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there are millions and millions of people declaring bankruptcy or on payment plans for bills that they do not have to pay this is NPR's life kit I'm Marielle Sagara and today we're talking about medical debt with Jared Walker he's the founder of dollar four a national non-profit that helps people eliminate their medical bills for Jared this fight is personal a decade ago he and his wife got two phone calls just minutes apart about family members who were having medical crises I remember hearing conversations like how are we going to pay for it that started Jared on a journey to learn all about medical debt how to get rid of it how to negotiate it down and how to not get too stressed out by it on today's episode Jared and I will help you handle your medical bills step by step starting with biggest misconceptions what do you think is the biggest misconception about medical debt I think that people see that bill in the number on that and they think I have to pay this quickly and I have to pay this exact amount um and that's just not the case you have time these these numbers they're numbers yeah I think that's a big one because you get this bill in the mail and you think it it's in all caps it says you know do upon receipt or do in two weeks or whatever and you think you have to just pay it or somebody's coming after you they are absolutely going to make it seem like there's this big sense of urgency there's not and and I also think that a lot of people think that they're alone in this and that is absolutely not the case there's no shame this is not you know because of some failing on you apart you didn't choose to have a medical crisis this has everything to do with a broken system and not and not you well let's get into it let's teach people how to how to negotiate her medical bills all right so you get this bill what is the first thing you would tell people to do first thing I would tell people to do is see if you are eligible for charity care basically if you are within a certain income range the hospital has to waive your medical bills most hospitals in America are nonprofits they have to have these policies to have their nonprofit status and typically a policy will say something like if you're at or below you know 300 percent of the federal poverty guideline then you're eligible for free care or reduce care do they have to tell you that you're eligible for it uh no to I mean they should but typically that is put on the patient see if you're eligible apply fill out all the applications send it in and then bother them a few times until they actually respond okay so that's for non-profit hospitals does it also apply to for-profits so the federal law does not but most every for-profit hospital will also have a charity care or financial assistance policy it's just there's not a federal law saying that they have to so they're typically a little less generous us um and but but they a lot of them still have them so if you want to find out if you're eligible for charity care what would you do you can always just Google your hospital name plus the words financial assistance and you can usually find your policy pretty quickly you can also go to Dollar four um we have a free eligibility screener we have the financial assistance policy data for every hospital in the country and you can put in your household size income what hospital and it will tell you what you're eligible for so let's say you don't qualify for charity care what other options do you have so the second thing would be to ask for an itemized bill this would be your time to basically fact check the hospital you want to see if all the procedures on there actually happened you would want to look up what happened all of the CPT codes and there are a few websites that you can look up to you know compare code see if they were correct and what's a CPT code CPT code is just going to be the like code associated with the procedure so every single thing that is going to happen at a hospital will have a code associated with it and you can look that up on these websites and they'll tell you oh this code represents you know this scan that you got or whatever so you can be like I never had that scan exactly yeah I remember actually having something like this happen when I went to get a hearing test um and I got the bill back and it said that I had some some kind of ear procedure done that I definitely didn't it was something that you would know you had done because it was kind of invasive and yeah so I called the billing office and they were like oh no that's always done with a hearing test and I was like no well it wasn't you know yeah they ended up wiping that 54 off of the bill good on you yeah I know that is super super common D you would get charged with something that that didn't happen so that's making sure that the bill itself is correct and then there's also okay you charged me a hundred dollars for an aspirin that doesn't seem fair like you did give me an aspirin but this is ridiculous that feels like it falls into the category of this is just too much you know yeah and there there are that's where like those websites come in to play as you can see like a lot of times they'll have what is the fair price for these things and there there's like a lot of uh there's a lot of tick tock videos out there that say like oh if you ask for an itemized bill it's just gonna come back lowered automatically because they're going to look through it and see like oh well we can't charge them 100 for an aspirin or whatever uh which can happen that does happen um but sometimes you have to make those things known like hey this is an overcharge what what's going on here and um with obvious stuff like like the aspirin or whatever it they're usually pretty easy um other ones you have to fight it yeah it's kind of wild to be getting into all this the fact that this is how our Health Care system works that it's on the patient then to look at the bill and and be digging through the weeds like this it yeah it is wild and it's like there's so much pressure on the patient to find like we shouldn't have to fact check the hospitals for for these things but we do um and and there are people that go to school for years and years and take tons of tests just to figure out what these codes mean and we're like over here you know Googling on you know getting on Tick Tock trying to figure out how to how to figure out your medical bills it's it's insane okay so you look to see if you're eligible for charity care and then if you're not you look to see if your bill was correct um maybe you took a look at the codes just to see if they seemed right looking at some of the websites that explain what codes are used for what codes are used for what you have also looked at your bill to see if any of the charges just seem really over the top your bill is technically correct what can you do you can negotiate the first thing would be like do you have some cash that is like the most powerful thing in this whole situation if you can if you can close the account now uh they will take a lower price so that's step number one if and a lot of people are in that situation uh but if you are you can call the hospital and the first thing I ask is what's a settlement amount like what will you take right now if I can close out this account typically we can get 30 to 50 off just by just by asking that if I pay you right now what could I get lowered off this bill do you recommend that rather than being like I have 500 will you close it oh no never show your hand I would just say hey uh what's a settlement amount and then see what they'll offer um but they're not going to offer you the lowest amount right they're gonna it's a it's a whole game and even then like all if it's not a number that I like I'll just say okay talk to you later and then hang up call the next day and see if the next person like I have called three days in a row talk to a different person got three different numbers what do you do if you get the same person do you just hang up uh no I just I just I'm just roll with it like I feel like it'd be like Oh wrong number sorry behind no I mean we we've called like day after day after day um it's like you kind of have to you have to be that person uh which is fine if you do that a few times and it's not the number that you want then you can start offering you know hey I have this right now would you take it um I typically I don't start with like anything lower than 50 because it would be pretty rare that they would give you more than 50 off um but there are better negotiators than I so if if you want to go wild but it's um that that's where I typically start do you ever mention hey like I'm having trouble paying this absolutely telling the story tell them what's going on tell them why it's hard tell them why you can't and then ask for the supervisor like if you're not talking to the person you feel like this person is not understanding me or this person is not budging on this like ask to speak to somebody else gosh it is exhausting though especially if you're doing it on your own to keep calling back and keep having it on your calendar like it's this reminder of this debt hanging over your head but maybe also a reminder of something painful that you went through you might even be recovering from some surgery or you know going through chemo or whatever it may be like you don't have the bandwidth to be calling the hospital all the time um so I I even ask patients hey if you're not able to deal with this uh is there a family member that you could give me their number and then we can do this together you can just call the hospital and and make sure that you know they're allowed to speak on your behalf which you can do and um you know a lot of people do that as well yeah it seems like maybe if a friend is like hey how can I help how can I help you can you can say well here's this list of things you could do you could call the billing office you know me absolutely I have a few family members and I'm like oh if this were to happen to me like I would call them because I know that they're gonna call and be so annoying and they're going to get it done sometimes you have to play a little more Hardball I guess right typically the the first few calls you're not calling to to do that you're not calling to like I'm offering you this take this or you know I'm never gonna pay her you know whatever it's just like Discovery like you're just trying to figure out you know hey what's it what's the settlement amount what's it like you're just trying to figure out who you're dealing with um then when it comes down to it like when you're actually like hey I'm I'm making an offer um absolutely like we're we're kind but uh sometimes we aren't you know like sometimes you have to yeah you have to ask to speak to the supervisors supervisors and and you have to be annoying and you have to tell them how absurd this is and uh and why you shouldn't have to pay the you know whatever false amount um you have to like advocate for yourself and it's it's a lot if you get to the point with the billing office that you're saying okay I I am able to pay this much I can't pay it up front they'll often work with you to pay in installments right and those are interest-free sometimes payment plans are the best option which you know get on the minimum amount whatever you can afford um which is always less than what they like throw out like I've had people like well we can take monthly installments of twelve hundred dollars it's like no I'm gonna pay less than that um so you can negotiate what that payment is each month you just might be paying it off for a while what kind of mindset might people employ here like if you're trying to If you're looking forward and you're like okay like I know it's not going to be resolved easily because I already called and it sounds like it's going to be a mess how do you stay mentally healthy during that time I typically tell people put all the bills stack up all the bills in in a drawer like set them aside when it's time to deal with it take them out do your thing like but don't let these things just you know fill your whole Space keeping in mind like you have time it's not as urgent as they say it is and like that's important because I do think that people a lot of times people panic they put on a credit card you don't want to do that and because you'd much rather have debt at a hospital than you know 20 on a credit card all right now that we learned how to negotiate with the billing office it's time to see how this kind of conversation might actually play out I'm gonna role play as the person at the billing office and Jared is gonna play the patient in this first scenario Jared went to get a hearing test but his bill included an elaborate ear procedure he never actually received and uh fair warning for some reason I got really into this role play and uh I don't know I think I might have an acting career ahead of me hello my name is Jared walker uh what is your name it's Marielle awesome Muriel I write that down uh always write that down and then um hey I have a question about a bill that I just received and um I'd like to okay what's your what's your billing number what's the number on what's the account number on the um form count number is one two three four five six that please one two three four five six okay what's your concern so my concern is I'm looking at this medical bill that I got and uh I noticed that there's a charge in here that that I didn't actually have happen at the hospital and I'd like to dispute this bill um and I'm wondering what the email address is for that and the uh and the mailing address so I can send in my dispute for this error uh what's the what's the code of the error uh the code is three four five six please hold [Music] imagine two minutes of hold yep yep oh wait I was trying to decide if I was gonna do like like make you wait the whole time okay sir two minutes is like all start time I'd kill for me um five minutes of hold uh and I come back um yeah that's the code for uh an uh at an ear Snuffleupagus procedure um they we do that with all the the hearing tests and you had a hearing test done so that's um what that would have been included yeah I actually actually know what the code was for because I because I'm looking at it here um and that never happened so I'd like to just get the address and the email address uh for where I can send this dispute for the error on the bill it happened because the doctor has it in her notes Here I appreciate that um can you just provide me the email address and the mailing address so I can send in this dispute on internet um the email is um Billing at your doctor's office.com and the address is um 555 your doctor's office Lane in Vancouver perfect I will ship this off thank you boom there it is so why did you say the things you said I mean I try and make those like those kind of Discovery calls at the beginning I try to make them as quick as I can just to be like hey I need this I'm going to send this in this one this is what's gonna happen I don't need to like get into all the details with you I'm just going to do this thing because I know that that's that's what it is but the person on the phone probably can't change the bill for you but they might make you think that they're in control of what's on the bill yeah definitely they're going to make it seem like um they know all about it and that you're not able to dispute it or or whatever you are you can always like you can always ask for the supervisor um but really they know the address they know they know the email just get that and keep rolling okay scenario two Jared got his bill back and everything was technically correct but some charges seemed way too high hello this is your doctor's office hello my name is Jared Walker um I have got my account number here handy if you need that yeah please yeah tell me what that is awesome it is one two three four five six what's your concern today Jared so I am looking at this hospital bill and I'm noticing some charges that seem a little excessive I'm looking at the ibuprofen and the bandages uh I see that I was charging a hundred dollars for an ibuprofen and fifty dollars for some bandages um and I am a little concerned with how high those are and I'd like to see if I can get those either just taken off or significantly lowered oh yeah we don't do that awesome well I'm going to then ask for the email and the address so that I can dispute the bill so when somebody tells you they don't do it do you just give up right away it's a marathon you have to make multiple calls at some point there needs to be a conclusion so that is when you would you know get a little more fired up and say hey this is incorrect and I want to talk to your supervisor right now and talk about why I was charged so much for X or whatever all right scenario three everything on Jared's bill is accurate but he'd like to negotiate anyway hello doctor's office this is Jared Walker um I am calling because I'm looking at this bill and I would like to try and close it out today how does that sound sounds fine to me awesome okay so I have a thousand dollar bill and I would like to see if you all have a settlement amount on that if I pay that right now what can you pay um well I'm gonna ask you what the settlement amount would be if you have to talk to your supervisor that's totally fine I will wait all right let me call him hi Jared how can I help hi there um I have got this thousand dollar medical bill and I'm wondering if you all have a settlement amount for me uh to see if I can close this out today yeah we sure do um we typically will accept 50 of the bill if you pay up front yeah I'd take that awesome let's do it okay Jared pleasure doing business with you awesome thank you hope you're feeling better thank you see that one went so well it did it did I mean it's uh and sometimes we go that way but it's really just like there's always a settlement around there's always an amount they'll take that's less um figure out what that is figure out what the what they're gonna offer and usually it is yeah it's like we'll take 20 off the bill um call again tomorrow see if you can get 30 40 50 like whatever it is um I liked her by the way she was really friendly oh yeah loved it sometimes she was trying to help yeah sometimes you get those which is great if you were to pick a word that people should embody as they approach negotiating down a medical bill what would the word be it's it's like the persistence it's grit it's like buckle up get ready this is going to be a battle and this might not get solved today it might not gets off next week or next month but like we will figure it out Jared thank you so much for being here thank you really appreciate it okay time for a recap if you get one of these scary medical bills in the mail Don't Panic you've got options first see if you're eligible for charity care search your hospital name plus financial assistance and you should be able to find what you need if you don't qualify ask for an itemized Bill and comb through it does it include any procedures that never happened are there any costs that seem way out of line either way you can call the billing office and dispute the bill also you can always negotiate if you can afford to pay something up front call the billing office and ask for a settlement amount what they'll accept if you pay the bill in full that day Jared says you might get them to cut the bill in half if you can't afford that you can still negotiate and you can get on a payment plan which is much better than putting the bill on your credit card lastly remember this is a long game you might not get anywhere with the first couple calls but keep plugging away and don't be afraid to ask friends or family for help sometimes they're looking for ways to support you and you could really use an advocate [Music] thank you foreign [Music]