How to not freak out: Our most important advice ever
Yes, easier said than done. We’ve got strategies for you.
Hey there —
Recently, our pal Jared Walker was on the excellent NPR podcast Life Kit, to talk about negotiating medical bills. He crushed it, of course.
And beyond the basics we’ve covered in the newsletter recently — don’t rush to pay, see if you’re eligible for charity care, get an itemized bill and fact-check it — the best piece of advice Jared shared was to not freak out in the process of disputing a bill.
“You have time,” he said. “You can take a deep breath, get a plan and go from there.”
He suggested some great ways to use that time. Including — especially — the take a deep breath part.
But not freaking out takes practice. This is an infuriating system we’re dealing with here.
We’re gonna unpack some of Jared’s tips here, and we’ll expand on them with material from the most-useful Arm and a Leg episode yet: How to keep your cool in a tough situation — specifically, negotiating a medical bill.
Our guide for that episode was Lauren Taylor, who has been teaching self-defense for decades. But as Lauren teaches it, self-defense means a lot more than hitting and kicking. It’s about standing up for yourself in all kinds of difficult situations. Self-defense can be everything from using your words to walking away.
There are three big lessons that these great teachers have for us:
Stay on your agenda
Take care of yourself
Staying on your agenda
This is Lauren’s term, and it becomes most important when you call someone, or have an in-person conversation. Staying on your agenda means stopping — almost ignoring— any efforts to sidetrack the conversation.
The first step comes before the call. Ask yourself, what do I want from this conversation? The answer should be as specific as possible, like a piece of information you need. That’s your agenda.
For example, when Lauren was pretty sure an insurance company was violating her legal rights, she called the state attorney general to find out how to appeal the company’s decision.
But the person who answered the phone at the AG’s office did not have a super-helpful opening line.
“She was like, ‘Well, I'm sure you missed a deadline.’” Lauren recalls. (Sound familiar?)
A natural response would be to argue back or get defensive. (No, I didn’t miss any deadlines.) You might also back down. (Did I? Oh gosh, sorry to bother you.)
Either way, you’d be sidetracked — on the other person’s agenda.
Instead, Lauren repeated her request: Please tell me how to file an appeal.
It worked and she got her answer.
Jared did a brilliant job of staying on his agenda in a role-play with Life Kit host Marielle Segarra, who played a not-so-helpful billing rep.
Check out how Jared keeps coming back to exactly what he wants, repeating it three times almost verbatim:
WALKER: So my concern is I'm looking at this medical bill that I got, and I noticed that there's a charge in here that I didn't actually have happen at the hospital, and I'd like to dispute this bill. And I'm wondering what the email address is for that and the mailing address, so I can send in my dispute for this error.
SEGARRA: Yeah, that's the codefor an ear Snuffleupagus procedure. We do that with all the hearing tests, and you had a hearing test done, so that's what - that would have been included.
WALKER: Yeah. Actually, I actually know what the code was for 'cause I'm looking at it here. And that never happened. So I'd like to just get the address and the email address for where I can send this dispute for the error on the bill.
SEGARRA: It happened because the doctor has it in her notes here.
WALKER: I appreciate that. Can you just provide me the email address and the mailing address so I can send in this dispute?
In the end, Marielle ran out of b.s. responses.
Jared’s sample call with Marielle is also a great example of pacing yourself: He’s not trying to resolve the entire dispute in one call. He’s calling for just two pieces of information, the email address and the mailing address where he can send in his dispute.
He suggests keeping those initial calls about your bill as short as possible and says you don’t need to get into every detail immediately.
It super-sucks that disputing these bills has to be done in stages. If you’re like me, you want the whole thing resolved in one call.
But seeing each call as just one part of a long-term project is a great way to avoid hitting a dead end and getting exhausted.
This approach becomes especially important if the person on the other side of the call is just unpleasant, or the whole thing is getting overwhelming.
And Lauren reminds us: Don’t be afraid to pick up the conversation later.
“If you're too filled up with feeling to be doing something that feels useful,” Lauren says, “you can absolutely say, ‘I can’t talk about this anymore. I'll call back another time.’”
And as lots of people have told us: Next time you call back, you may get someone who’s more helpful.
Jared says in some cases, making multiple calls is just due diligence, like when he’s asking for a discount to settle a medical bill.
“If it’s not a [discount] number that I like, I’ll just say, ‘OK, talk to you later,’” and try again the next day, he told Life Kit. “I have called three days in a row, talked to three different people, got three different numbers.”
Taking care of yourself
This part is all about planning.
First, Jared recommends setting physical boundaries on fighting your bill. Make a place in your home where you can stow all the paperwork, so you don’t have to look at it (or worry about it) all the time.
“When it’s time to deal with it, take them out, do your thing,” he says. “But don’t let these things fill your whole space.”
Second, Lauren recommends making a plan for how you’re going to deal with the feelings that are likely to come up during direct confrontations about the bill, like fear or rage.
That includes a plan for what you can do during the call to take care of yourself and a plan for what you’ll do after the call.
Start by choosing a couple of things you’ll be able to do right away if the person on the other side of the phone is hostile, unhelpful or pressuring you to do something you don’t want to do.
If tough feelings come up, Lauren remembers to take deep breaths, and tunes into the feeling of her feet on the floor. These orienting exercises give you some space from the encounter. And Lauren has other suggestions for connecting with your immediate environment.
Maybe ask yourself: What are five things I can see? Can I find three blue things? What's one thing I can hear? What's one thing I can feel?
You’re not trying to squash difficult feelings – that doesn’t work – but you’re practicing shifting your attention to something else, even for a moment.
That can also mean reminding yourself about what else is true right now, as Lauren suggests: “Oh right now, I'm sitting in a room in my apartment and, you know, my loved ones are around me or my pets are around me, or I have a plan for dinner or I'm going to call a friend right now. I'm okay.’”
That’s your plan for during the call. Lauren also suggests knowing what you’re going to do after the call to deal with the rage and anxiety the whole thing may bring up. Line up a run, scream into a pillow or find another way to release your stress.
You might even secure some support. Lauren suggests calling a friend or a family member to let them know you’re getting on the phone to dispute your bill. Then, ask your loved one if you can reach out to them to vent.
And if you’re lucky, you may know someone who can do more than listen to you vent.
Bonus: Enlist an ally
Maybe you know someone who would join the call with you. In a recent Arm and a Leg episode, patient advocate Kaelyn Globig told us that when a patient introduces her as their advocate to a billing rep, she can hear that rep “straighten up a little bit.”
That left me thinking: You could introduce anyone to a billing rep as your advocate. The rep doesn’t have to know that person is your relative or your roommate or whatever.
And if you’re really lucky, maybe you’ve got someone who can make the call for you.
“I have a few family members in my life, that I’m like: Oh, if this were to happen to me, like, I would call them [to address the bill],” Jared tells Life Kit. “Because I know that they’re going to call and be so annoying, and they’re going to get it done, you know?”
Whatever it takes.
Just to remind you of Jared’s original point: You’ve got time. Awful medical bills won’t go away on their own, but you have time to make a plan and learn how to stay in this fight.
Stay on your agenda. Pace yourself. Take care of yourself. And if you can, enlist an ally.
Seriously, I think the tips in this newsletter may be the most crucial advice we’ve ever given or received. If you have some tips that you’ve found helpful, leave them below. We may share one or two of them.
I’ve got extra links and resources for you below, too.
And now, go do something nice for yourself. The weather is starting to get pretty warm here in Chicago, and last weekend I took my first long bike ride of the season.
(OK, it wasn’t that long. But it was nice, and I went with a friend, and that made it great.)
I’ll catch you soon.
Jared Walker on Life Kit: Medical bills can cause a financial crisis. Here's how to negotiate them. Audio | Video | Transcript
Lauren Taylor on An Arm and a Leg: How to keep cool in a tough moment: A self-defense expert breaks it down Audio | Transcript
BONUS from Vox: Never pay a medical bill without asking these questions first. Link. Not a complete list, but really, really good.
She’s talking about CPT codes, the series of numbers that identify the procedure you got – or that your bill might SAY you got.
Never hesitate to report the offending party to the appropriate state level consumer protection agency, for example your state’s department of insurance. I have had much success in getting insurers to toe the line by doing that. It works better in leftist blue states with huge bureaucracies (looking at you California!).
I'm a medical coder and you would not believe the frequency of plain old human error coding mistakes that go on bills. Worse, the pressure physicians and hospitals put on coders/billers to "upcode" (code for something more extensive and expensive), slap on a ton of questionable diagnoses, or bill for something that didn't happen is intense. Never never never pay a bill without verifying every code (diagnoses and procedures).