A former Aurora Healthcare nurse is sharing her insider knowledge on how to spot errors in medical bills after successfully reducing her own bill from $24,000 to less than $1,500.
Nicole Walker, who worked as a nurse at Aurora for about 20 years, reached out after seeing a TMJ4 story about another Aurora patient who was frustrated with billing issues.
Watch: Wisconsin woman speaks out after mistakenly receiving $24,000 medical bill:
"I read your story online, and I thought well, it doesn't surprise me," Walker said.
Walker received a bill from Aurora for $24,000 following a recent medical visit, but says her experience working in healthcare gave her the knowledge to identify errors and advocate for herself.
"If you don't have that knowledge, you don't know what to do, and you may just get frustrated enough to say, I'm just gonna pay it and be done with it," Walker said.
When she first received the shocking bill, Walker didn't panic but immediately took action.
"I was like, What the heck?" she said.
The process wasn't straightforward.
"First, I call the hospital, and they're like, 'Well, now you need to call your insurance company.' You call the insurance company, they're like, 'Well, you have to call the hospital,'" Walker said.
Walker recommends that patients locate their Explanation of Benefits (EOB) form from their insurance company as a first step.
"That tells you exactly what the hospital or clinic billed, what they paid, if you have a discount, if you're in network, what that discount is — and what you owe," she said.
The next step is requesting a detailed statement from your healthcare provider that lists all charges and services, then comparing it to the EOB.
Walker recommends this practice for all medical visits, not just major procedures. "Every visit, even your clinic visits. My husband, he went for his physical, which under our insurance is covered 100% and all of a sudden we're getting a bill for like 80 bucks," she said. Using the EOB and a detailed bill, she was able to spot the discrepancy and get the charge removed.
Using that same method, Walker discovered a significant coding error in her $24,000 bill.
"I had gone in with stroke-like symptoms," she said. "But it got coded, that I was in an accident, and someone else had to pay because an ambulance took me from an urgent care with stroke-like symptoms to the hospital."
Walker emphasizes that getting a bill adjusted typically isn't a quick process, and healthcare systems may continue collection attempts while you're working to resolve a billing issue. Her advice is to remain firm but polite.
"I'm not paying until this is resolved. And once it's resolved, I will pay what I owe. I'm not going to pay anything at this point," Walker said as an example of what you can say to anyone who calls or emails you asking for payment.
"Just stay polite as best you can, because nothing is going to get resolved if you become angry and upset and start yelling, they're just going to hang up on you."
If patients can't resolve billing issues directly with their healthcare provider and insurance company, Walker suggests contacting the Insurance Commissioner of Wisconsin, a resource she has used successfully in the past.
"They will either determine 'Yes, there was a violation under the insurance laws,' or 'No, there wasn't.' However, I have had them tell me 'No, there wasn't a violation under the insurance laws, but you can do x, y, z,' so they kind of pointed me in a different direction," she said.
Additional resources for patients include asking to speak with the healthcare system's financial advocate, as you may qualify for bill reductions if you have a high-deductible plan or no insurance. Walker also recommends reaching out to your workplace HR representative, who may have resources to help with complicated medical billing issues.
This story was reported by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.
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