A Case Written by a University of Chicago PhD Student and GSU Member
In this section, I will outline actions that you may want to consider in order to fight back when you receive a ridiculously expensive medical bill. I will first introduce my case as an example, and then list some tips and comments. Since this guide is mostly based on my personal experience, the information may not cover all scenarios. However, I believe that this case introduces some general ideas about how the insurance system works on the University of Chicago campus, especially for those who are not familiar with the American medical system.
I am a graduate student on campus, an international student, and I have signed up for the U-SHIP plan managed by United Healthcare insurance. During Christmas holidays in 2014, I suddenly had an extreme toothache/facial pain. At that time, it was impossible to point out which tooth was causing the pain, or whether it was even a case of toothache. Because it was Saturday evening, I knew that I would not be able to visit SHS or local dentists, and I called the nurse hotline for medical advice. The nurse gave me some basic treatment advice and then told me that I should visit an emergency room (ER) if the pain increases. Later in the evening, the pain increased to the point that painkillers would not work, and I couldn’t eat, talk, or sleep at all. So I visited the UCMC ER (Emergency Room of the University of Chicago Medical Center). Unfortunately, the UC hospital ER did not have dental facilities for closer check-ups so all they could do was to prescribe me painkillers, which, of course, did not work.
Approximately 2-3 weeks later, I received two notices from the insurance company explaining my payments: one said that the hospital has charged $387.00 for the doctor visit, and I will be paying $31.79 after insurance; the other one said that the hospital has charged $646.00 for emergency room, and I will be paying $646.00. In other words, the company has only covered one of the two charges and denied the other.
So I worked on my appeal letter for the denied case: I spoke with United Health Care (UHC) coordinators on campus, collected necessary documents, and drafted letters. However, not only did the UHC deny my case of appeal, but also cancelled what they had already paid, telling me that they should not have covered it in first place. Their reasoning was that my ER visit could not be covered by U-SHIP because the policy does not cover dental or optical problems.
Being left with two charges that were over $1,000, I prepared for another case of appeal with the help of on-campus insurance coordinators from Student Health and Counseling Services and UHC. I also made an appeal to the UC hospital, asking them to consider providing me with financial assistance. In the end, the UC hospital took in my appeal. They provided me with the “Charity Care” program and waived my ER bill (a “100% discount”).
Lessons I have learned
- Visiting hospitals:
- When visiting a hospital, it is extremely important to secure official referrals from the Student Health Service, the Student Counseling Service, the nurse advice line, or other valid parties that the insurance policy states. I had the impression that health insurance coordinators were able to help me largely because I had followed the guideline recommended by UC student health website, i.e., calling the nurse advice line and being referred to an ER.
- Collect all documents you can from the hospital.
- I recommend that you record your hospital visit experience. If a dispute occurs, it could easily be a time-consuming and frustrating process, and you may forget some important details or become incoherent over the time. Recording your own experience helps you to be calm, coherent, organized, and more strategic when you have to challenge your bills. I wrote down my experiences as they occurred (how the pain broke out, medications I had tried, when I called the nurse advice line, whom I talked to, what I had heard, my visit experience, etc.) and these notes were very helpful when I had to draft my letter or talk with insurance coordinators.
- I did not take an ambulance to the hospital. If possible, consider using other modes of transportation (e.g., your friend’s car, etc.). In America, riding in an ambulance can be very costly, and there is no guarantee that the ambulance will take you to a hospital that is included in the health insurance company’s network of providers. A visit to an out-of-network hospital might result in a costlier medical bill that is more difficult to resolve.
- When A Dispute Arises from an Unreasonably Expensive Medical Bill:
- Do not panic. In the United States, medical bill disputes are regular processes that practically everyone is expected to undergo.
- Act fast. If a dispute arises, it is incumbent on you to defend and prove your case. This will inevitably require all sorts of documentation and can be very time-consuming. For example, I had to spend several weeks speaking to different representatives and collecting documents when the nurse advice line failed to provide my call information to the insurance company. Also, you can make your appeal only within a designated time frame, which is not short, but not too long either. Moreover, after the bill arrives, the time bomb starts ticking: I had four months to act or pay the hospital bill before the hospital would hand over my bill to collectors.
- Check what has happened. In some cases, hospitals and companies make mistakes and end up billing patients with unreasonable amounts. For example, I know of one student who had his bill handed over to collectors because the hospital did not correctly enter his insurance information. Check meticulously how you ended up with the charge. In addition, keep in mind that your claim might be denied if the doctor submitted the claim with the wrong ‘code.’ It can be worthwhile to talk to your doctor or care provider to find out if they can resubmit the claim under a different code to increase the chance that it will get approved. There are tens of thousands of codes that insurance companies use to categorize different types of care and many treatments can theoretically be coded in a variety of ways, some of which will make them eligible while others might result in a claim being denied.
- If you are concerned about your insurance coverage, you could make a request to the doctor to print out a list of hospitals/doctors that accept patients who are low-income and/or uninsured. Not everyone may be eligible, but some may find this helpful (e.g., low-income family with children).
- Be proactive. Consider and take all actions that are available to you. Unlike many other countries, the American medical insurance system is run by private companies that pursue profit. Unless you act, no one will act for you. One thing I regret is that I had naively thought that the insurance company would pay for my other bill, and did not immediately apply for UC hospital’s financial assistance program. If I had been a little more active, I would have spent slightly less time undergoing the frustration. Some people also have mentioned that Obamacare might be available for students as well (see the Guide to Obamacare). This kind of information changes all the time, so invest your time and check what actions you can take.
- Be patient. Disputes take a long time to get resolved l. I spent 5-6 months until I was finally released from the ER visit bill.
- Be strategic. Go through the U-SHIP insurance policy carefully and consider how you will be able to defend your case. (Insurance policy is available online on Student Health and Counseling Service webpage)
- Speak with others. I found talking to others not only practically helpful, but psychologically soothing as well.
- A) Speak with insurance coordinators from UHC who have offices on campus. Although the coordinators are from the company, they are willing to help students and will provide practical advice regarding claims and disputes.They are more sympathizing than representatives that you can talk to via the company’s official phone center or email service.
- B) Speak with the student health insurance coordinator from UChicago. Unlike the UHC coordinators, she can actively advocate for your case against claim issues.
- C) Speak with other students. Consider speaking to members of GSU (you could write to us at firstname.lastname@example.org ), members of the student health advisory board, and others who might have had similar experiences.
- D) Speak with the hospital’s financial aid office as soon as possible. You can attempt to negotiate not only with the insurance company, but also with the hospital. Many graduate students qualify for their financial aid (also referred to as “charity care”). This process will take some time as well, so start early.
- UCMC Financial aid: How to Apply
- Non-U.S citizens, including those without SSN, can also apply for the UCMC financial Aid Program.
- All you need to do is to fill in an application form, fill in the information, attach related documents (i.e. copy of your ID, copy of your federal tax return, documentation of family income), and send everything to their office.
- You can request the form by calling them (773 702-5276) or download it from their website.
You can turn in the application form via mail, fax or by visiting Outpatient Services, 1A on the first floor of the DCAM, where the hospital will forward the forms for you. Keep in mind that UCMC financial service office is located outside Chicago, which means that even if you visit the hospital, you won’t be able to talk to the officers who are in charge of the financial program.