In This Article
Do you want to understand how to pay your medical bills without getting taken advantage of by the US Healthcare System? Learn from Dr. Virgie Bright Ellington! In this episode, she will give you three simple steps to ensure you pay only the fair/lowest retail price for your medical services – all as per HIPAA federal law!
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About Our Guest
Dr. Virgie Bright Ellington is an internal medicine physician and medical billing expert.
A determined patient advocate, Dr. Virgie practiced more than 20 years in primary care and psychiatric settings and as a health insurance executive.
Dr. Virgie now helps patients understand complex medical procedures, communicate effectively with their healthcare providers, and avoid financial devastation from crushing medical bills through her “What Your Doctor Wants You to Know” series.
She is the author of What Your Doctor Wants You to Know to CRUSH MEDICAL DEBT and the host of the weekly “HEALTH, WELLNESS & MEDICAL BILLS” show on the VoiceAmerica radio network.
Connect with Dr. Virgie
Links and Resources
Look up CPT codes: https://www.aapc.com/codes/cpt-codes-range/
Check prices: https://www.cms.gov/medicare/medicare-fee-for-service-payment/feeschedulegeninfo
Intro/Outro: You know what it is? That's right. It's time to talk money with your money nerd and financial coach. Now tighten those purse strings and open those ears. It's the Money Talk with Tiff podcast.
Tiffany Grant: Hey everyone. I am excited because I have Virgie, bright Ellington on the line, and she's here to talk to us about a topic that I had not heard of until she came on the show, and that is Medical Financial Literacy. So, hey Virgie, how are you today?
Virgie Bright Ellington: I am fabulous. Tiffany, thank you so much for having me, and congrats on the little one that's joined your team.
Tiffany Grant: Aw, thank you so much. Thank you. Thank you. It's good to have you
Virgie Bright Ellington: back and glad she's
Tiffany Grant: joining us. Absolutely. It's definitely fun times over here for sure.
Virgie Bright Ellington: Maybe not a lot of sleep, but a lot
Tiffany Grant: of fun. Right, right. So speaking of, okay, so medical, financial literacy. What is that? Um, in, in your terms, what is medical financial literacy?
Because I've never heard of it, and I'm sure my audience hasn't either,
Virgie Bright Ellington: so we're just coming outta. Financial literacy month. And so people think of financial literacy as like personal finance, knowing basic things like, you know, to negotiate for a car new or used. You don't pay the, what I call the M R S P, the manufacturer retail sticker price.
So things like that. We know not to put things on credit if at all possible, meaning. Only the high ticket items that you cannot be expected to pay off in one or a few months and something ideally that appreciates like a home. So that's what I call personal financial literacy, and that's what I think folks mean when they mean financial literacy.
Medical financial literacy is basically knowing how to make sure that you don't become a cause victim of the United States Healthcare System, and that's because. Medical bills are the number one cause of debt and bankruptcy. And if you can imagine stress in the United States, and if you think about, well, if medical bills are the number one cause of debt, What's the number one cause of divorce?
Money stresses. Money, disagreements, financial problems. Money problems. Right? So there's a direct relationship between debt and divorce, between relationships and debt. So that's why it's important to become medically financially literate because there is. Only one right way to pay a medical bill to make sure that you don't become a cost victim of the US often, unfortunately, predatory medical billing system.
Tiffany Grant: Well, let's talk about that because I know a lot of people have questions about medical bills and things of that nature, and. You know, as far as I'm concerned, I feel like I might be lacking in medical financial literacy because, you know, I go to the doctor, I get the bill, I pay it, you know, and I just go on about my business and that's that.
Um, or back before I started my journey, I would not pay them and they would just go on my credit and I'm like, oh, well medical bills don't count. Um, which is, False by the way, but um, that's what I used to believe. And so let's just dive a little bit into that. Like what are some things, cuz my audience is generally twenties, thirties, forties.
What are some things we should be thinking about now so that way we don't fall victim or, you know, fall into that trap?
Virgie Bright Ellington: Well, basic medical, financial literacy is knowing the one right way to pay a medical bill. And that's because, and you said, you know, Tiffany, I'm someone who just knew nothing about how to pay medical bills or to pay it, or that kind of thing, or I get overwhelmed.
Well, the us, most of the US healthcare system, unfortunately, and I'm talking about hospitals, medical senators, that kind of thing, Count on us. 99.9% of us don't know. How to pay a medical bill so we're not taken advantage of. We are not medically financially literate. Let me tell you something, Tiffany.
I've been a board certified internal medicine physician. I've been a, I was a former health insurance executive, but it wasn't until I became a patient that I figured out, oh my gosh, I've been taken advantage of too, that it is a thing. It's a thing for. Providers, usually large institutions, hospitals, medical centers, and nonprofit ones do it just as much, if not more than for-profit ones.
By the way, take advantage of our lack of medical, financial literacy. So what to do? The big thing, the basic thing to do to have basic medical financial literacy, Tiffany, is to learn and to know. The only right way. There's only one right way to pay a medical bill, and that involves three steps. Step number one is when you get a bill in the mail, usually you get your bill in snail mail.
Sometimes they'll call you in the phone, but usually the first bill is by snail mail. You're gonna say, you know what? I don't see anything on here that says C P T C as in can't. P as in pay. T as in this can't pay. This codes c p T codes are to medical services. What barcodes are to products in a retail store.
Every medical service that you can get in the United States has a unique code. Just like if you go to the store, the corner store, and you grab, uh, a bigger bottle of your favorite brand, Poland Springs, let's say, of water than you usually do. You buy the. The 16 outsides instead of the eight ounce outsides, because you're especially thirsty.
Well, they have those two different sizes, have different, uh, different barcodes. Same thing with medical service in the US They have each test, procedure, operation, ER visit, office visit, blood test, anything you can think of. They each have their own unique. C P T codes, their own unique codes. And the reason why you need that is because in step two, you're going to, after you've called and asked your provider, you're gonna call that number in step one.
That there's usually a number that says, or a little line that says under this, what I call a fantasy number, where they say, this is how much you owe. It's a totally made up number. If it's totally fictional, if there's no C P T codes describing each service that you received, you're gonna call and say, Hey, I need something, quote something with C P T codes.
And so, That's step one. Once you get that, once you say, okay, I need something to C P T codes, when you receive a bill, and at this time it's a real bill because it has C P T codes, and then each one C P T codes are not service codes. Sometimes they'll trick you and say service codes, or they'll say, detail bill or itemized bill.
Itemized bill rather. So when you receive something that has C P T across the top, it'll say C P T or C P T codes, or C P T slash Hicks pics. Hcpc S, which is a subtype of C P T codes. Once you make sure, okay, step one is done. I got this little piece of paper in my hot hands that has something with C P T plus all of the services that I received that they're billing me for.
Then step two, you're gonna take that and google each c p t code and that's like doing a price scanner on it. Like you run the, the bottle of water through the price scanner and up pops a brief description of the item and what that particular retail is charging for that item. Same thing with C P T code.
Step two, run it through Google, put in C P T code, the five numbers or five digits. And you're going to say, okay, so it describes, let's say, you know, there's a 99 213 code that describes like an outpatient office visit. Okay, great. Then you're gonna Google while you're there, what Medicare pays for that service and for each of those services, because that's the best price.
That like call the most fair price, best retail price and most fair, lowest retail price for that. Service that medical service. That's what Medicare pays. And people think, well Medicare, that has nothing to do with me cuz that's for old people. Well, n yes, it's well known for being the federal government healthcare for people over the age of 55 who don't have healthcare insurance through their, through an employer.
But it's also covers people with certain chronic disabilities or medical problems who are under the age of 65. But the point is that is recognized by all providers in the United States as being the. Very basic, lowest fairest, most fair retail price.
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Virgie Bright Ellington: So step three, you're gonna total up all of those numbers, all of the medical services you received. And when you're in step two, also, you're gonna see the description. You're gonna be like, okay, I'm double checking to make sure I'm not being double billed, making sure that I totally received all of every single service that I'm being billed for.
And you're gonna total all that up to take it to step three, which is saying, okay, you're calling back the provider and saying, and the example I like to use a lot is, let's say you had to have emergency hernia surgery. And hernia repair surgery, and you call 'em up and you say, look, you know what? I know I got a bill for $10,000 for this emergency surgery that I have, but you don't have to tell 'em according to your research.
You don't have to say anything. Just say, in my case. I am willing and able to pay $3,000. I'm just using a hypothetical example. Let's say that was the total you came up with for what Medicare pays for the services you received, according to the C P T codes on your will bill that you got. And you're gonna say, who can I speak with who can help me set up a payment plan?
So this is the other thing about step three, Tiffany, is that. Step three is you ask for an interest free. Payment plan directly with the hospital or provider medical center that is in your budget. So you know, no one expects an emergency. Right. That's a definite definition of emergency. Right. And so you're like, you know, this couldn't happen at the worst time I am.
Money is so tight. I'm just so you know, I don't have any, a lot of income coming in and the only. Amount that I can come up extra in my budget is $50 a month. So you're gonna say when you're talking to them in step three, when you call them back, and in step three you're gonna say, you know, I can only afford to pay $50 a month on this $3,000 bill, and you're gonna get pushback.
And in your mind, Tiffany, you may say, well, why would they accept that? It'll take forever to pay that off. And you may get pushback from the, the front desk rep. The customer service rep in the billing or patient accounts department that's on the phone with you, you know, they're trained to push back and they're gonna be like, you know what?
We helped you and saved your life, or save the life of your loved one. And you know, we deserve to get paid. Well, yeah, you do. And you will get paid. I can pay $50 a month until it's paid off and you're thinking, oh my gosh, it's gonna take 60 months. That's five years. Yeah, and you are going to do that. This is what you're gonna stick to your guns and stick with that.
And the reason is, if they try to talk you into saying, well, can you do a hundred? Can you do a hundred? You know, can you do a hundred dollars a month? If you can't, then don't agree to it because the moment that you fail to make that a hundred dollars payment, if you can only do 50, they're gonna, they can rightfully send you directly to collections, even if you're making the payments every month.
So those are the three steps of the only right way to pay a medical bill to make sure you're not get, you don't get overcharged and taken advantage of. I'm over here
Tiffany Grant: like O M G, I feel like I've probably been taking advantage of
Virgie Bright Ellington: my whole life. We all have. We all have Tiffany. I have to. That's how I got into this line of work when I realized, holy crap, these, this is a thing.
They, they're doing this on purpose. This is how they get down. This is how they make money. Just taking advantage of the, of the lack of. Medical financial literacy. Basically the lack of financial literacy in the American public. Folks are living or living in this country who have to interact with the US healthcare system.
Tiffany Grant: And so now I'm over here like, okay, C P T codes. And even when you were talking. I was like trying to Google and guys, it's not hard to Google this stuff either. Like I was able to pull up links to the Medicare, um, information she was talking about. Um, I just pulled a random c p t code and put it in Google and it, it all popped up.
So I'm so grateful for this information and I will make sure that I share those links as well in the show notes. Um, because this is just so interesting. I never even knew CP. T codes existed, let alone calling and asking for them. So I have a question. Like if we call and ask our provider for the C P T code, like are they legally obligated to give it to us?
Oh my gosh. Or can they push back? I swear
Virgie Bright Ellington: folks that are listening, I swear. Tiffany is not my plan. You would've thought that I set her up and say, all right, Tiffany asked this question. Perfect question and I'm so really, I'm so glad you asked, because when you call the provider's billing department, the hospital systems, patient accounts department, and you say, I need something, quote, I need something with C P T codes, unquote.
Sometimes, unfortunately, too many times you will get a response of, well, um, we don't have that kind of bill here, or we don't have that kind of information here, or that's something you're gonna have to call your insurance company about. We don't, that's like claim information. We don't have that information here.
Then you're going to very politely say, okay, who can I speak with? Who can help me get something with C P T codes as per hipaa, federal law, unquote, hipaa, federal law, people think of it as the privacy law, and that's actually. It was a side offshoot of the law. The law was supposed to protect every person in the United States who has to get medical care to be able to take ownership.
They have ownership of their healthcare, their records, everything pertaining to services that was provided to them by, uh, provider in the United States. And that includes, of course, your medical records, but any records pertaining to your care, including financial records. So the reason why, unfortunately, Uh, the many providers, too many providers will try to get around giving you you meaning the patient, the American patient.
A bill with c p T codes is because they know that they can hide a lot of crap, a lot of stuff that they have no business just made up fantasy. I call it wishful thinking. Wishful numbers, a fantas list because they're wishing and hoping and praying and you fall for it. They don't send these fantasy.
Creations of a bill, a wishlist to insurance companies. Insurance companies will only pay based on a C P T code. Mm-hmm. So if an insurance company is not gonna pay something that doesn't have a C P T code, why should you? Mm, that's a
Tiffany Grant: really good point. And so that brings me another question because, you know, my wheels are turning now.
Um, when it comes to, okay, so let's say for instance, I have great health insurance and they pay for, let's say the majority of, you know, the costs, whatever those are. Should I still call and ask, like, let's say my bill's only like, I don't know, $15 or so. Should I still go ahead and ask for the c P T codes to make sure that they bill the insurance correctly?
Like, does that have any, um, you know, negative implications on my account? Like if they didn't bill it correctly, does it affect my insurance in any way?
Virgie Bright Ellington: Brilliant, brilliant question, Tiffany, again, and thank you so much for asking it. And folks, I swear I did not plant Tiffany. I did not say, Hey Tiffany, ask me this
Absolutely wonderful question. And I talk about this in the context of the three steps. You're run it across. Every single bill you get, it's like running a bill through a price scanner every single time. If it's something that you know that you can afford easily, that's not gonna break your budget and cost you and your family, you and yours, go ahead and pay it.
I don't run it against like a bill that's like $50 or less. I don't do that. And you know, at this point in my life, probably less than a hundred bucks, I probably don't do that just because it's not worth, at this time in my life, it's not worth the time for me to pick up the phone and say, okay, I need you to resend it with c p t codes.
But I will say this a tip. If you have insurance, call your insurance company and ask them for the e o b. Get the number in the back of your, get your insurance card, turn over the number in the back and call them and say, Hey, I need an e o B explanation of benefits for the services that I received on this date of service by this particular provider.
And that always has c P T codes. Mm-hmm. So if you're interested and if you don't want the hassle of going through the provider and waiting on the phone, you'll get a faster response. If you have insurance from your insurance company, because you know things, everything is online, they'll just direct you online if you want that information.
By the way, in snail mail, hard copy, they'll send, they'll tell you how to get that also. But you can find the C P T codes of what the provider build your insurance if you're curious.
Tiffany Grant: Ah, okay. Interesting. Very interesting. Because I know that also comes into play when we're thinking about like our deductibles and things of that nature.
Yes. Um, all of that. Plays into how they bill your insurance provider. So this is all great information. I'm over here taking a ton of notes. Um, so thank you so much Virgie, and I'm like, we still have so much to cover when it comes to medical financial literacy, so I might have to have you back. Um, but I think I gave people enough homework for today.
Uh, so with that being said, how can people find out more about you? You know, medical, financial literacy, where can they find you?
Virgie Bright Ellington: Well, you can go to crush medical debt. Dot com and there's a free, uh, basically a checklist there. You can go to free resources, and in that list of free resources, there's also the checklist that reminds you of the three steps of the only right way to pay a medical bill and other information essentially to.
Basically get help with your medical expenses for free. So that's a great first place to start. If you have questions, you wanna reach out to me directly, I can be reached at Dr. V, like Virginia, I r g I e at Crush Medical Debt.
Tiffany Grant: Dot com. Perfect. Thank you so much. And I'll have all of those links in the show notes as well as the ones that I came across when I googled this information, uh, so that way you can access it easily.
So thank you so much, Virgie, for coming on the show today. This was amazing.
Virgie Bright Ellington: Thank you for having me, Tiffany. Much appreciate it. Good talking with
Tiffany Grant: you. Absolutely. Bye.
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Do you want to understand how to pay your medical bills without getting taken advantage of by the US Healthcare System? In this blog post, we're summarizing the key takeaways from an enlightening episode of Money Talk With Tiff. Dr. Virgie Bright Ellington, a leading expert in Medical Financial Literacy, shares three simple steps to help you pay only the fair/lowest retail price for your medical services – all as per HIPAA federal law.
What is Medical Financial Literacy?
Medical Financial Literacy refers to understanding how to avoid being taken advantage of by the US Healthcare System, which often causes debt and bankruptcy for many individuals. In this episode, Dr. Ellington presents a foolproof method to pay your medical bills the right way, helping you save money and avoid financial stress.
Step 1: Request CPT Codes From Your Medical Provider
Dr. Ellington suggests the first step in taking control of your medical expenses is to obtain the CPT (Current Procedural Terminology) codes from your healthcare providers. CPT codes are like barcodes for medical services and are standardized across the industry.
Remember: Medical providers are legally obligated to provide these codes according to the HIPAA federal law.
Step 2: Determine the Fair/Lowest Retail Price
Once you have the CPT codes, you can look up their fair/lowest retail price by visiting the following resources:
The fair/lowest retail price is usually based on what Medicare pays for the service. By comparing these prices with your medical bill, you can make sure you aren't being overcharged.
Step 3: Negotiate an Interest-Free Payment Plan
Once you have the correct prices, approach your medical provider and negotiate an interest-free payment plan. The payment plan should be based on your budget and the sum of each CPT code's respective Medicare costs. This way, you can pay off your medical bills without experiencing financial strains.
Tips for Those With Insurance
If you have insurance, it is crucial to request an Explanation of Benefits (EOB) for the services provided. This will confirm the CPT codes billed, ensuring you are paying the correct amount for your medical services.
Following Dr. Ellington's expert advice, you can navigate the complex US Healthcare System with ease, save money, and maintain financial stability.
If you find these tips helpful, be sure to subscribe to the podcast for more expert financial advice!