Lori Mangum, 32 years old, was diagnosed with a head of apple-sized cancers. Six years, 10 surgeries and aEUR” later, the skin cancer has been eradicated. Her pain is still there, however, as she has medical debt.
Mangum spent $36,000 on her own, even with insurance. These charges included the hospital, anesthesiologist and pharmacy as well as follow-up care. She still has $7,000 to pay.
Mangum recalled thinking that she should be able figure it out, as she struggled to pay her medical bills and treatment costs. This should be something I can do for myself.
However, the U.S. medical billing and insurance systems are complicated and can be confusing for many patients.
Mangum stated, “It’s incredibly humble aEUR” and sometimes even humiliating aEUR”, to feel like you don’t know what to do.”
You’re not the only one worried about racking up debt in a financial crisis. According to KFF (Kaiser Family Foundation), around 100 million people have health care debt.
You can still protect and inform yourself. NPR and KHN spoke to patients, consumers advocates, and researchers to gain valuable insights into how to manage or avoid medical debt.
Nicolas Cordova, a New Mexico Center on Law and Poverty health care lawyer, said that it shouldn’t fall on patients who have medical problems to navigate this complex system. Consumers who are informed have a greater chance of avoiding debt traps.
This means that you need to be familiar with the details of all policies, regardless of whether they are your insurance coverage, a hospital’s financial aid program, or state consumer protection laws. Ask lots of questions and persevere. Cordova said, “Don’t accept ‘no” for an answer. Sometimes you might get a “yes”.
Even those with insurance can end up in debt. In fact, consumers advocates say that the main problem is that many people are not insured enough. This means they could be hit with high out-of-pocket expenses from coinsurance or high deductibles.
Here are some tips and tricks to help you manage your medical debt at any stage of your care.
Learn about your insurance coverage, out-of-pocket expenses and other details
Even if you are healthy, you should get the best insurance coverage possible aEUR. Know what your copays, coinsurance and deductibles are. Ask your insurer to explain all possible out-of-pocket expenses. You cannot make any changes to your policy outside of certain time frames, such as after major life events or open enrollment.
If you are eligible, sign up for public insurance
You might be eligible for public insurance such as Medicare or Medicaid if you are uninsured and still need to get health care. Ask your provider or hospital to verify your eligibility before you sign up for a care plan aEUR”. Then, stay with providers who are part of those programs.
Make sure you check if your specific care is covered
Once your doctors have created your treatment plan, make sure you check if all providers are in-network. Also, verify that any portion of the treatment is preauthorized. Joy Dockter, a Central California Legal Services lawyer, stated that you should ask many questions about your insurance company, doctor’s office or hospital, particularly regarding planned procedures. Are my authorizations in order? What will my copays be? She advised that you should find out all details as soon as possible.
Mark Rukavina is a program director for Community Catalyst. If the drug you want doesn’t have coverage through your insurance, inquire if the drugmaker offers a patient assistance program. Many do, but eligibility requirements can vary.
Get a cost estimate
Ask for a cost estimate if you are uninsured. Rukavina pointed out that the federal No Surprises Act (which took effect January 1) requires providers to give “good faith” estimates to patients about how much planned care will cost.
Check if you are eligible for financial aid aEUR”, and be prepared to present your case
Nearly every hospital offers financial assistance or “charity care” in some way. Each hospital has its own eligibility criteria, but will usually waive or reduce bills for patients with incomes below two to three times that of the federal poverty level. For a family of four, $83,250 would be three times the federal poverty threshold.
Employees often qualify for a discount or free care. Jared Walker, the founder of Dollar For, an organization that assists patients in securing charity care, stated that even though they are not employed, many people can still be eligible for this discount. His group has an online tool that allows patients and their doctors to verify eligibility.
It doesn’t matter if you aren’t sure if you qualify. You will need to gather documents like pay stubs and income tax returns. This is not an easy task. Walker stated that health care providers may require documentation to be faxed. Walker stated that persistence pays, which is one of the most common phrases I have heard from experts.
You may be able to apply for financial aid at a hospital if you have already been approved for government benefits such as the Supplemental Nutrition Assistance Programme (SNAP).
You don’t have to be a U.S citizen or legal resident to apply for asylum status. This is the case in New Mexico, Maryland, and New Mexico.
You might also be eligible for financial assistance in the following ways:
You might be eligible for charity care programs if you are an ambulance service, which can result in huge costs. Ask your doctors if they are aware of any other charitable programs that could cover expenses such as rides to medical appointments.
Ask for the cost of every prescription or service you are receiving.
Lori Mangum, a Louisville cancer patient, advised that you keep an eye on the costs and adjust as necessary. She is now chief operating officers of Gilda’s Club Kentuckiana. This support group for cancer patients relies on Lori Mangum. She suggested that you ask a friend or support group for help in keeping track of costs. Don’t assume that insurance only covers one aspect of your treatment.
You can save money by examining your care. Mangum stated that she was too late to realize she could have purchased her Tylenol from home, rather than paying “exorbitantly high” prices at the hospital. She stated that self-advocacy starts with asking for information about the cost of each service, treatment and medication in advance.
Verify whether providers are included in the network
The No Surprises Act provides consumer protections that should limit out-of network charges. The law prohibits unexpected billing for emergency care and routine care with providers outside of the network. Rukavina stated that the law also restricts what out-of-network providers can bill and allows patients to dispute charges.
Check that all providers aEUR”, including an anesthesiologist are in-network with your insurance. It may be worth appealing if the charge wasn’t made clear to you in advance.
Rukavina pointed out that bills that exceed $400 can be disputed if you’re not covered or using your insurance. Rukavina suggested that patients call the No Surprises Help Desk at 800 985 3059 to learn more about the No Surprises Act. Rukavina recommended that patients who have complaints file an online complaint to the Consumer Financial Protection Bureau.
Double billing is possible
Check each item on your bill. Mangum stated that it is not uncommon for items to be double-billed. It is worthwhile to check that you were not overcharged, even if you have been discharged.
Talk to the hospital directly
Advocates for consumers said that people mistakenly believe that medical costs are fixed and non-negotiable. John DeAnda was one such person. He fell while cleaning at a New Mexico hospital. After four days of testing, doctors couldn’t diagnose the problem, but the hospital charged him $8,000 for his care, which he still has to pay, plus interest, nine-years later.
DeAnda said, “I didn’t know you could negotiate.” “What I would have done differently is that I would have spoken to the hospital first to see if they could make a deal with us” before the bills were sent off to collections.
Negotiate with the billing department or hospital administration if you are unable to pay the bill. Ge Bai, an associate professor of accounting and health policy at Johns Hopkins University, stated that “that’s almost always possible” as hospitals don’t want to incur the administrative burden of sending collections bills.
Ask about other financial assistance that the hospital may offer. You can negotiate the monthly payment terms to make it affordable. This will save the hospital from the administrative headaches associated with unpaid bills and may help to avoid being sent to collections.
Prioritize food and shelter above medical bills
Lenders and financial institutions treat medical debt differently to unpaid consumer bills. People take out a loan to purchase a car. They don’t have to be ill or injured to borrow the money. Just because someone has medical debt doesn’t mean they are less reliable or more likely to pay their bills. Recent agreements by the three major credit-rating agencies have stated that people’s credit scores will not be affected by unpaid medical bills for one year. After a bill has been paid, it should be removed from your credit report immediately. Unpaid medical debt below $500 should be removed from credit reports starting in 2023.
Marceline White, executive director, Maryland Consumer Rights Coalition, stated that you should first pay for your life necessities, such as rent, mortgage, gas to commute to work and food.
Credit cards that promise to pay your medical bills are not recommended.
Experts advise against using credit cards provided by hospitals and doctors to pay for medical bills. Credit cards, personal loans and second mortgages will be included in any other forms of consumer debt. It’s the same as if you spend too much on luxury cars or clothes. This is one reason why medical debt is often not reported. A lot of it disguises itself as other types of debt. Converting a medical bill into a personal loan or credit card will increase your credit score, and your ability to borrow in future.
Even after the fact, you can still be eligible for charity care
Sometimes, hospitals fail to screen eligible patients for financial assistance programs. Law requires that non-profit hospitals offer community services and charity care. Self-advocacy is a great way to make a difference. Hospitals sometimes retroactively approve patients and forgive their debts. Dollar For volunteers will assist patients in pushing for this.
If your bill is not accurate, dispute it
Rukavina stated that debt collectors must provide a written notice within five days of contact with patients detailing the amount owed and the name of the creditor. Also, Rukavina explained how they can dispute the bill. If patients respond within 30 days, they can dispute incorrect bills. Rukavina stated that even patients with bills in collections can inform bill collectors they want financial assistance. The collector can’t charge more to a patient who qualifies if the patient is eligible.
Get free legal assistance
To resolve legal matters, including those involving medical debt, lawyers across the country are available to assist consumers at no cost. Many of them have dealt with hospitals and third party collections companies so they might be able argue your case for you, particularly if either or both have violated your state’s consumer protection laws.
Don’t ignore the problem
Rukavina said that while the impulse may be understandable, it won’t help. In fact, it will only make the debt more difficult to manage. As overwhelming as this may seem, you can keep fighting for your family and yourself.
