Category: Podcast

I want to talk about how to save big bucks if and when you have to go to the emergency room. It’s probably inevitable —especially if you have kids— but it doesn’t have to be ultra expensive. There are all sorts of strategies for saving, even in the midst of a tense situation. My guest is Michelle Katz, otherwise known as “Nurse Katz.” Michelle is a trained nurse, a healthcare advocate and the author of several books about saving money on healthcare, most recently, Healthcare Made Easy. Welcome to Easy Money, Michelle. Nice to have you back.

Isn’t the first way to save money on an emergency room visit not to go to the ER in the first place? How do we know whether we need the ER or Urgent Care?
If you cut your finger off, head to the emergency room. If you just CUT your finger, urgent care should probably do the trick. Or put another way, if life or limb are at risk, go to the ER. But if you have a lesser problem that you do want to be seen for, but that isn’t an emergency, maybe one of the many new urgent care centers will work for you.

OK, if you do need to go to the ER, you say take a medical bag of essentials. What should it contain? This bag should contain your doctor records, known allergies and current medications. The medical bag will help you avoid paying for things you do not need. For example, I once helped a woman named Suzanna negotiate an $8000 ER bill down to about $1500.
• She was charged nearly $300 for a pregnancy test that normally costs about $10 in a drug store.
•She was also charged close to $800 for two tests that had been given by her own doctor the previous day. The tests were $75 at her doctor’s office.
•Another charge was for medication Suzanna already had at home. The price on the hospital bill was 90 times higher than the price she’d paid for the same drug.
This is why bringing your own records and supplies can save you big money at the ER.

You also say to document everything while you’re in the hospital. Or have a loved one do it for you if you can’t. Why is this important?
Incorrect admission and release dates: The hospital staff had billed him for a bunch of procedures the day before the heart attack happened. What are they, psychic?
Misplaced decimals: At the hospital, he had been given a medication that normally costs about $87.40, but he was billed $874 for it! Often billing clerks just hit an extra digit by mistake or misplace a decimal.
Fat Fingers: This is what they call it when a data entry clerk hits the enter key too many times. In this case, I spotted a medication that was listed seven times even though it’s supposed to be given a maximum of four times daily. Any more than that would have been an overdose!
Erroneous Medications: I also noticed that my friend’s bill included a charge for pills. But he had a breathing tube in his mouth and couldn’t take pills. All meds were given via I-V.
Medical Mistakes: Finally, the hospital caused an I-V infection in his arm, and then charged for the extra day he was forced to stay because of it. Patients shouldn’t have to pay for the care required to undo medical mistakes, but it happens frequently.
This is why you should document every treatment you receive and any medications you take.

You suggest people get a copy of their medical chart. Is this their right? And what might they learn from it?
This is legally yours and it will not only help you recall some of the finer details of the event, but it also might help uncover some of the mysterious charges on your bill.   Medical charts have clued me in to wrong dates, wrong times, wrong amounts, double charges, unnecessary tests and even a wrong diagnosis.

Next tip: Always ask for an itemized bill. What is this and how is it different from a regular emergency room bill?
When you go shopping and pay with a credit card, you get 2 receipts. The credit card slip just says the total amount you owe. The store receipt lists all of the individual things you bought and how much they cost. An ER’s normal bill is much like that credit card slip. It contains the total and not much more. The itemized receipt is much more like the store receipt, with all sorts of details about the exact treatments and medicines you were charged for. You want that itemized receipt so you can check it against your own documentation. Every time I have ever done this for someone, I have found errors in the hospital’s favor. Fight those and you will save hundreds or thousands of dollars.

You say to contact the billing department before they contact you. Why?
As soon as you get all of the above information and highlight what seems like an obvious mistake to you and write down your questions, pick up that phone AND ALSO contact the billing department in writing and make that appointment to go over your bill…  Any delay on your part may throw your bill back onto the track to collections… Once you find someone to talk to, you can ask about your options.

You say you can ALWAYS negotiate your bill. I know that you prefer to negotiate the cost of elective medical procedures in advance. But when it comes to the ER, often we aren’t in any condition to bargain until later. Can haggling still work after the fact?
If you have a high deductible, there may be a balance even after insurance kicks in that is a tough amount to swallow.  Take the time to sit down with this billing person to talk about your situation and ask for a discount.  If that amount is too high, work out a payment plan that works for YOU and get your final agreement in writing.  You might be surprised what you can work out if you just ask.  Sometimes hospitals will accept a low cash amount to settle out your bill since setting up a payment plan can be time consuming and cost more for the hospital depending on the situation.

You may also have to negotiate with your insurance company, right? They often try not to cover things.
Yes call your insurance company to double check the information it has received from the hospital:  In this process, I once discovered that one of the main reasons a patient’s insurance company did NOT pay was that somewhere in between filing the claim and capturing it, her birthdate was transcribed wrong. When you find mistakes, get them corrected and then get a reprint of the bill.  Be sure your insurance company has a correct copy.

What are your last steps in dealing with an ER bill?
Once the the balance is correct and/or negotiated down, pay for it immediately and be sure to get the zero balance in writing and keep this isn your file for at LEAST a year. Then, Say thank you:  I cannot emphasize this enough.  It is rare that the billing department gets a thank you.  So be the rarity!  A simple thank you may get you an ally in the billing department that may “have your back” if something goes amiss in the future.

Michelle Katz, Healthcare savings advocate and author, thank you so much for sharing these great tips on Easy Money.

Buy Michelle Katz’s Newest Book: Healthcare Made Easy: www.amazon.com/Healthcare-Made-Easy-Questions-Affordable/dp/1440580197/ref=sr_1_2?s=books&ie=UTF8&qid=1517869802&sr=1-2&keywords=healthcare+made+easy

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Thousands of homes will become available for sale through foreclosure this year —or any year. And while it’s a hardship for the families who lose their homes, it can be an opportunity for others to buy a house at a bargain. It’s sort of the cycle of life.
When a lender forecloses, it’s no reflection on the home. It just means the previous owner couldn’t make the mortgage payments. There are two main junctures at which you can purchase a foreclosed property: on the courthouse steps when it is being auctioned off to satisfy the debt owed to the mortgage company. Or after that same bank has bought the property back itself in order to recoup its investment. This second is known as a bank-owned or “real estate owned” property and is actually more common.
You hear the phrase “auctioned on the courthouse steps” frequently, but the truth is, not all courthouses have steps and not all of these auctions are conducted at courthouses! Some states hire professional auctioneers and ask that the auctions be held at the auctioneer’s office. Others allow them to be held on the premises of the property they’re selling. Other options: some auctions are run by the local sheriff’s office and others are handled by attorneys. I’m going to refer to ALL of these as courthouse-steps scenarios.
If you are hoping to buy a property in a courthouse steps scenario, where the bank is repossessing the home from the mortgagees, it’s a good idea to attend several auctions and get a feel for how they work before you actually bid. Keep in mind that many –even the majority—of these auctions are canceled at the last minute when the homeowners somehow work out a deal with the bank to stay in their home. So try to re-check listings before heading to the auction site. You should also know, that even for a courthouse-steps scenario, you are allowed to hire a real estate agent to represent you. Just be sure to choose one with experience in this unique subset of the realty world.
Typically you cannot get inside to see the property when buying from the courthouse steps, but here is one helpful hint: if the property changed hands in recent years, there may still be photos and details archived in the Multiple Listing Service that real estate agents have access to or on a real estate website like Zillow. So check.
Now let’s talk about bank-owned properties, where the bank has already bought the foreclosed house itself. You should know that banks are not required to disclose defects in the property in the same detail that regular sellers are because they have not lived in the home. It’s important to hire an expert home inspector to look for expensive flaws.
Nearly all bank-owned properties are listed on an as-is basis. That means the bank is stating it will not repair defects to the property. If you find flaws, you should lower your offer accordingly. Alternatively, if the property has been sitting around for awhile, even though the bank has listed it “as is,” the bank may be willing to pay for repairs in order to get the home off its books.
It’s best to approach any home purchase with your own pre-approved financing in place, but since you are dealing with a bank, it is quite possible that they will want you to get pre-approved by their own mortgage department as well. Some banks selling properties will actually offer to provide you a mortgage for a property. It’s a fine idea, as long as you have shopped around elsewhere and know you are getting a good rate and fees.
Industry experts say bank-owned properties are already marked down 20% to 30% compared to other homes in the neighborhood, so you may not have much luck making a lowball offer. However, if the home has been on the market a long time, your chances are better of talking the price down. Still, when Zillow analyzed the closing price of regular homes versus foreclosed homes, it found that you can get a discount of 7 to 27 percent on a foreclosed home. And when you’re talking about big numbers, those percentages are real money!

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