of the site
Want to save money on hospitalizations whether or not you’re insured?
Hospital bills can give
you more than a headache:
they can bankrupt you, too.
Dr. Pezzi explains in this page
how to save money, whether or
not you have medical insurance.
Even if you have medical insurance that covers hospitalizations, you may face astronomical co-payments and other charges. The situation is even worse for folks without insurance, who are typically billed far more than what hospitals accept from insurance companies.
Is there anything you can do about this? Yes, you can fight back, legally.
I'll explain. In my years as an emergency room doctor, I witnessed countless patients sign papers given to them by admitting clerks. Most patients sign those papers without reading or amending them in any way. By doing that, you are legally obligated to the terms of that contract. However, a few astute folks read them and crossed out ones not to their liking, or modified the contractual terms so they are more equitable. I never saw any clerk or hospital refuse those patients admission. I've sat in enough meetings with hospital administrators to know they want every penny they can get their hands on, so if they make only $16,000 from you instead of $20,000, then they'll accept that $16,000. It's far better than losing the money for the admission if you go to another hospital, and their ER doctors don't want the hassle of transferring you elsewhere.
So what do hospitals do? They accept your terms, instead of the other way around. The standard contracts that patients sign for emergency treatment and hospitalization are written by hospital attorneys who write one-sided documents favoring their clients, the hospitals.
Your financial health is imperiled by dirty tricks that hospitals often pull on their patients, such as charging for services, tests, medications, and procedures never rendered. (This and other hospital cons have been documented numerous times by 60 Minutes and other investigative journalists.) Try walking out of Wal-Mart without paying for a $5 item, and the store will call the police and prosecute you. In contrast, hospitals can fraudulently steal hundreds of times more from you and get off scot-free. Even if they are caught, they generally must only refund the overcharge. However, hospital bills are so difficult to make sense of that they can look like hieroglyphics even to doctors. Consequently, millions of patients have paid billions of dollars to hospitals that are, in my opinion, highly unethical for preying upon people when they are going through such vulnerable times in their lives.
How to fight back
Besides reading the hospital admission contract and crossing out or modifying any clause in it that is not agreeable to you, add the following:
For insured patients: You and all affiliated providers agree to accept my insurance coverage as payment in full for all charges related to this hospitalization.
For uninsured patients: As payment in full for all charges related to this hospitalization, you and all affiliated providers agree not to bill more than what you currently accept from any insurance company, Medicare, or Medicaid.
You may also wish to add the following terms whether or not you have medical insurance:
- You will furnish proof (not just an itemized list) that all products and services billed for were rendered.
- If you bill for any product or service not rendered, you agree to pay punitive damages of 1000 times the amount billed.
- You agree not to refer my account to a collection agency for any reason, whatsoever.
- If my treatment did not meet the standard of care in any way, or was otherwise imperfect due to an error of commission or omission, I owe nothing.
Don't overlook the tremendous bargaining power of the last clause. Hospitals are filled with overworked doctors and nurses who make mistakes in caring for most patients. I could fill dozens of books listing the errors I've personally seen and heard about. Even seemingly minor mistakes can have devastating consequences, as in this example.
Healthcare workers sometimes botch easy, routine procedures. For example, I went to a local hospital to have two lab tests performed. Even though they are supposedly one of the top hospitals in the United States, their phlebotomist made several errors in drawing my blood. He likely follows the same procedure on every patient, so not only is he incompetent, but he has incompetent supervisors, too. And what about his co-workers? Several of them worked together in one room; hadn't anyone noticed what he was doing wrong? Are they following the same inept procedure?
For all the lip service they give to "quality assurance," hospitals remain places in which errors remain a routine occurrence. Perhaps it isn't fair to have 100% of your bill forgiven if one error is made, but for years hospitals have been the sole arbiters of fairness. It's time to level the playing field and give patients the same power that hospitals enjoy. Since virtually all admissions can be shown to be imperfect (consult me to review your chart, and I'll refund every penny of the consultation fee if I cannot find at least one error or imperfection), you can use that last clause as a bargaining chip in negotiating a reduced fee with the hospital.
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How you can help hospitals improve their quality of service
I reviewed countless medical records during the years that I served on a hospital's Quality Assurance Committee. If I spotted an error, such as not doing something that should have been performed, I'd let the guilty doctor know about it. However, I'd see the same docs making the same errors month after month, year after year, in spite of numerous notices from me. Is there a better way to force them to improve? Yes. If they were not paid for cases in which they made a potentially serious error, it wouldn't take them long to shape up. Hospitals are so hidebound that they won't utilize money as a motivational factor, but consumers can use their power to send a strong message to them: We won't pay for subpar performance.
Regarding the clause about collection agencies: There is a limit as to how mean and nasty hospitals can get, so when they want to be more thuggish and still seem to be a lily-white institution that's a warm and fuzzy part of your community, they let collection agencies do the dirty work for them.
One of my relatives listed me as a reference on some credit card that he subsequently defaulted on. Since then, bill collectors have phoned innumerable times—sometimes every few minutes—hounding me, even though I don't owe them a penny. I've found that many bill collectors behave like atavistic, knuckle-dragging Neanderthals. If you think you have health problems now, just wait until you and your relatives suffer months of stress after hospitals sic a collection agency after you.
Exactly how can you add those clauses to the hospital admission contract?
You could:
- Print a copy on paper and carry it in your wallet or purse, and then copy those sentences to the contract before signing it. You may wish to cut the paper to the size of a credit card and laminate it (the printing on uncoated paper eventually scuffs off).
- Have a stamp made bearing the desired clauses, and stamp each duplicate page of the carbonless form.
For more information, and to see a real-life example of how one person used my advice to save money, see Saving money on ER & hospital bills.
Disclaimer: I am not a lawyer and cannot give legal advice. However, modifying the terms of a contract before you sign it seems to me to be a God-given right that no court could deny. You may wish to consult a licensed attorney in your state, who may give you additional recommendations to make the hospital admission contract more equitable. If so, please let me know about his suggestions so I can add them to my list. Thank you!
