Resources

Listing of Information in This Section

  • Sample Form Letter to Protest a Surprise Out of Network Bill
  • Sample form letter requesting medical records and itemization of an exorbitant medical bill that has been presented in a single aggregate sum for collection
  • Sample form letter to send to debt collector disputing debt and requesting debt verification
  • Recommended questions that self funded employers should ask their healthcare insurance brokers to uncover conflicts of interest
  • Fair Price Listings for various medical treatments and procedures
  • Professional patient advocate services
  • Medical debt bankruptcy filing resources
  • Self funded employer coalitions to purchase group healthcare benefits
  • Government resources to identify healthcare price solutions
  • Employer fee paid brokers to help employers implement direct pay healthcare plans
  • Websites that connect patients to vetted mail order pharmacies both U.S. and foreign
  • Pharmacy benefit managers who pass on drug manufacturers rebates in full and do not engage in spread pricing
  • Affordable Medical Imaging Services
  • Additional Reading

Sample Protest Letter to Challenge a Surprise Out of Network Bill

Dear Sir or Madam:

The bill(s) enclosed are for out of network services performed on (date) during my admission to (medical facility), a facility that is in my insurance network. I went to this facility precisely because it is in my network. I was not informed of these providers’ out of network status nor did I consent to being treated by any out of network providers. Since I did not give informed consent for treatment beyond the terms and network of my insurance policy, I suggest that you contact my insurer to work out payment. I will only pay that portion of the bill that I would have paid for in network services.

Please stop this effort to collect a bill that I do not owe for a service I was never informed would be out of network.

If I get another notice of this bill, I will report this collection effort to the (your state) Department of Insurance and (your state) Department of Consumer Affairs.

Sincerely,
Your name

Sample Letter Requesting Itemization of an Exorbitant Medical Bill and Supporting Medical Records

Dear Sir or Madam:

I am requesting my medical records and itemization of the bill that you presented to me, along with the medical records that allegedly support these charges. It is my right to receive these records in any form I request, whether by postal mail or email, under the Health Insurance Portability and Accountability Act within 30 days and for a reasonable handling and processing fee.

If I do not receive the material within that deadline, I will reserve my option to file a complaint with the federal Health and Human Services Office for Civil Rights, which prosecutes HIPAA violations.

Sincerely,
Your Name

Sample Letter to Debt Collector Disputing a Debt and Requesting Debt Verification

SENT BY CERTIFIED MAIL RETURN RECEIPT REQUESTED

Your Name
Your Address
Date

Debt Collector’s Name
His Address

Re: Account number for the debt, if available, plus “Dispute of Debt and Verification Request”

Dear Debt Collector’s Name,

I am responding to your contact about collecting a debt. You contacted me by phone/mail on (date) and you identified the debt as (any information provided about the debt).

In accordance with the Fair Debt Collection Practices Act, I am writing to inform you that I dispute this debt. I do not believe I owe the amount you are requesting. I want you to waive the debt and clear this account.

If you believe I owe the debt, then in accordance with the Fair Debt Collection Practices Act, you must verify that I am responsible for the alleged debt. You must also verify that you are the entity entitled to payment.

If you have proof of my responsibility for this debt, please mail me the documents that support your position. I also need to see evidence that the prices charged by any and all medical providers were usual and customary amounts that such medical providers would accept from their in network insurance providers.

I need a full accounting. I want to know the medical service delivery date(s), a description of each service delivered, and an itemized medical bill, including the identification of the original creditor and the medical billing codes used to document the alleged care provided.

Please stop all other communications with me and with this address, and record that I dispute having any obligation for this alleged debt. If you stop your collection effort on this matter and forward or return it to another company, please indicate to them that it is disputed. If you report it to a credit bureau, or have already done so, you should also report that it is disputed.

Thank you for your anticipated cooperation.

Sincerely,
Your name

Recommended Questions Employers Should Ask Their Health Insurance Benefits Brokers

  • Do you or your company get paid any commissions from insurance companies or other organizations based on my organization’s health benefits?
  • Do you or your company get paid bonuses from health insurance companies or other vendors based on my organization’s health benefits?
  • Do you or your company receive any trips, meals, gifts or other perks from health insurance companies or other vendors based on my organization’s health benefits?
  • Do you or your company get paid bonuses and/or commissions from health insurance companies or other vendors based on the loss ratio or the profitability of the plan?
  • Do you or your company get paid bonuses and/or commissions from health insurance companies or other vendors based on the overall volume of employer sponsored health plan members or groups?
  • Do you or your company get paid bonuses and/or commissions from health insurance companies or other vendors based on the retention of health plan members or groups?
  • Do you or your company ever participate in “no shop” or “no market” offers on behalf of insurers or other vendors?
  • Do you or your company participate in vacations, trips, meals, or other perks provided by insurance companies or other vendors?
  • Do you and your company always disclose all bonus and commission money, trips, meals, or perks to each employer group?
  • Do you or your agency participate in fee only payment agreements where the only income you receive comes directly from the employer?
  • Do you or your agency participate in any payment arrangements where the employer pays you directly and your broker or agency also receives a commission or bonus from an insurance company or other vendor?
  • If you take direct payments from employers, what percentage of your benefits revenue is fee based and what percentage is commission and bonus based?

Listing and Contact Information for Resources Referenced in This Website

1. Fair Pricing Listings for Various Medical Treatments and Procedures

  • FairHealthConsumer / www.fairhealthconsumer.org
  • Healthcare Bluebook / www.healthcarebluebook.com

2. Professional Patient Advocates

  • National Association of Healthcare Advocacy / www.nahac.com
  • Advocacy Connection / https://umbrahealthadvocacy.com

3. Bankruptcy Filing Resources

  • Upsolve / https://upsolve.org

4. Self Funded Employer Coalitions to Purchase Group Healthcare Benefits

  • National Alliance of Healthcare Purchaser Coalitions / www.nationalalliancehealth.org
  • Colorado Purchasing Alliance / Purchaser Business Groups for Healthcare / www.pbgh.org

5. Government Resources to Identify Healthcare Price Solutions

  • National Academy for State Health Policy / https://nashp.org

6. Employer Fee Paid Brokers Who Help Self Funded Employers Implement Direct Pay Healthcare Plans

  • E Powered Benefits / www.epoweredbenefits.com
  • Mitigate Partners / www.mitigatepartners.com
  • Health Rosetta / www.healthrosetta.org. Rosetta certified consultants are nationwide.
  • Alight Solutions / https://www.alight.com

7. Website That Connects Patients to Vetted Mail Order Pharmacies Both Here and Abroad for Good Quality Low Cost Drugs

  • www.pharmacychecker.com — website started by a physician

8. Pharmacy Benefit Managers Who Pass on All Manufacturers Rebates and Do Not Engage in Spread Pricing

  • Navitus Health Solutions / https://navitus.com

9. Affordable Medical Imaging Services for MRI’s, CT’s, etc.

  • Green Imaging has facilities in all 50 states / https://greenimaging.net

Additional Reading

This website is extensively based on the following books:

  • Win Your Insurance Appeal in Five Days by Laurie Todd
  • The Price We Pay by Dr. Marty Makary, M.D.
  • Never Pay the First Bill by Marshall Allen
  • The Great American Healthcare Heist by Chris Deacon, Esq.
  • An American Sickness by Elisabeth Rosenthal, M.D.
  • Priced Out by Uwe Reinhardt, Ph.D.
Scroll to Top