An anonymous reader wrote to us to ask what he should do about unexpected bills from a medical clinic. He chose the clinic precisely because he can’t afford hospital bills in the hundreds of dollars, and was led to believe that there’d be no out-of-pocket cost. It turns out there was.

Some time ago, I don’t have the exact date, I went to my local low-income clinic because I had a serious nosebleed problem. Frequent nosebleeds, often several times a day kind of problem. They referred me to the Ear, Nose & Throat Center at St. Elizabeth Hospital, faxed them a voucher, and assured me (verbally, my mistake!) that I would not have an out-of-pocket cost. I set up an appointment.

In October, making good on the appointment, I visited the center. I met an ENT doctor, he gave me a quick consultation and then treated an exposed blood vessel in my nose with a mild topical anesthetic, followed by silver nitrate. I’ve since looked; I don’t have exact numbers, but the anesthetic and silver nitrate couldn’t have cost more than about $20 for this visit. More on that later.

Fast forward to November. I get a completely unexpected bill from Affinity Medical Group (who owns St. E’s), for a whopping $430. I don’t think I even had that much in my checking account at the time. I called the clinic and asked, “wasn’t this supposed to be free?”. They told me that they pay a certain amount and the hospital is supposed to waive the rest (wtf?), and to bring them the bill and they’ll take care of it. That I did, but they didn’t fix the problem.

Earlier this week. I got another bill, for $300. Again I call the clinic and they tell me the same thing, and I bring them the bill. Problem solved, right? Wrong. Later that day, I get a call from the clinic, and they tell me the hospital will waive the visit, but not the treatment (you know, the few minutes with sticks and substances that really should’ve cost about $20), which is what that $300 charge is for.

I try talking to the hospital. First I get customer service, and they basically reiterate the same thing–the visit is covered, but they won’t pay for the “procedure.” Then they transfer me to patient relations. She says they can’t waive the charge, but there may be financial assistance given that I’m a decent distance below the poverty line, and she’ll call me in a week or two with what she finds. She also told me that the due date on the bill isn’t a hard date, but just a friendly suggestion (wtf?). I’ll hear them out on the financial assistance thing, but if that doesn’t work out, where should I go next?

I asked someone who works in the patient accounting department at a different hospital what she thought of this guy’s story. Here’s her advice.

For this man:

1. He needs to go to the hospital’s financial assistance office and set his own appointment. They will give him paperwork to fill out and tell him what documents he needs. They may even see him while he is there. Do not sit around waiting for some patient relations person to call him back. They are undertrained and overworked, and he’ll probably never hear from them again.
2. If they can’t work out any assistance for him, he needs to call the Patient Accounting Department or whatever they call it. Ask to speak to the rep who handles his account. (They usually divide them up alphabetically.) He needs to tell them quite forcefully that he can not and will not pay this bill in full. If he is worried about it being on his credit he can ask for a 40 to 60% discount of the bill. We give those all the time.

He should have made a copy of the voucher and maybe called back to St El after the appointment to discuss exactly what expenses would be waived. The sad thing is most people would not even think to do that. Unless you are sick a lot or deal with hospitals and insurance you wouldn’t think to doublecheck everything!

For everyone else:

Any time you are scheduled for a visit and/or a procedure, talk to the actual financial office. Ask for exact amounts of co-pay or out of pocket expense. Have them fax to you a paper stating what you are expected to pay.

Every time my mother has to go somewhere different, I call that office. I verify her insurance and ask exactly what they need her to pay. I then call her insurance company and tell them where she is going and what they said she had to pay, and then I ask if that is correct. The insurance companies almost always have a contract with the providers and know exactly what they allow them to claim.

Want more consumer news? Visit our parent organization, Consumer Reports, for the latest on scams, recalls, and other consumer issues.