How We Did It

Hi everyone! First, let me apologize for taking so long to share this information with you. I think that Joe's recovery took a little bit more out of me than I initially realized. As soon as he recovered enough to work, he shipped off to the city to work on a TV show that he does every season. He had a few scary physical setbacks during the shoot, and only now that he is home am I beginning to truly relax.

But I feel a tremendous responsibility to share our experience with others - particularly the way that we dealt with billing issues. So many of you played a part in helping us pull through - and I am happy to say that the financial problem appears to be mainly behind us, which is nothing short of a miracle. We have you - our friends, family and friends-of-friends-and family to thank for that.

Joe and I also owe a tremendous debt to our good friend Trevor Houser, who had to raise money in order to have a tumor surgically removed from his brain several years ago. Trevor fully recovered from his ordeal, and remembering how he'd reached out, and asked for donations made it somehow OK for us to do the same.

Trevor also came to visit right after Joe was released from the hospital and opened my eyes to the way that medical bills are negotiated in this country (more on that later). What's more, members of his family made extremely generous donations to Joe's medical fund. They were/are amazing examples of people paying it forward - something that I have vowed to do myself. The following play-by-play of what I did to negotiate our bills is my first stab at doing so.

Many of you know other people who are suffocating under a mountain of medical debt. If any part of what Joe and I did can help them, I hope that you'll forward them our story.

1. WE APPLIED FOR MEDICAID: Joe and I did not qualify. However - it's definitely worth a shot, because (at least in NY) they only look at the month you are in. So if you've had a bad month you might actually qualify. In our case, Joe's tiny unemployment check alone was too much for us to be considered.

2. I VISITED THE UNCOMPENSATED CARE OFFICE IN THE HOSPITAL: We live in a poor area, where tons of people have problems paying their medical bills so this was a standard conversation. In a wealthier area, you might have to fish a bit harder. If there is no such program at the hospital/doctor's office you are dealing with, I suggest you jump ahead to # 3.
One of the gnarly parts of medical care in this country is that the billing people were calling me three or four times a day while Joe was still in ICU. They actually would come visit him while he was delirious and try to talk money with him. I think he told them to F off though, and since he looked like Keith Richards on a bad day at the time, it packed a powerful punch, and they backed off.

When I met with them, I just tried to be polite (failing miserably at times I'm sure). My thinking was that they deal with people at their worst all day every day, so yelling and crying was probably not going to make me stand out in their minds. I was just frank with them from the gate saying that we had no money and so we were going to have to figure out a way to work something out. To be honest, I was more worried about them discharging Joe way too early because they knew we were broke (happens all the time), than I was about how we'd pay the bills.

They explained the financial guidelines for qualifying for uncompensated care - and right away I could tell that we did not qualify. Between the two of us, we just made too much, according to the last year we had filed a Federal Tax return.
Even though we'd already been disqualified verbally and was told the application required a copy of that tax return, I decided to put together an application based on the last six months alone, which had been hideous for us financially. The woman I delivered it to, told me in no uncertain terms that this would probably not get us anywhere. But I insisted it be submitted, "just in case." Here is that initial letter in case it can help anyone draft a similar one. I sent copies of all supporting documents along with it.

I followed up on my application several times, just to make sure it had been passed along, and everything appeared to be in order. However, the person who needed to review it and make a decision would not do so for a month or so. So we waited.

Soon afterward, Trevor visited. While here, he explained that hospitals have very low negotiated rates with Medicaid (which I knew), and also very low negotiated rates with health insurance companies (which for some reason had not occurred to me). Therefore, they try to "make good" with charges to out of pocket patients. For example, for one item we might be billed $3,000 per day, while Medicaid would pay $200 for the same service and Blue Cross/ Blue Shield might pay $225.

Knowing this information emboldened me tremendously. Because I thought - hospitals and doctors accept these low-ball payments hundreds of times a day - why not make our own low-ball offer? Now keep in mind - we owed not only the hospital, we owed like 6 different specialists, plus countless labs, etc., and all needed to be negotiated separately.

3. I DECIDED TO CREATE LOW BALL OFFERS: I knew that if I made uninformed low ball offers it would be too easy to dismiss me outright. I wanted to base my offers on something real. I'm always like this when it comes to negotiations. I have like zero ability to bulls#*@. So I have to come from a place of authority if I want to firmly stand my ground. I decided to offer everyone what Medicaid reimburses, since Medicaid is the lowest of the low ballers. That required a ton of research.

4. I DID A TON OF RESEARCH: Here is where to find the Provider Manuals that let you know what Medicaid reimburses doctors and hospitals for a given procedure (this link is for NY only, you will need to find similar information on your own state's Medicaid site). Warning: it is mind numbingly difficult to decipher the difference between certain procedures - but it's super necessary. It took me weeks to come up with the numbers that I did. If the hospital or doctor that billed you happened to put the billing code of the procedure on your bill, that will really speed your process. A few doctors offices that did not print the billing codes on the bill were gracious/naive enough to cough them up when I called in and gave a very vague/squirrely explanation (I suck at sneaky) but others (smartly) refused to give me any information. The reason this matters is that there may be five procedures that appear to have the same name listed in a row in the fee schedule. Three of them might get reimbursed $40, while one gets $400, and another $4. So you kinda need to figure out which one you had.
I know - daunting - but if I can do it ANYONE can do it. Listen, I don't even know Joe's phone number. Seriously - that's my level of sucking at numbers. So you can do this.

5. I SUBMITTED THE OFFERS: here is a sample of the letter and the accompanying chart that I sent the hospital. Here is a sample letter that I sent one of the doctors (note: I sent similar letters, all with different amounts to all of Joe's health care providers).

You'll see that I was inconsistent about blacking out all of the $ figures - on one hand, I wanted to be discrete - on the other, I really don't care if it can help people negotiate this themselves.

6. I STARTED HEARING BACK: Much to my shock - many of the doctor's billing offices called right away and accepted my low ball offers outright. I had not anticipated that, but I was thrilled. Because we had raised nearly $20,000 from donations, I was able to pay each doctor who agreed to the negotiated rates immediately.

7. I CHECKED IN WITH THE HOSPITAL A MILLION TIMES: Now that I'd sent them an offer, I wanted the hospital to know that my low ball offer trumped my application for a discount - assuming that my offer (around $18 thou) would be lower than any discounted rate they might come up with.

8. WE HEARD BACK FROM THE HOSPITAL: In a turn of events that no one cold have predicted, the hospital had approved our application for Uncompensated Care, and ruled that we qualified for a 40% discount. In a classic case of medical billing math (which is impossible to follow and may well have been crafted by meth users after a seven day bender) the $40% discount brought our $50,000+ bill down to $14,000. Lower than my low ball offer.
I have no idea how they came up with these figures - and I remained suspicious and nervous about them until the day that I went into the hospital and paid the entire bill. Phew!

9. I SENT FOLLOW UP LETTERS: to the two doctors who had not responded to my offers: Here is a sample follow up letter (scroll to page 2 for the follow up portion). You might note that I exaggerated the hospital bill amount slightly (it was actually closer to 50 than 60), Hey, I was going for drama. One office quickly agreed to the low ball offer, the other had a billing clerk call and say that they did not do "any charity stuff." I asked to speak to the Office Manager, to make my request directly to him/her. My plan was to go up the ladder until I heard, "no," from the physician himself before considering any bill a lost cause. As soon as I spoke to the Office Manager, he agreed to my low ball offer

So in NO CASE did anyone counter offer or barter back and forth with me - and in NO CASE did I get a flat out no (OK, a flat out no that I listened to).


As I mentioned at the beginning of this epic post - Joe has recently returned home and is with me in Hudson. We are trying to return to life as normal (snow just began falling!). Just last week, Joe went to his first appointment with Lyme specialist Doctor Bock at the Rhinebeck Health Center. The appointment was crazy expensive but it's so important that Joe's ongoing care be overseen by someone who really knows what he's doing. My point is - this whole situation is not going to get wrapped up in a tidy little bow at the end. Financing health care costs will continue to be an issue - but nowhere along the lines of where we were. We are not in any danger of losing our house, or declaring bankruptcy - which is completely amazing. A few thousand dollars here and there doesn't scare me anymore - because in a few short months we were able to deal with (and close out) $60,000 worth of medical bills.

There is so much more that I could say about this - but I'll spare you another million pages. We are grateful that we live in Hudson and are surrounded by such an awesome, supportive community. Hudson, I love, love,love you.

We are grateful that Joe was treated at Columbia Memorial Hospital - a hospital that no one seemed to have anything good to say about. The level of compassion and respect that the nurses and doctors showed us there was unmatched by any medical experience I have ever had and that includes top hospitals like Cedars Sinai in LA. What's more, had we been in NYC when Joe got sick, there is no doubt that the bills would have been double or triple. Columbia Memorial we love you.

To everyone who chipped in, there are no words. You changed our lives and we promise to do the same for others moving forward, whenever and wherever possible.
xxx
Halie and Joe.