By Dale Sagen

Vice President, NFP Captive Practice

 A nonprofessional could summarize my career as a health insurance specialist. Often when close friends or family members need help with their health insurance or healthcare, I gladly offer pro bono support. In early 2022, I was asked by a family member to help them fight a medical bill they had received. This bill was for two simple office visits for their new, first born, healthy baby girl. The standard procedures only included well checks, blood work, and vaccines. The problem was not the care received, yet the total medical bill for those two office visits was $3,202. 

How could that be? You see, leading up to labor and delivery and into the first month of parenthood these parents were prepared. Family medical leave was enacted, they had a nursery ready, car seat was engaged, clothes were washed, and diapers were on standby. Still, they forgot one crucial item in the whirlwind of employment, healthcare, and novice parenting. They forgot to enroll their daughter on their employer sponsored health insurance plan. The plan had a 30-day special enrollment period post birth; however, it was missed. Because of that mistake, their new baby was uninsured until the next open enrollment period. 

Most providers (Hospitals and offices) will still see patients who are uninsured. There are in fact some federal and state laws that enforce that standard. Yet little has been done by legislators to limit what they will charge those patients for the care. 

Providers will have a base rate for the services they provide listed in what is called a chargemaster. This is essentially a price point that has been developed specifically for the uninsured. The reason is because when you have health insurance through an employer, a state exchange, Medicare, or a variety of other sources they generally have an agreement with providers to provide a discount from the chargemaster. To the usual individual with health insurance, you receive an explanation of benefits that shows discounts the insurance was able to attain on your behalf. The goal is a happy patient who feels the cost of their care was drastically reduced by approximately 50% (Chase, 2017). Most patients without these discounts through health insurance feel like they are being left out of the club and helpless to the doctor that they depend on for future care.

I was fortunate enough to attend the YOU Powered Symposium conference in Phoenix, again in early 2022, when a gentlemen named Marshall Allen was giving a keynote address. It was a unique speech as he is a journalist. Most presenters at conference I attend are either consultants, clinicians, or service providers for health plans. His analysis on healthcare was that the billing practice is cruel, and he had stories and data to back this up. I went home and ordered his book, “Never Pay the First Bill”, to arm myself for this hospital bill fight I had now become passionate about.

My courage was high after reading Mr. Allen’s book. There was a sample letter, citations to resources to compare cost, a guide to winning appeals, how to handle debt collectors, and when to sue in small claims court (Allen, 2021). I did not need much to win this battle though.

I requested an itemized bill and began my research on healthcare costs using a website called Fair Health Consumer (www.fairhealthconsumer.org). I was able match the procedure codes with the database to find a conservative estimate to the cost of care had the patient been enrolled in health insurance. I then wrote a letter to the provider listing their billed charges compared to typical insurance costs for that locality and asked for a 49% discount from billed charges. Pretty close to Mr. Chase’s average of 50%, which seemed fair.

The provider quickly accepted the discounted price for a total cost of $1,629. Some reading this will argue I could have fought harder or found financial assistance. However, we agreed this was an acceptable cost.

I hope this story empowers you to challenge egregious healthcare bills and help others do the same. With, or without health insurance.

Works Cited

Allen, M. (2021). Never Pay the First Bill. New York: Penguin Random House LLC.

Chase, D. (2017). CEO's Guide to Restoring the American Dream. Seattle: Health Rosetta Media.