How to Fight Surprise Medical Billing Effectively

Aaron Garcia
August 17, 2022
 Mins Read

Surprise medical billing has become extremely popular and confusing for many patients. Unaware patients get surprised when they receive a thousand-dollar bill that they believed their insurance already covered. A study states that each surprise bill had $2,011 worth in unexpected charges. Usually, it happens when they use their insurance at the healthcare service outside of the insurance provider’s network. In such cases, medical practitioners bill them for the balance amount that wasn’t paid by the insurer, and the patient is utterly perplexed. These cases also attract attention from the federal government and can put undue tension in the payment process. Also, since the healthcare industry is not constricted by market forces, the provider’s list prices can be extremely high. In this post, we help patients by giving them different ways to Tackle Surprise Billing Issues

What is Surprise Billing?

Most people choose providers in their circle to receive insurance. When the patient doesn’t pick his/her medical team, the hospital may select some ancillary providers that insurers don’t cover for. However, in some emergency cases, patients can’t pick their provider and end up availing services from centers that don’t belong to their network. Since they’re rushed to the nearest hospital without much thought, they’re billed if their insurer doesn’t cover for them. While insurers cover some costs, they don’t cover the entire amount for out-of-network providers. So, the patient is stuck with balance bills that they’re unable to pay immediately.

5 Ways to Tackle Surprise Billing Issues

Scan your Bills Carefully for Errors

Most healthcare provider’s billing teams handle a lot of information daily. Naturally, the medical staff can make errors while generating your bills. You’d be shocked to know that nearly 8 out of 10 hospital bills are faulty. So, it’s highly probable that you’re charged for the services you didn’t avail. Your bill may also have filled wrong or incomplete data about you on claims. For the services you availed, you might feel that you’re charged a lot more than you expected. Verify your bill to understand if they’ve charged extra for the medication brands your insurer doesn’t support. You’d also need to look at your insurance policy and be aware of any changes that affect your payment. So, even if you’re healthy, ensure you stay up-to-date on the communication from your insurance providers.

Also, make sure you receive an itemized bill that includes each service and its price separately. If your bill seems vague, request a detailed one from your medical practitioner’s billing team. Don’t be afraid to confront them and get clarity on what you’ll be paying for tests, scans, and any hospital-provided items. Additionally, record your bills and any data you receive from your hospitals. Prepare yourself by recording phone calls and storing relevant e-mails. If you’re unable to get a resolution, these documents will help you fight your case. If your costs exceed the estimate, ask your insurer why it happened. In such a case, ask your hospital if they’ll accept the original estimate amount.

Talk and Negotiate with your Care Providers

Ensure you establish good communication with your insurers, doctors, and healthcare centers to raise valid concerns. Ask your insurer to provide details on each itemized charge, and highlight the ones they didn’t cover. You can also ask your insurance company to negotiate with your healthcare centers and get a lower rate for your services. Additionally, you can also discuss and try to lower your excessive balance bill. To do that effectively, research the costs of services or surgeries you availed and use that as a parameter. Then, approach your hospital to understand if they’ll charge the market rate.

File an Official Complaint with your Insurance Company

If you’ve tried to resolve your issues through healthcare and insurance providers, you can take the legal way forward. By appealing with your insurance company or regulator, you can solve your surprise billing issues. Usually, you’ll find information and instructions about the appeals process on your medical bills. During that time, inform your doctor that you’re disputing your insurer, and request them to refrain from sending your bills to the collections department. To dispute the bill, ensure you collect notices and documents to back your claim from your medical practitioners. Hold on to the original documents and make multiple copies to prepare for the process.

Exploit the Shaky Legality of Billed Charges

When there isn’t a mutual agreement about the prices of services, courts usually pick the market rate. In many cases, courts will ask the providers to collect the market rates, and that can be much cheaper than your expensive bills. So, if you haven’t consented to hospital charges, request courts to waive these charges or offer lower rates. In case you’re offered a lower bill, ask your insurer to cover this reasonable cost for you. So, effectively you’ll end up paying from your pocket entirely.

Request Financial Aid or Easier Payment Plans

Suppose you discover that the costs are legitimate and that you’re liable to pay them. You can still ease your payment by asking your medical center for convenient payback options. Prefer the options that offer you the least interest rate. Most billing teams have plans in place that for you to use and pay your bills without putting it on a high-interest credit card. You could also find about the various financial aid schemes your healthcare provider offers. If you’re unemployed or don’t have insurance, these plans will help you out. After verifying your unemployment through bank statements, you’ll be eligible for these aids.

Throughout the process, ensure your doctors are aware about your payment status and patiently proceed through the steps to tackle these Surprise Medical Bills. With proper planning and effective messaging, you can easily reduce or nullify your charges.


We hope we cleared your doubts on the next steps to take to save yourself from surprise medical bill issues. So, if you’ve charged incorrectly, you know how to deal with it effectively. By being aware and proactively handling these issues, you can easily negotiate with relevant parties and reduce your costs.

Article by
Aaron Garcia

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