When you go to some sort of health care provider for the first time, you are invariably presented with some forms to fill out. One of these usually contains language that says you agree to be responsible for any and all charges not covered by your insurance. Cross it out, put your initials next to the stricken text, then sign the form.
This has been my practice for at least the past ten years. Why on earth would any person of sound judgement agree to pay for anything without first knowing how much it is going to cost? I still get a little anxious when I walk up to the little window and hand in my completed forms, fearing they will give me some shit about refusing to bend over. I think I've gotten shit about two times out of... 50? In other words about 95% of the time no one will argue with you. Sometimes they don't bother to look at what you've written, at least not right away. Sometimes they do, but you know what? The grunts in the front lines are, for the most part, weary and do not want to fight.
You will thank yourself for adhering to this sensible practice. I got a bill for something like $9000 for an upper endoscopy from a place that styles itself The Ambulatory Center for Endoscopy. I had crossed out the offending language on my forms. I sent them a letter that said, show me when and where I ever agreed to pay you whatever amount that you unilaterally determined to charge me after the fact, without my prior knowledge and consent, and I will reconsider. Until then, you will accept whatever you get from the insurance company and that's that. They backed down.
A couple years later I had the pleasure of doing business with these people again. They billed me some two thousand dollars. I sent them a letter that said, gee, this sounds familiar, and the outcome will be the same as last time. You get what you get, and fuck off. They sent me another statement for the same amount. I sent them another letter saying, what was it in my previous letter that you didn't understand? That was some months ago and I haven't heard from them since.
You can just guess what would have happened if I had been too timid or ignorant to resist. They'd have taken the money from me and put it in their pockets. Fuck that.
By the way, if you think striking out the objectionable language is irrelevant as a matter of law -- either the contract is enforceable or it isn't -- you may or may not be right, depending. I just found this jewel in the Blue Cross/Blue Shield 2009 Service Benefit Plan, a PDF weighing in at 136 pages:
"In some instances, a Preferred, Participating, or Member provider may ask you to sign a 'waiver' prior to receiving care. This waiver may state that you accept responsibility for the total charge for any care that is not covered by your health plan. If you sign such a waiver, whether you are responsible for the total charge depends on the contracts that the Local Plan has with its providers. If you are asked to sign this type of waiver, please be aware that, if benefits are denied for the services, you could be legally liable for the related expenses. If you would like more information about waivers, please contact us at the customer service number on the back of your ID card."
Interesting, isn't it? Note that they don't tell you not to sign. Heaven forfend they should alienate their Providers. Their attitude towards you the patient is, you're on your own, good luck. They could use a little help with their punctuation, too.
But the important point of the above excerpt is that following my advice may well save you a bundle. Remember these two simple words: fuck that.
All of the preceding discussion assumes you actually have the good fortune to enjoy health insurance. Any fool knows this system is broken and Single Payer is the way. Of course that will only happen over the insurance companies' dead bodies -- which is fine with me.
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