In just the last few decades, health care spending in the U.S. has skyrocketed. Today, nearly 1 out of every 5 dollars spent goes toward health care, and efforts to cut costs are at the forefront of consumers' minds.
In a WebMD Reddit AMA about how people can cut health care costs, patient advocate Erin Bradshaw discussed a variety of topics, from common expensive mistakes patients may make to how to save on GLP-1s and the potential for using AI to find cheaper prescriptions.
Bradshaw is the executive vice president of the advancement of patient services and navigation in program development at the Patient Advocacy Foundation (PAF) in Hampton, Virginia.
Here are her answers to some of the questions asked during the Reddit AMA.
When a patient receives a large medical bill, what would be the first thing you'd recommend, before calling the hospital or insurance?
Bradshaw: Don't assume the bill is correct, and don't rush to pay it. A quick review of your Explanation of Benefits (EOB) can catch a surprising number of issues before you ever have to make a phone call. We estimate that about 50% of medical bills have errors, so a quick review is absolutely worth your time. Check your name and insurance info, dates of service, procedures, and charges. Watch for duplicate charges. Even small errors can turn into big costs if they go unnoticed. If something doesn't match what you experienced, that's often a sign of an error.
Coding and billing errors happen – they're not all intentional and may be a result of automated billing systems, human error, or incorrect CPT or ICD-10 codes that don't match the services or diagnosis.
What's the best action plan when a claim gets denied?
Bradshaw: First, make sure you're dealing with a true denial – not just an error. Sometimes, the issue can be resolved quickly by calling your provider and asking them to correct and resubmit the claim (for example, fixing a coding issue or missing information).
If it's a true denial, you should receive a letter explaining:
- Why the claim was denied
- The steps to file an appeal
- Important deadlines to follow
Use this as your roadmap – it tells you exactly what the insurance company is looking for.
What can a patient advocate do to help when someone is facing a denial?
Bradshaw: An advocate (like Patient Advocate Foundation case managers) can take on the administrative burden of the appeals process, coordinate directly with your provider and insurer, gather the necessary clinical documentation, and build a clear, fact-based appeal on your behalf.
We also offer step-by-step, self-guided resources, including sample appeal letters.
A good advocate doesn't just help – they change the outcome.
Do you have advice on getting your insurance company to pay for a medication: One that's expensive and not possible out-of-pocket, that's not the only one, but is the best one?
Bradshaw: Start with the exact reason why the insurance company is denying it. For example, "not medically necessary," "step therapy required" (you have to try a cheaper drug first), or "non-formulary" (not on their approved list). The strategy depends on the reason.
You'll need to appeal the denial by following the steps listed in the denial letter. Be aware of timelines. Your prescribing doctor is your strongest tool. They'll need to draft a letter of medical necessity on why this medication is the best one for you. Whether you've tried or failed will be applicable in the appeal.
In our experience, over 40% of denials get overturned by appeal, but relatively few people bother going through the process. We offer educational resources about the appeals process, including sample letters, here.
If you go through all levels of appeal and are still denied, connect with the manufacturer of the medications assistance line and ask if they offer a compassionate program for access to free medication.
What's something that's perfectly legal in medical billing that feels like it should be illegal?
Bradshaw: The same procedure at the same location can cost different patients dramatically different amounts. It can change depending on your insurance plan, where you are in your deductible, and, of course, whether you're insured at all.
Are there any free apps or tools people can use to compare drug or procedure prices?
Bradshaw: Transparency measures require hospitals to post their prices online, but many hospitals find it's less expensive to take the fine rather than comply with the law. Others post the prices, but not in a way that's user-friendly. However, hypothetically, you may be able to compare drug or procedure prices through hospital transparency measures.
We've also used Healthcare Bluebook, or you can check the Medicare prices for different procedures. With sites like GoodRx, you can see how much you could pay for your prescriptions using different pharmacies. You may even be able to use AI tools to help narrow your search for less expensive prescriptions.
What would you say is the most expensive mistake you see patients make when it's not an emergency?
Bradshaw: That's assuming the system is transparent, coordinated, and designed to guide patients to the most affordable option. It's not. Most patients don't realize that prices can vary dramatically for the exact same service – imaging, labs, and even minor procedures. For example, an MRI may cost $400 at a standalone center and over $2,000 at a hospital, just based on where you go.
Another big one is not using your insurance the way it's designed. If you don't confirm that your provider or facility is in-network, you can end up facing much higher out-of-pocket costs, a completely separate deductible or, worse, no coverage at all.
What all of this comes down to is that the system doesn't automatically steer you toward the most efficient or affordable path. The biggest savings happen when patients pause and ask a few key questions, compare options, and double-check:
- Do I have options for where I get this care?
- Is everyone involved in-network?
- Is there a lower-cost pharmacy option?
- Does this bill actually match what my insurance says I owe?
Does more government involvement in health care make prices go up or go down?
Bradshaw: That's a difficult question to answer because the government's approach to health care can vary widely between different administrations or even different states. What we do know is that currently, health care costs rise higher than inflation, and those costs are being passed on to consumers through rising insurance costs and cost-sharing. We need legislators to come up with direct approaches to these problems instead of increasingly complex workarounds.
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Photo Credit: E+/Getty Images
SOURCES:
Erin Bradshaw, patient advocate, Patient Advocate Foundation, Hampton, Virginia.
Kaiser Family Foundation: "Health Care Costs and Affordability."
