It’s no secret that medical bills often contribute to personal bankruptcies declared in America. What you might not know is that many of those who file for that reason actually have health insurance.
According to the news release announcing the results of a 2016 Kaiser Family Foundation/New York Times survey, “62 percent of those who had medical bill problems say the bills were incurred by someone who had health coverage at the time (most often through an employer). Of those who were insured when the bills were incurred, three-quarters (75%) say that the amount they had to pay for their insurance copays, deductibles, or coinsurance was more than they could afford.”
We’ve put together seven steps you can take to handle hefty hospital bills and reduce the burden on your bank account, credit score and long-term financial health.
“Planning ahead to ensure you have the proper insurance coverage is one way to help alleviate high medical costs, and it’s important to work with an unbiased, licensed health insurance agent to explore all insurance options,” said Mike Stahl, Executive Vice President and Chief Marketing Officer for HealthMarkets, one of the largest independent health insurance agencies in the U.S. that distributes health, Medicare, life and supplemental insurance products from more than 200 insurance companies. “Supplemental insurance products are a crucial way to cover gaps in your major medical health plan. These plans are relatively inexpensive and can help offset the out-of-pocket costs from a medical event. For example, there are Cancer insurance plans that pay you a lump sum when you have cancer; there are Accident plans that do the same in the event of an accident and injury, and many more. Having these protections up front will allow you to concentrate on regaining your health and not have to worry as much about the medical bills,” Stahl added.
If it’s not an emergency situation and a procedure needs to be done, be sure to ask what costs are involved before the procedure happens so you can find out what’s covered with your insurance. Try to get as itemized as possible (lab work, anesthesia, hospital stay, medicines administered, etc.) so you can get the full picture. Nowadays, every step seems to come with a cost. Let’s say you go in to see your regular doctor and they order some lab work and an x-ray, to be done before you leave. There’s a charge for the office visit with your doctor, the lab work itself, the x-ray itself, plus separate ones for the professionals who interpret the results, potentially leading to five or more bills for what seemed like one trip to the doc. It can add up quickly.
If you don’t have insurance, be forthcoming about your circumstances so the facility can work with you on possible payment options that can be more manageable. Many places have options for under-insured or uninsured folks but don’t mention them unless asked. Request assistance in writing and get their response in writing if they agree to a discount or special payment program.
Dr. Chirag Shah, a board-certified emergency medicine physician and founder of online lab testing service Accesa Labs, says it’s worth asking for cash pricing upfront. “Many people are surprised to find out that paying for medical services without using insurance can be affordable. People who are struggling with the high cost of medical services should ask what the cash price of the service is before getting the service done. While this does not apply in emergency situations, paying for services like elective lab testing out of pocket can save a lot of money and reduce the likelihood of getting a large bill in the mail.”
If you’re scheduling a procedure to be done, there are resources online to give you a rough idea of typical costs in your area. Using tools like HealthcareBluebook.com and FairHealthConsumer.org can help you estimate costs so you can make the proper decisions about your healthcare.
Jane Kaye, President of HealthCare Finance Advisors, explains, “The American healthcare system is extremely complex for patients, and some of the complexity is due to the way we administer health insurance. Behind every healthcare transaction there are two different contracts that define the patient’s financial obligation. The first contract is between the insurance company and the hospital, and this contract lists all the services covered by the contract, and the rates the insurance company will pay for each service. An individual hospital will have a unique contract with each insurer, which means there can be many different rates for the exact same hospital procedure. The second contract is between the insurance company and the employer. Each employer decides how to structure the health insurance benefit for its employees, resulting in different out-of-pocket obligations for employees who work at different companies but have the same hospital procedure. Finally, Medicare and Medicaid have their own national or state payment schedules. And most of these rules do not apply if the patient is without health insurance.”
If you aren’t able to research prior to the procedure, you can still do so after the fact to compare to your billing statement. Keep in mind, if you’re not insured, prices are often much higher.
It’s important to document your visit every time you receive medical care. Whether you bring someone with you who can take notes or simply type notes on your phone as you’re in the room with your doctor, you should document what’s happening so you can keep track of what you’re being charged for.
When you went to the ER, what tests did they perform? Did they give you an IV? Pain medication? Write down a recap as best you can so you can match medical codes when you receive the bill. So often, you hear of patients being hit with additional fees for services that were never rendered. If you’re billed for being administered a medication you weren’t actually given, you need to be aware so you can dispute the charge. While the exact percentage of billing errors is unknown, experts have estimated anywhere from 30% to 90% of bills contain some type of inaccuracy.
If you are insured, you should receive an explanation of benefits letter from your insurance company prior to even receiving a bill. This typically outlines the amount billed by the doctor, amount paid by the insurance company and the amount you owe. This letter is a good heads-up and gives you a little time to make sure things are correct. When the bill arrives, it should match the total outlined on the explanation of benefits.
Kaye adds, “I have worked with many patients who receive a hospital bill before the claim is adjudicated by the insurance company. I have experienced this myself, and it is a major problem because the amount due will not be accurate according to the terms of the insurance contract with the hospital. It is very important for the patient to wait until the claim is fully adjudicated before making a payment. The main exception to this is when the hospital requests a deposit or prepayment before services are provided. This is a common and reasonable request, and the amount prepaid should be discussed and possibly negotiated if it is based on an estimate.”
It’s important to note that there are more than 70,000 codes used in billing statements. These codes are used to standardize treatment and coordinate with insurance companies. Often, patients see these codes, composed of letters and numbers, and are too intimidated to challenge what they all mean for their payment. Don’t be afraid to ask questions and compare what’s listed to what you documented so you can ensure you aren’t being overcharged. Common errors include codes that don’t line up with your diagnosis, duplicate billing or being billed at a code that’s similar to the treatment you received but is costlier. If you find discrepancies, contact your insurance provider and the billing department so you can have an accurate bill on record. Look at the date listed for each code and write down when you received the bill, when it’s due, what your payment plan is and when you made payments.
If you find you can’t afford the amount due or the amount is significantly higher than what research suggests it should be, it’s time to negotiate. Act quickly – don’t let the bill become delinquent. Ask for the bill’s due date to be suspended or extended while it’s being disputed. In addition, confirm if the entire bill will be on hold or only the parts you’re disputing so you can pay on time. The key is to be polite but firm about your financial circumstances. Service providers usually prefer the route of being paid something rather than nothing, so be willing to work out a payment plan so your bills don’t end up in collections.
If you get turned down initially, don’t take that as the final decision. Work up the billing department ladder until you reach someone with high authority who is willing to work with you. Hospitals may offer a payment plan with 0% interest. While it doesn’t reduce the bill, you won’t have to worry about the amount growing larger. If that’s not an option, you might consider applying for a personal loan. If you’re insured, you can also file an appeal with your insurance company. Just like you, they don’t want to pay more than they have to, so if you’ve identified an error, they will likely want to help resolve the issue too. If you aren’t happy with the response you received, you can file a complaint with your state’s insurance regulator.
Consult an Expert
If you don’t have the time or wherewithal to tackle this medical debt on your own, it may be time to call an expert. Jack Hooper, CEO and founder of Take Command Health, a startup that promotes advocacy and transparency in the world of health insurance, says, “Up to 60% of medical bills have errors, and the numbers are usually not in your favor. Using a medical bill negotiation service, like the one we offer our members, saves you time, money, and headaches. Let the experts do the legwork for you.”
If you have access to free or reduced-cost patient advocacy through your employer or health plan, that is a good place to start. Typically, for an hourly fee or a cut of the savings they secure for you, you can get assistance by hiring a medical billing advocate who will identify errors and negotiate on your behalf to reduce what you owe. You may find it’s worth the cost in order to pay a fair amount for your medical services in order to avoid the stress of negotiations and possible damage to your credit (medical debt sent to collections have a six-month grace period before appearing on your credit report). If you’re covered by Medicare, you can contact the State Health Insurance Assistance Program in your state for free personalized help.
Medical bills can spring up when you least expect it, so being prepared, taking notes, doing a little research and negotiating can all help lead to a more manageable payment that doesn’t compromise your financial health. What steps have you taken to handle hefty medical bills? Let us know in the comments below!
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