The Secret to Getting a Fair, Timely and Accurate Medical Bill

Most journalists are introverts. It’s true. We consciously or subconsciously choose journalism as our profession because it forces us to talk to people. We prefer to talk with other journalists at a bar.

I’m no exception, especially when it comes to being an assertive consumer. Overcharged for a grocery item? Not worth a trip back to the store. Poor service at a restaurant? The server probably is having a bad day. Amazon delivered the wrong item? I’m sure I can use a set of magnetic cabinet latches.

Apparently, my passive consumer personality is not going to serve me well when it comes to medical bills. At least according to a new study in JAMA Health Forum. The study suggests that the best way to deal with high medical bills and unaffordable medical debt is to become what I would call an asshole.

Three researchers affiliated with the University of Southern California wanted to know how patients advocate for themselves, i.e., be good consumers when they have a problem with a medical bill. The researchers defined “problem” as a bill that a patient thought was too high or had a mistake.

The study pool consisted of 1,135 consumers age 20 or older. The researchers surveyed them last fall on their medical bill advocacy behaviors.

Two hundred and three, or 18%, of the consumers said they or someone in their family had a problem with a medical bill over the past 12 months. The leading source of their problem was physician offices, cited by 33%. Emergency departments/urgent care centers and hospitals were second and third at 16% and 15%, respectively.

In ranked order, the reasons the 203 people had a problem with their medical bill were:

• 43% said they felt the bill was unfairly high.
• 40% said they could not afford to pay the bill.
• 33% said they felt the bill was too high because of a mistake.
• 27% said their bill seemed confusing.

Now here’s the part that I can relate to. Only 136 people, or 67% of those with a problem medical bill and 12% of all those surveyed, reached out to the source of the bill for an explanation. Sixty-seven, or 33%, of the people with a problem medical bill did nothing. (That’s me.)

Asked why they didn’t reach out, the reasons in ranked order for the 67 people who did nothing were:

• 82% said they didn’t think it would change the bill.
• 27% said they felt uncomfortable reaching out.
• 18% said they didn’t have time.
• 10% said they worried that reaching out would harm their medical care in the future.
• 6% said they didn’t know how.

Who are these 136 people who complained about a medical bill to their doctor or hospital? (That’s not me.) The researchers asked the respondents to rate different personality traits on a sliding scale. Then using some fancy math, the researchers identified the personality traits most highly correlated with the likelihood of complaining about a medical bill.

In ranked order, the six highly correlated traits of a person who calls out a problem medical bill were:

1. Higher extroversion
2. Higher financial literacy
3. Higher neuroticism
4. Lower agreeableness
5. Higher conscientiousness
6. Higher openness

“Higher financial literacy, higher extroversion and lower agreeableness were also associated with greater likelihood of reaching out, after controlling for other personality traits,” the researchers said.

Many of the assertive, less agreeable people got something for their effort:

• 27% had their bill corrected.
• 13% set up a payment plan.
• 13% had their price lowered.
• 12% understood their bill better.
• 7% got financial assistance.
• 4% had their bill totally canceled.

We all have people in our lives who brag about getting something like a flight or a dinner for free or at a discount because they complained. What does it say about our healthcare system if you have to become that person to get a fair, timely and accurate medical bill? Journalists are screwed.

Thanks for reading.

To learn more about this topic, please read, “The Complexity of Medical Bills Rolls Downhill for Consumers,” on 4sighthealth.com.