Our Process

The Process

Business people leaning on table in meeting

Brokenhealthcare.org’s system of fighting unfair billing is centered on “Denial of Payment.” Our website is here to provide patients with the information they need to properly and effectively fight these unfair bills and to ultimately change the system. We will also offer advice, help draft letters, communicate with hospitals and collection agencies and, when necessary, provide pro-bono legal representation to patients.

Your Letter Writing Campaign

Our process for denying payment is simple and straightforward. It is designed to be effective without hurting your credit rating. You will be engaged in a letter writing campaign. The core of this process is simply to demand information we believe every patient is entitled to, but that hospitals refuse to provide. You will be asking for specific information about your bills, which you should be entitled to but which hospitals consistently refuse to give. This information includes price lists, explanations of how prices are derived, bills that detail the services provided, details of the negotiations with insurance companies, uninsured discount policies and evidence that the hospitals are complying with price laws.

You will repeatedly assert that you will pay the bill once the hospital gives you the information you are requesting. The hospital will eventually pull the bill because it would rather lose your money than reveal details about its pricing and negotiated deals with insurance companies.

Each and every letter should state that, “I am disputing my bill. Please ensure my record is clearly marked disputed and be sure that should you send my bill to a collections agency, that you include a copy of all correspondence and mark the file as “disputed.”

The Bottom Line

The-Bottom-Line

You cannot be asked to pay more than you were originally billed. So what do you have to lose?
While we cannot guarantee that you will never have to pay your bill or the ultimate outcome in your individual case, based on our experience, every bill is arguable.

By challenging your bills and refusing to pay, you are not just saving yourself money. You are becoming part of a cause.
Only when enough of us deny payment to hospitals will they change their ways. We are trying to bring the system to its knees.

 

Before you start:

  • Make several copies of each your bills, or scan them for repeated use
  • Organize your bills so that you are addressing all bills related to each hospital visit together

 

Step One: Your First Letter

The first step in our process is to contact the hospital and request the following information (see sample letter)

  • A detailed copy of the bill
  • A copy of the hospital’s price list for all related services
  • An explanation of how the prices are derived
  • An explanation of how any discounts were derived

Just because you signed something saying you would be responsible for your bills does not mean you have agreed to simply pay any bill presented to you. Hospitals must explain their prices and how they are derived. It is insufficient for them to merely say the charges are “customary” or other such language.

Request an explanation of how they derived the price of services you are being charged for and ask for specifics. For example, is the bill based on the time you spent in the hospital, the time doctors and nurses spent with you, the skill level or years of experience of those who cared for you? What is the formula they are using to calculate your charges, if any?

See sample letter . Need help? Contact us

 

Step Two: When the Hospital Responds

  • If there is not enough detail so that you fully understand the bill, ask for more detail.
  • If they have not provided a price list, explain that you simply don’t have the confidence that you are being billed for the right services
  • If they have not explained the system by which prices are derived so that you understand it, request that they try again. Do not accept that it is too complicated. They have an obligation to explain their prices in a manner that you can understand.
  • If they do not explain their discounts or say that you should check with your insurance company, remind them that it is the hospital and not your insurance company that is asking you for money.
  • If your bill was reduced because your insurance company paid part of it, demand a copy of the agreement between them and your insurance company. It is not your problem that they say it is “confidential.”
  • On your second letter, be sure to end with: “Because I still do not have adequate explanation of my bill, I am formally disputing this bill. Should you decide to send my bill to a collection agency, be sure to mark the file, “DISPUTED.”

We are entitled to price lists so that we can shop for services. It is not enough that a hospitals says you can request an estimate for services. There are many things they might charge you for that were not included in your estimate. For example, if you have complications you might be charged for other things not in your original estimate, so it is only reason that you have a complete list of the hospital’s prices. Also, tell them you want the prices YOU will be charged, not their list prices (called a charge master).

See sample letter . Need help? Contact us

 

Step Three and Beyond:

Hospitals will likely continue to send you all kinds of explanations for why they can’t answer your questions. They may tell you pricing is private or confidential. They may tell you that there are just too many events or procedures that can happen in a hospital to list them all. They are likely to tell you that things are complicated, or are based on a system, or that they adhere to “benchmarks” and “standards.” It’s all nonsense because you are entitled to this information. It has been our experience that hospitals will argue that they can’t possibly provide all this information to every patient. That is also nonsense. They could simply put all of the information on their website once.

  • Be clear with the hospital that you are disputing your bill and will not pay it until you receive the information you have requested
  • Counter any argument against providing you with the requested information, by asserting that you can’t pay a bill without fully understanding it
  • Counter any suggestion that you seek information from your insurance company with the fact that you are disputing your hospitals bill, not your insurance bill

See sample letters . Need help? Contact us

 

Need Extra Help? Let Us Help You!

We offer advice, provides templates and a process anyone can follow, draft letters, contact hospitals and collections agencies, and even provide pro-bono legal representation. Call us at (303) 684-5869 or complete the Contact Us form and we will help you challenge hospital bills!

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