PHA Case Study – Unreasonable balance for a surgery bill


Sharon had emergency surgery at an in-network facility, but was left with a large out-of-network balance on her bill because the on-call surgeon who performed the procedure was not in her plan’s network. Although the claim was already paid by her insurance company at the highest plan benefit level (90 percent of allowable). Sharon was still left with a $4,230 balance. Her Personal Health Advocate negotiated with the doctor to lower her payment to $2,000 and saved Sharon $2,230.

What The Healthcare Survival Guide Says

Step up and negotiate with your doctor or hospital to get a discount on your claims – 61 percent of patients who asked for a discount form their doctors got one (pg. 36). In some cases, hospitals offer a significant dollar or percentage discount if you pay cash (pg. 43). Keep track of the hospital care you receive; make a list of all your procedures, tests, medications and supplies. This will help you when you need to review your bills later. Double-check and question every charge. Overcharges such as being charged for the wrong number of days in the hospital are common (pg. 43).

For more in-depth advice on this topic, check out our blog post on negotiating with your doctor.

If you would like a free copy of The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money, you can download it at


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