Expert Advice

Urban legends won't pay your hospital bill

By David Miller

Have you heard that using your cell phone while filling up at the gas station can result in serious vehicular fires and injuries? Did anyone warn you to check underneath toilet seats in restaurants for the deadly Blush Spider, whose bite killed several people in northern Florida? Or, if you are Canadian, has anyone urged you to write your representative to block the proposed 5-cent surcharge on Internet e-mails to make up for Canada Post's lost revenue?

These are all recent urban legends and they are not true.

We've all received forwarded e-mails or heard whispered reports about events that seem a little too strange to be true, and usually they are. We should know immediately that these reports are tall tales, but they have a sliver of plausibility because they either hint at inside knowledge or touch a secret insecurity we all have, so it's difficult to completely dismiss them.

Still, they can be good fun as long as you don't fall for them.

Unfortunately, there are some urban legends circulating about health care billing and I hate to see people taken in by them.

One common misconception is that if you pay only one dollar a month on a large bill, that's enough to keep your account current; the provider won't be able to undertake collection proceedings. This is not true. Unless the provider has agreed to a payment plan of a dollar a month, they are entitled to press for collection of the whole amount at any time.

Or how about this gambit: Send the provider a check for part of the balance and write, "paid in full" on the check. If the provider cashes it, you don't owe the rest of the balance.

This is not entirely true.

It turns out you can offer a partial payment for certain disputed claims this way, but there are limits too (one man wrote, "paid in full" on his divorce settlement but the courts said that was foul play.) In reality, most providers will not cash this type of check -- they will return it to you and count your payment as past due.

Some patients have heard that hospital and doctor bills are negotiable -- that the bill is just the provider's first offer. If you make a counter offer for a lot less, the provider will accept it and you'll save money.

A variant of this involves submitting a negotiation offer to a provider on a form that looks like it came from a self-help legal guide. It could work if the provider feels inclined to accept the offer but it is under no obligation to take less, and most won't unless you qualify for some type of charity care program. The form doesn't help a bit, by the way.

Another legend holds that you are not responsible for a spouse's or child's medical bills if someone else took them to the doctor or hospital without notifying you (often times this someone is the non custodial spouse).

This is not true, either. Since you are responsible for your spouse or child, you are responsible for their bills as well.

A last urban billing legend is that the medical provider must accept whatever your insurance pays as payment in full -- they can't collect the difference from you. It ain't necessarily so!

For Medicare patients, or when the insurer has a prior contract with the provider, providers generally do have to accept the insurance payment as payment in full. But noncontracted providers can bill you for any unpaid balances. Also, the provider can always collect for any services not covered by your insurance policy.

So, beware of urban legends and things that seem too good to be true. When it comes to your real-life decisions, check the facts before you act and don't believe everything you hear.

But if you feel you must check underneath the toilet seat in the restaurant tonight, I understand.

David Miller is vice president of finance at Children's Medical Center of Dayton.


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