder for them. They can’t simply do it.
10. If a bill is reported on my credit report, can I have it removed?
Most likely. So far, we’ve had them removed 100 percent of the time. We’ve had them removed by initiating, or threatening to initiate, legal action naming the collections agency and the medical provider. Laws have also been proposed in Congress that would prevent disputed medical debts from affecting your credit. And while it’s not in law, it has been an unwritten rule that when medical debts are paid, the negative mark is removed. In other words, the risk is much less than you might otherwise expect.
11. I disputed the bill, but the collections agency doesn’t seem to know that. Now what?
Call them and make sure they know. Or write them a letter. Tell them that you’ve been disputing the bill with the hospital, physician, etc. for several months. Usually, hospitals don’t mark your bill as disputed or forward your dispute letters to the collections agency, even though your letters demand they do just that. They cite privacy concerns, which is a nonsensical excuse, especially when you’ve requested they do so in writing.
The collections agency might ask you to send them the dispute letters. You can if you like—there’s nothing wrong with it—but we do not ourselves. We demand they get the dispute letters from the biller and that they have the biller address our questions and concerns. If the biller doesn’t cooperate, your bill will almost always get dropped.
12. Should I send my dispute to the collections agency?
You can, but you don’t have to. They have a legal obligation to do due diligence on your case. It’s THEIR responsibility to have a clear record of the dispute. We’ve never once had a collections agency tell us it was our job to provide proof of the dispute. They have to do their due diligence. Also refer to the prior question.
13. The collections agency said it validated my bill. What now?
You keep disputing it. This doesn’t mean anything. All they are saying is that they contacted the hospital and the hospital said, “Yeah, we sent them that bill.” You call them up and tell them you’ve been requesting an itemized bill, billing information and whatever else you’ve asked for. Tell them that you have no way of confirming you received those services without it. You have rights. Say that you also want to validate the bill. You don’t have to leave it to them to audit your bill, you can do it yourself. We also recommend you get a copy of your medical record to compare to your bill.
14. Why is it important to dispute my bill?
So that you have legal grounds to stand on. If it goes to court, it will anger a judge and jury that you’re requesting basic information from the hospital and they’re refusing to give it to you. It also shows that you are serious, that you’re not going away and that you’re willing to pay if they give you the information and the charges appear to be legitimate, accurate and fair. Ignoring a bill makes it easier for a collections agency or hospital to win in court. Disputing it makes it very difficult. Government reports suggest that the majority of hospital bills have errors in them and that those errors almost always favor the hospital.
15. Why did my insurance company deny a bill that, to me, obviously should be covered?
The insurance companies don’t have anyone to hold them accountable. We find that sometimes they deny claims simply because they can. This is ridiculous and unlawful, but they get away with it by citing their appeals process. You can always appeal their decision. You can appeal their rejection of your appeal. You can file a complaint with your state insurance commission. If you’re insured through your employer, they sometimes have someone who can advocate on your behalf as well.
16. I appealed a denied claim, but my insurance company denied my appeal. What should I do?
Appeal again! We recommend that you appeal as many as three times–sometimes it can take that long to get an insurance company to hold up their end of the deal. If they STILL deny what you think they’re obligated to pay, you can file a complaint with your state insurance commissioner and attach the complaint to your next appeal.
17. How do I get a copy of my medical records?
Many hospital and facilities have online access. You can find out by using the internet to search “hospital online medical records” and the name of your hospital. If you don’t find out that way, you can call the hospital customer service number and ask. We recommend using the online option if available, because some states are authorized to charge per page for your record. If you need a copy for your doctor, they’ll usually fax it straight to them.
18. Why would I want/need a copy of my medical records?
Hospitals and emergency rooms typically deal with short-term problems and then send you to your doctor to follow-up or deal with the long-term problems. It’s good to have your medical records so your doctor knows what tests they’ve run and you don’t have to pay for multiple of the same tests.
Also, without your medical record, there’s no way for you to review your bill and validate that all of the services and medications you’re being charged for were actually provided.
19. Why should I take the risk and dispute my bill if there are no guarantees?
While there are no guarantees, we’ve had a lot of success. Not only will this help you save a lot of money in the short-term, but when we achieve the goal of healthcare price transparency, you’ll be able to make better, more informed healthcare purchase decisions in the future. You’ll be helping your fellow Americans, too. By disputing your bill, you’re joining a movement.