Katiana Brenner knew when she looked at her youngest son that he needed help.
It was Thanksgiving week last year, amid a historic surge in cases of RSV, and 9-month-old Hudson’s tiny lungs were struggling to draw breath. A scramble to the pediatrician’s office led to an emergency visit at Children’s Hospital’s Highlands Ranch campus, where a doctor said Hudson’s condition was so serious that he needed even more intensive care. He needed to go to Children’s main campus, a 30-minute drive across town.
And that is when a second fear for Brenner and her husband crept into their minds: Could they afford the cost of the trip?
“I was worried about it. I actually asked the doctor if we could drive him,” Brenner said. “I couldn’t believe I was in the hospital worrying equally about money as I was my child who was struggling to breathe.”
The doctor said no — Hudson needed to go by ambulance for his safety. At the Children’s pediatric intensive care unit, Brenner remembers Hudson surrounded by kids just like him, all hooked up to oxygen, their little chests heaving. But, steadily, blessedly, Hudson recovered and returned home a week later.
The bill arrived the following month: $4,410 just for that 25-mile ambulance ride, about $150 for every minute of the drive.
But there was more. Because the ambulance company had coded the trip as “nonemergency,” Brenner feared that their insurance wouldn’t cover any of it. The $4,000 they had expected to spend on the bill for Hudson’s hospital care had suddenly doubled.
“It was a little overwhelming,” she said.
But what could she do about it?
“There’s certainly no lack of people who need help with their medical bills.”
Dealing with — and even just worrying about having to deal with — a complicated, expensive medical bill is these days more American than apple pie.
According to the most recent Colorado Health Access Survey, more than 1 in 10 Coloradans reported struggling to pay medical bills — and that rose to more than 1 in 3 for people who received surprise bills like Brenner did. More than half of those who struggled to pay medical bills said they took on credit card debt to do so. Nearly 40% said their bills made it hard for them to afford necessities like food or heat.
Roughly 12% of all respondents said they put off getting needed medical care due to fears about the cost.
“There’s certainly no lack of people who need help with their medical bills,” said Stephanie Arenales, the director of the Colorado Consumer Health Initiative’s Consumer Assistance Program.
The program helps people — for free — to fight their medical bills, teaching them how to navigate the battle lines between insurers, hospitals, health care providers and medical billers. The program recently celebrated its fifth anniversary, and in that time reports helping more than 2,600 people during its lifespan, with a combined savings exceeding $7 million. Its caseloads have increased 18% over the past year, Arenales said.
And one of those new cases was Brenner’s. She found out about the program when searching for ways to fight the ambulance bill and, after placing a phone call to the program, began working with CCHI’s Melissa Duncan to attack the problem.
“I was just relieved to have someone hear my story,” Brenner said.
CCHI’s Consumer Assistance Program has limited resources — though it is working to bring in new funding to help it expand. Currently, it can take on about 100 cases at a time, on a first-come, first-served basis. But the methods it used to help Brenner with her bill provide a roadmap for how people can fight expensive medical bills on their own.
Tip No. 1: Wait
When bills start rolling in, a lot of folks get an itch to pay them in order to leave the stress behind. That’s what Brenner felt when Hudson’s bills came in the mail, until she spoke with Duncan.
“I think otherwise I might have just paid it,” she said.
But Duncan and Arenales said people should try to hold off until they are sure they have all the paperwork they need and all their questions resolved.
When the billing calls come, Duncan recommended that people tell their insurer and health care provider that they are challenging the bill. Keep repeating that any time a bill collector calls, she said.
“The big thing is communication between all parties,” Duncan said.
Tip No. 2: Gather
To fight a bill, you’ll probably need more than just the billing statement from the health care provider or hospital.
Most importantly, you will also want the explanation of benefits from the insurer — it usually comes in the mail or is readily available online, as well. But some documents will require more digging.
You’ll want to make sure you have all the details on your insurance plan. Two documents are important here: the summary of benefits and coverage, which is usually a handful of pages and typically available through your insurer’s online portal; and the much bigger evidence of coverage, which you may have to call your insurer (or your employer, if it’s a health plan through work) to get.
Those documents allow people to compare whether their insurer correctly matched the charges to your specific coverage, Arenales said. For instance, is the medical provider billing a higher amount than what the insurance company says its members should have to pay?
And you may also need additional documents. In Brenner’s case, because there was a question about medical necessity — that ambulance coding calling the trip nonemergency, Duncan told Brenner to request doctors’ notes and medical records from the hospital. They were looking for the word “emergency” to show the insurance company to prove that the ambulance trip was needed.
“I think of it as a puzzle, piecing together this piece of paper and this piece of paper,” Duncan said.
Tip No. 3: Document
Brenner quickly discovered that fighting a bill is not an easy endeavor.
“I’ve always heard from people when you have big medical things, ‘Oh you’re going to spend so much time on the phone,’” Brenner said. “That’s true.”
But just as important as putting in the time to make all those phone calls was recording everything she learned from them.
“Take notes,” Arenales said. “Take a lot of notes about who you called when and what they told you. Document as much as you can.”
Tip No. 4: Learn
Medical bills sometimes speak in a language all their own. There are diagnosis codes and procedures codes, covered benefit language and minute exceptions.
That’s why it’s important to learn as much about the process as possible — including beforehand.
“Do your best to be informed before you get care so that you hopefully don’t end up with a big bill that you have to deal with,” Arenales said.
CCHI has a variety of resources on its website explaining the basics of health insurance and medical billing. The Colorado Division of Insurance — the state agency that regulates some, but not all, health insurance plans in the state — also has educational resources.
Arenales cited one example of where education can come in handy when confronting a bill: the hospital’s financial assistance program for people with lower incomes. Hospitals are required to tell uninsured patients about such programs, but insured patients may qualify, too.
Tip No. 5: Complain
If you are at an impasse with your insurer or health care provider, you can try filing a complaint with a regulatory body.
The Colorado Division of Insurance handles complaints against insurance plans that it regulates. (The agency also has an informational flyer called “When Your Health Insurance Company Says No.”)
The federal Centers for Medicare and Medicaid Services fields other complaints, including some for people not covered by either Medicare or Medicaid. The state Division of Professions and Occupations may take others.
Because it’s not easy to know what kind of complaint goes where, an assistance program like CCHI’s can be helpful in offering direction. Arenales said sometimes just a simple, not-too-long phone call is all it takes to figure out where to direct a complaint.
Tip No. 6: Know when you’re in over your head.
Brenner said she knew she needed expert help on the bill when she started digging into the fine print.
The ambulance company that transported Hudson was out-of-network for her insurer, but there are laws that are supposed to safeguard families from getting slammed by out-of-network health care bills. Only, in her family’s case, there were catches.
Colorado law protects against surprise ambulance bills — but only for insurance plans regulated by the state. Her husband’s insurance, which covers Hudson, wasn’t one of those plans. The federal No Surprises Act applies more broadly — but it doesn’t cover ground ambulances, though it does regulate air ambulances.
“It just felt like we were in this big loophole,” she said.
This was about when she reached out to CCHI’s Consumer Assistance Program. Over a period of months, they collected paperwork, made phone calls, submitted documentation, and stated their case.
Then in April, with Hudson now a fully recovered, happy toddler, Brenner got a statement from her insurer. She scanned for the final total, anticipating more fights ahead.
“You may owe the provider $0,” the statement said.
She was elated — but cautious. Duncan said the insurer apparently agreed with their explanation that the ambulance ride was a necessary emergency service and so covered it in full.
No more bills have arrived, but Brenner said she remains on guard. She said it’s not fully clear why the bill got covered — so she doesn’t fully trust that it won’t somehow come back someday.
“That’s the weird thing,” Brenner said. “The entire system is so confusing that it’s hard to say what did it.”