When severe pain sent Eva Zavala to an emergency room last March, her treatment involved an ultrasound and some blood work. Her visit left her with a medical bill for more than a thousand dollars, after insurance.
It was an overwhelming cost for Ms. Zavala, 22, a medical assistant in Oregon. She had barely made a dent in the total amount she owed when, several months later, she came across a video on TikTok.
It was a one-minute clip of a woman she didn’t know, presenting a scenario that closely matched Ms. Zavala’s experience: “You go to the emergency room, you get a bill for a thousand dollars,” the woman, Shaunna Burns, said in the Dec. 3 post.
Ms. Burns, 40, of North Carolina, instructed her viewers to call the hospital and ask for “an itemized bill with every single charge,” explaining that the billing department might then remove absurd fees, like a $37 Band-Aid.
“Any of those stupid charges, they’re going to take them right off,” Ms. Burns said in the video.
Ms. Zavala remembered that advice a few days later when she was going over her bills. She decided to give it a shot. “I thought, you know, what could I lose doing it?” she said. “And so I called and I let them know who I was, and I just asked for an itemized bill for that hospital visit.”
About two weeks later, her itemization came in the mail. She opened it and saw that her balance had been reduced to zero.
“I couldn’t believe it, that it was just gone,” she said.
It was unclear whether her phone call was the reason for the reduction. Ms. Zavala’s itemization showed that the hospital had applied “financial assistance” to her debt in September. But Ms. Zavala said she had never asked for assistance and didn’t know it had been applied, even though she had checked her balance in October.
The health care system that administers the hospital Ms. Zavala visited said in a statement that it offers flexible, generous financial assistance programs, and that people who apply for them are typically notified in writing within two weeks of the eligibility determination.
Ms. Zavala shared her experience in a tweet that racked up hundreds of comments, tens of thousands of shares and hundreds of thousands of likes. Many said that a call to the billing department — in some cases to ask for budget assistance — had worked for them or their friends.
Ms. Burns’s advice reached the masses via a social media platform more commonly used to share goofy dance videos, funny skits and other works of art. And something about her description of this particular tactic — a fix that seemed simple but also sort of mysterious, like a magic trick — seemed to hit a nerve.
In an interview, Ms. Burns said her Dec. 3 video was not planned. She had been sick in bed and was dealing with calls from debt collectors when she decided to share a tip in case others were dealing with similar situations.
“I thought, ‘What if people out there don’t know that they have the right to tell those people to screw off?’” she said.
In the replies to her video on TikTok and Twitter, thousands of people commiserated over how baffling the American health care system can be, and how arbitrary the costs.
Asking for an itemized bill won’t always save patients money, since every case is different. But it’s worth trying, said Erin C. Fuse Brown, a health care expert and associate law professor at Georgia State University. It’s not only a way to expose frivolous charges; the process could also reveal human errors or open the door to negotiations.
“It’s a good place to start because it allows the patient to be able to see what they’re being charged for and then push back on particular items,” Professor Fuse Brown said.
Irene Flippo, an advocate for patients dealing with medical bills, said there was a widespread need for education about handling medical costs. “A lot of individuals have this fear about dealing with it: what things should they say and how they should address these issues,” she said.
Ms. Flippo shared several tips for people dealing with medical bills: Request a review of the level of care, along with an itemized bill. Look for errors or duplicate charges. Check resources that can help you compare prices. Appeal. Negotiate. Get an interest-free payment plan, but alert the hospital if you are at risk of missing a payment. See if you qualify for financial assistance. And if billing department workers are not helpful, email top executives at the hospital.
“TikTok, I believe, is younger generations mostly,” Ms. Flippo added. “And so to see the response this woman had gotten, it only reconfirmed to me there’s definitely a lot of concern among that age group’s individuals about their medical costs.”
Ms. Zavala said she understood why people approached health care providers with a sense of powerlessness. “Knowing that it’s so expensive to go, and the fact that your insurance doesn’t cover everything, I think it stops a lot of people from going and getting the care they need,” she said.
She added that she did not fault hospitals entirely for the high medical bills, noting that some of the problems begin with drug companies.
According to the American Hospital Association, in 2018, hospitals provided patients in need with over $41 billion in care for which no payment was received. “As a field, we will always continue to look for new and more effective ways to work with patients who need help understanding their bills or meeting their financial obligations for the care they receive,” the group said in a statement.
Ms. Burns said she learned her way around hospitals after years of caring for three daughters, one of whom was kidnapped for more than a year and now struggles with complex post-traumatic stress disorder.
She described herself as a pushy person — the kind who offers tips, assistance or coupons to strangers without being asked. Her TikTok videos are presented without frills or filters. Her delivery is no-nonsense and peppered with expletives. She often shares detailed journal entries or encouraging messages.
She is not the only one using TikTok to dispense advice. When she gets questions about credit, she sometimes refers them to Alisa Glutz, an Arizona mortgage professional who shares tips on her own TikTok profile. And there are several health care practitioners who share health and wellness tips on social media.
Ms. Burns acknowledged that some of the cost-cutting advice she has given — “Don’t take an ambulance unless you are legit dying!” — could become something of a liability if it did not work out. “I’m not out there as a medical professional,” she said.
But she added that people were still writing to her to ask questions about their medical bills, and that she advised them whenever she could.
“You don’t have to be ashamed to be in debt,” she said. “And you have rights, and you can have confidence and stand up to these people.”
