From $7,000 to $770: How One Patient Advocate Fought Back Against a Surprise Medical Bill
What seemed like a simple medical procedure quickly turned into a financial nightmare for Tim Winard. A routine colonoscopy—one he thought his insurance would cover—had left him on the hook for a medical bill of more than $7,000.
He thought he had done everything by the book: called his insurance beforehand, followed their instructions, and gone to an in-network provider. And yet, he found himself staring at a huge bill.
Tim isn’t alone. Every day, patients across the country receive unexpected medical bills. Studies show that as many as 80% of medical bills have errors. Very few challenge them and just pay the bill. Tim decided to challenge it. And he didn’t do it alone.
A Call for Help
Unsure of where to start, Tim reached out to a patient advocate, Linda Michelson, who specializes in medical billing disputes. Linda assured him that he wasn’t powerless.
Linda went through the insurance explanation of benefits and the medical bill. The doctor’s office originally scheduled the colonoscopy at an ambulatory surgery center (ASC). However, the day before the procedure, the gastroenterologist office switched the procedure to a hospital. They did not explain to Tim how this might affect his balance due.
“Outpatient hospital charges are much higher than those at an ambulatory surgery center,” said Linda. “Mr. Winard’s policy had a coverage limit of $1000 per day for outpatient hospital care, with a 20% coinsurance. Insurance only paid about $700.”
The Fight to Lower the Medical Bill
Linda helped Tim file a settlement offer to the hospital, which was denied. They then persuaded the insurance broker to pressure the insurance company to lower the Tim’s responsibility. Tim ultimately only paid $770.
“It’s important for everyone to know the benefits of their health insurance,” Linda warns. “Most policies provide a Benefits Summary which shows things like: copay for primary care visits and specialist visits, coinsurance for office, outpatient, and inpatient services, coverage for lab tests, radiology etc. People need to review this information closely.”
Need Help With a Medical Bill?
Tim’s story is proof that patients don’t have to accept medical bills at face value. They can negotiate balances and patient advocacy works.
If you or a loved one are struggling with an unexpected or overwhelming medical bill, a patient advocate can help review your charges, negotiate costs, and fight for the fair treatment you deserve.