IF THERE IS ONE The main reason people get frustrated with health care costs is this: We think that health care is like 99 percent of the things we buy. A price is a price. A trip to the hospital is no different than a trip to the pharmacy. I shook my back over the weekend, Advil is the drug, and a bottle of 100 pills costs $10.29. But the reality is that paying for health care is like buying a car. It’s a conversation. Here’s how to talk your way through the big topic of health insurance today.
What to Do When You Don’t Have Time
And you probably don’t: It takes a medical professional about 22 phone calls to resolve a billing dispute.
Title: You don’t have the time you doubt it will take to solve your billing problem.
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Who can help: Patient representative.
Answer: You share your information with your healthcare provider and they take responsibility, finding ways to lower your bill and do more. Some nonprofits provide this service for free; there are also for-profit promoters, such as those listed in the AdvoConnection Directory. Other business benefits include acquiring companies such as Goodwhich provides patient care services.
Title: Your bill is about to go to a collection agency because it has been held for too long.
Who can help: You, or a patient advocate.
Answer: It takes chutzpah — and a willingness to risk your credit — but if you let your medical debt hang around long enough to go to collections, you can negotiate a better deal. Linda Michelson of the Medical Bill Advocate says: “The older it gets, the more the billing office wants to remove it. When you hear a collection, make a bid that’s backed by data: Get rates through a non-profit organization FAIR Health. Note: The three major credit bureaus have made a big change, and now you have a year to six months before a medical loan can ruin your credit. Also, a paid loan will leave your report.
What to Do If Someone Makes a Mistake
It’s pretty cool. About 50 percent of the loans the National Patient Advocate Foundation deals with are delinquent. (Some figures are higher.)
Title: There is an error in your bill. For example, a little fantasy on your arm was called Tommy John surgery.
Who can help: Your insurance.
Answer: Call your insurance company and let them know about the problem so they can deal with the service providers—after all, your insurance company handles a lot of money, so it has a strong incentive to make sure it’s accurate. Note: Thanks to the new No Surprises Act, all hospitals are now required to treat emergencies as online services. (One big exception: Ambulances can still charge if they’re out of network, so consider Ubering if you’re lucky.) And you won’t get an out-of-network bill for services you didn’t choose. For example, if your online gastroenterologist has an outsider put you down before a colonoscopy, your bill should reflect the online cost of anesthesia, too.
Title: Your insurance will deny you coverage after the procedure.
Who can help: Your doctor.
Answer: Each insurer offers an appeals process that is similar to arguing your reasons for denial. You want to gather as much evidence as possible to show why your care was necessary – consider authoritative sources such as medical journals and, most importantly, a clear explanation from your doctor about why your condition required this procedure.
What to Do If You Don’t Have Money
More than 3 million Americans owe more than $10K in medical debt.
Title: You chose to pay out of pocket – but it turned out to be more expensive than you thought.
Who can help: State judge.
Answer: Under the No Surprises Act, which came into force in early 2022, if you pay out of pocket for work, you must be given a good estimate of the cost in advance. If the bill comes in more than $400 above the estimate, you can file a complaint with the US Centers for Medicare & Medicaid Services (see how at cms.gov/nosurprises/consumers), and the judge determines what is fair.
Title: The bill is correct, but it’s more than you can afford right now.
Who can help: Hospital billing department.
Answer: You have options depending on how far the money goes. Some hospitals offer “fast payment” discounts: If you can put everything on your credit card at once, it can drop up to 10 percent. And if you have a serious need, many hospitals offer a payment plan or financial assistance for patients with certain expenses. Application details should be on its website.
When the Problem Is the Point of the Object
Title: You are wrong, plain and simple. Remember the story of how one person paid $199 for a Covid test out of pocket and another used insurance at the same place and paid $6,408? Like that.
Who can help: Publications.
Answer: Show evidence that you have unfair, sky-high debts to the reporter. If the story escalates, the donor will be under more pressure to stop, or philanthropists may be able to help you with something like a GoFundMe campaign. Economist Loren Adler said: “This seems to have a very good track record of keeping people from paying, if you have a good enough story to tell.
This article first appeared in September 2022 Healthy Men.
Kevin is a writer and editor based in Brooklyn. He has previously been a financial analyst, computer salesman, mathematician, barista, and college football equipment manager.
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