Episode•May 11, 2023•23 min

Dr. Virgie Bright Ellington Demystifies Medical Bills | Ep. 228

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! 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 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 Twitter: therealdrvirgie Instagram: therealdrvirgie Facebook: therealdrvirgie Don't forget to rate, review, and subscribe to the podcast. If this episode was helpful, share it and spread the love! This podcast uses the following third-party services for analysis: Podcorn - https://podcorn.com/privacy OP3 - https://op3.dev/privacy

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Key Takeaways

1
Medical financial literacy is the key to avoiding predatory medical billing in the U.S. healthcare system
Medical bills are the #1 cause of debt and bankruptcy in the U.S.
99.9% of Americans lack medical financial literacy, which providers exploit
There's only one right way to pay a medical bill to avoid being overcharged
2
CPT codes are essential for verifying medical bills - they're like barcodes for medical services
Every medical service has a unique CPT code
Request a bill with CPT codes by citing HIPAA federal law if providers resist
CPT codes allow you to research the fair Medicare price for each service
3
Three-step process to pay only the fair price for medical services
Step 1: Request a bill with CPT codes from your provider
Step 2: Google each CPT code to find what Medicare pays (the fair retail price)
Step 3: Call back and offer to pay the Medicare total via interest-free payment plan in your budget
4
Medicare rates represent the lowest fair retail price for medical services
Medicare payment rates are recognized nationwide as the baseline fair price
Insurance companies only pay based on CPT codes, not fantasy bills
You have the same right as insurance companies to only pay based on CPT-coded services
5
Stick to your budget when negotiating payment plans - don't agree to unaffordable amounts
Providers are trained to push back and negotiate higher monthly payments
If you agree to a payment you can't afford and miss it, they can send you to collections
Interest-free payment plans can extend for years - that's acceptable

Intro

Tiffany welcomes Dr. Virgie Bright Ellington to discuss medical financial literacy and how to avoid being taken advantage of by the U.S. healthcare billing system.
Dr. Virgie Bright Ellington is a board-certified internal medicine physician, former health insurance executive, and patient advocate with over 20 years of experience. She is the author of 'What Your Doctor Wants You to Know to CRUSH MEDICAL DEBT' and helps patients navigate complex medical billing through her 'What Your Doctor Wants You to Know' series.

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– What is Medical Financial Literacy?

Dr. Virgie defines medical financial literacy as knowing how to avoid becoming a cost victim of the U.S. healthcare system. She explains the connection between medical debt, bankruptcy, and divorce, noting that medical bills are the #1 cause of debt and bankruptcy in America.

Medical bills are the number one cause of debt and bankruptcy... 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.
– Dr. Virgie

– The Three Steps to Pay Medical Bills Correctly

Dr. Virgie outlines the only right way to pay a medical bill:

Call the provider and ask for a bill showing CPT codes
If they resist, cite HIPAA federal law and ask to speak with someone who can help

Google each CPT code to find what Medicare pays
This represents the fair, lowest retail price for that service

Offer to pay the Medicare total amount
Request a payment plan within your budget
Stick to your budget - don't agree to unaffordable monthly payments

– HIPAA and Your Right to CPT Codes

Dr. Virgie explains that HIPAA gives patients ownership of all records pertaining to their care, including financial records. Providers often resist providing CPT-coded bills because they can hide inflated charges without them.

HIPAA federal law... was supposed to protect every person in the United States who has to get medical care to be able to take ownership... And that includes, of course, your medical records, but any records pertaining to your care, including financial records.
– Dr. Virgie

– Using Insurance Company EOBs as an Alternative

For those with insurance who want to verify billing without calling providers, Dr. Virgie recommends requesting an Explanation of Benefits (EOB) from your insurance company, which always includes CPT codes and is often faster to obtain.

– Resources for Listeners

Dr. Virgie directs listeners to crushmedicaldebt.com for a free checklist of the three steps and additional resources for managing medical expenses.

Books Mentioned

What Your Doctor Wants You to Know to CRUSH MEDICAL DEBT by Dr. Virgie Bright Ellington

Resources

Topics

medical billinghealthcare costs patient advocacymedical debtCPT codesHIPAA rightsfinancial literacyinsurance navigationpayment plansMedicare rates