In the fight against the ever-looming threat of surprise medical bills, there is no tactic too stupid or freewheeling to attempt. The rules of billing are so opaque and purposefully convoluted they may as well be completely made up. Some patients are responding by making up their own rules, per the New York Times’ report Thursday on the increasingly popular practice of patients writing in their own payment limits on hospital treatment and consent forms.

The Times reported that, at a recent emergency room visit for her husband, one woman crossed out language on the consent form that requires patients to pay whatever amount the hospital charges, replacing the vague language with her own payment rate of “maximum two times” what the government would pay under Medicare. That rate is considered reasonable by experts, and comes from suggested language given by Al Lewis, a chief executive at Quizzify, a healthcare education company. (Lewis has gone as far as making downloadable wallet cards for patients who want to alter their own hospital contracts.)

The move is the latest in a cultural shift toward pushing back on medical provides for astronomical charges, not unlike the viral TikTop tip-off about demanding an itemized bill from a healthcare provider. Legal experts told the Times it may actually work, in certain emergency circumstances, and with caveats. This tactic is mostly used on “balance bills,” or bills that happen when an out-of-network provider charges more for medical services than an insurer will pay, and patients get stuck with the difference. Few states have laws regarding balance bills, and, true to form, they don’t help patients with private, employer-based insurance. The woman in the Times story didn’t end up getting stuck with a surprise bill; she’s not sure if that’s because of her proactive stance on billing, or if, by sheer luck, her husband was only treated by in-network providers.

Generally, contracts require mutual consent to be valid, and changing the terms before signing the form yourself doesn’t really meet that standard. But payment consent forms are shady by nature, because patients typically sign them without having any idea what they’re agreeing to pay.

A Duke University law professor, described the agreement to the Times as “deeply exploitive,” and said that judges are “far too deferential” to vaguely worded contracts that require patients to pay whatever mystery amount the provider demands.

Within the completely bonkers world of medical billing, where simple throat swabs can cost $28,000, truly nothing is crazy. Entire four-figure bills have disappeared after a patient simply asked to see what it is they’re paying for. Medical billing ascribes to the central ethos of Whose Line Is It Anyway?, but without Drew Carey or any of the fun; the figures are made up, and the rules don’t matter. Playing on the exploitive system’s bananas terms may be the only way to beat it, at least until big, necessary change comes in to overhaul the entire thing.

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