A provider wants you to pay in advance. Should you?

Not if you don’t have to. And often, you may not have to

Maybe don’t hand over that credit card so fast? | Photo by rupixen.com on Unsplash

Hey there—

More and more often, providers are asking for payment in advance. Before a test or procedure, they might want you to pay whatever they expect your share to be after insurance. And maybe it’s not just a $30 copay, or something similar, but your whole deductible. Which could be thousands of dollars.

Um, yikes. Paying upfront goes against one of our major pieces of advice: Don’t pay a medical bill without fact-checking it.

So if a provider asks for payment upfront, can you say no and still get care? 

We dove into that question in the most recent episode of An Arm and a Leg and wanted to share what we learned here. 

We started poking around after hearing from a listener named Lynn, who was making a dermatology appointment with a new provider. The doc’s office wanted to get her credit card on file before she was even seen. 

They said they’d charge her card as soon as her insurance paid, without even sending a bill. 

Her first thought? “I’m not giving you this. I don’t want anything run through on my card that I haven’t checked out!” 

The office said paying in advance might be more convenient for Lynn. But we know bills have errors all the time. And once you’ve paid, you don’t have much negotiating power.

She wondered if she had to say yes, and we also wondered: What about other situations? Lynn’s appointment was a few months out. But what if she’d needed surgery, right away?  

That’s exactly what happened to Noah, who paid $585 before surgery. And learned afterward – once his insurance processed a claim for the surgery –  that he’d overpaid by $360. 

He spent months fighting to get that $360 back. In the end, he had to ask state officials to help him out.

(Noah says he’s lucky to live in a state, Washington, where the Attorney General’s office is pretty aggressive about consumer protection. We also think he’s smart to have known about them at all, and we should probably see if any local and state officials where we live might be similarly helpful.) 

We wondered: Could Noah have just declined to pay upfront?

So we checked with Louise Norris, an analyst with healthinsurance.org and one of our top health-insurance nerds. 

And the answer was: Yeah, Noah probably could’ve held back. 

The right to say no thanks

Louise told us providers mostly can’t insist on getting paid upfront – as long as they’re in-network with your insurance.

Being in-network means they’ve signed a contract with your insurance company that generally says they can’t require you to pay upfront beyond a specific copay (like $30 for an office visit). 

She noted that doesn’t mean they can’t request or even recommend that you pay upfront.

But Louise says generally – I know, that word “generally” seems like an important caveat – they’re supposed to back off if you politely decline.

If you tell them you’d rather wait for your insurance company to tell you what you’re supposed to pay, they’re supposed to say “OK.” 

Also, if you’ve got government-funded insurance — Medicare, Medicaid, or Tricare — there are even-stricter rules for providers, saying any request for upfront payment “must be made as a request and without undue pressure.” 

So: Saying, “no thanks” can work. 

And as Exhibit A: Our listener Lynn, whose question kicked off our inquiry. She just asked the folks at the doctor’s office: If she didn’t send back the form authorizing them to charge her card, would the doc still treat her? They said yes. 

Did you overpay in advance? It’s not too late

Don’t get scared off by Noah’s dreadful experience. It may be less painful to get your money back than you think.

The day our episode with Lynn’s story came out, we got a note from a listener named Heather in Ohio, who had immediately put all this knowledge to use — and gotten results: 

Earlier this year, my dentist told me my insurance wouldn't cover a procedure and asked me to provide prepayment. I believed them and forked over $660. 

After listening to the show, I realized I shouldn't have paid up front. So I called my insurance who said they absolutely would have covered the procedure. Then I called the dentist who agreed to send it to insurance and refund me my money.

So many people who call into your show talk about the time and energy associated with fighting back. This wasn't even that hard! I was just too scared to question the system, even though we all know it's broken. So thanks for making me feel empowered enough to question it :)

To which I say: Hell, yeah!  

Also, Heather, thanks for making my week.

Wanna try it?

As Heather noted, we hear a lot from folks who have a lot of trouble getting benefits to which they’re entitled. But sometimes, it’s an easy fix. 

Give me — give all of us — the benefit of your experience: If you’ve fought to get paid back (or are inspired to after reading this), let us know how it went! 

Respond in the comments here, or reply to this email. Let me know how much you need to be kept private. I’ll share what we learn in a future edition of First Aid Kit.

Thanks so much for reading! I hope your summer is off to a good start, and I can’t wait to hear from you. 

Watch out for bad air quality days, and take good care of yourself.

Till next time,

Dan

Bonus: Further reading

Hi, it’s Gabrielle Healy. I’m the audience editor at First Aid Kit, and I edit and produce this newsletter with Dan.

Here are a few recommendations for additional reading between newsletters.

The Hospital Bills Didn’t Find Her, but a Lawsuit Did — Plus Interest. This KFF Health News piece hit home, because I’ve moved three times in three years, and recently discovered a bill for some routine tests got sent to an old address without my knowledge. The infuriating situation described in this story is far worse than mine because it involves a lawsuit for more than $11,000. It gets (somewhat) resolved with the help of a patient advocate. 

A.I. May Someday Work Medical Miracles. For Now, It Helps Do Paperwork. We’ve been curious about how A.I. could affect what we pay for health care – and how we might use it to fight back. For now, I was surprised to read in the New York Times (but maybe I shouldn’t have been) that notetaking with an assist from A.I. is already appearing in doctor’s offices around the country. If you’re looking at (or even experimenting with) how A.I. can figure into dealing with medical bills and insurance denials…get in touch?  

Speaking of insurance denials:  Denials of health-insurance claims are rising — and getting weirder (Washington Post) and How Often Do Health Insurers Say No to Patients? No One Knows (ProPublica) both look at the same issue, and some of the same sources: KFF’s analysis of the scanty publicly-available data, and ProPublica’s deep dives on some of the outrageous ways some insurers deny claims. And both draw the same conclusion: The federal government could make claim denial rates available, but it hasn’t.

The ProPublica piece is much longer, with details on the information states compile but don’t make public, the special interests who don’t want this information to come out, and the story of ace health insurance nerd Karen Pollitz, whose work pushing for more transparency is informed by her experience as a cancer survivor. 

And speaking further of insurance denials:  That’s the topic for the next First Aid Kit or three. (Or more. It’s a big topic. Strap in.)

If you read these pieces, tell us what you think in the comments. We’d love to hear from you.