Yves here. The existence and extent of the medical debt problem in the US is yet more proof of what a mean-spirited, money-grubbing society this is.
One thing this article fails to mention is external appeal. Nearly all states have it; New York’s was good even before Obamacare required more states to implement it. I just found out yesterday I have to go fight over a very egregious and large insurance underpayment by Cigna that the Hospital for Special Surgery has been fighting since June 2021. Wish me luck, in that Cigna’s position is just abusive and I hope it will be bloomin’ obvious to New York State.
By Yuki Nugochi, NPR News. Originally published at NPR and Kaiser Health News
Lori Mangum was 32 when apple-size tumors sprouted on her head. Now — six years and 10 surgeries later — the skin cancer is gone. But her pain lives on, in the form of medical debt.
Even with insurance, Mangum paid $36,000 out-of-pocket, charges that stemmed from the hospital, the surgeon, the anesthesiologist, the pharmacy, and follow-up care. And she still has about $7,000 more to pay.
While she was trying to manage her treatment and medical costs, Mangum remembers thinking, “I should be able to figure this out. I should be able to do this for myself.”
But medical billing and health insurance systems in the U.S. are complex, and many patients have difficulty navigating them.
“It’s incredibly humbling — and sometimes even to the point of humiliating — to feel like you have no idea what to do,” Mangum said.
If you’re worried about incurring debt during a health crisis or are struggling to deal with bills you already have, you’re not alone. Some 100 million people — including 41% of U.S. adults — have health care debt, according to a recent survey by KFF.
But you can inform and protect yourself. KHN and NPR spoke with patients, consumer advocates, and researchers to glean their hard-won insights on how to avoid or manage medical debt.
“It shouldn’t be on the patients who are experiencing the medical issues to navigate this complicated system,” said Nicolas Cordova, a health care lawyer with the New Mexico Center on Law and Poverty. But consumers who inform themselves have a better chance of avoiding debt traps.
That means knowing the ins and outs of various policies — whether it’s your insurance coverage, or a hospital’s financial assistance program, or a state’s consumer protection laws. Ask a lot of questions and persist. “Don’t take ‘no’ for an answer,” said Cordova, “because sometimes you might get a ‘yes.’”
Even people with health insurance can land in debt; indeed, one of the biggest problems, consumer advocates said, is that so many people are underinsured, which means they can get hit with huge out-of-pocket costs from coinsurance and high deductibles.
Here is some practical advice about facing down medical debt, at every stage of care and after.
Before You Get Care
Get familiar with your insurance coverage and out-of-pocket costs. Get the best insurance coverage you can afford — even when you’re healthy. Make sure you know what the copays, coinsurance, and deductibles will be. Don’t hesitate to call the insurer and ask someone to walk you through all the potential out-of-pocket costs. Keep in mind that you cannot make changes to your policy except during certain windows of time, such as open enrollment (typically in the fall or early winter) or after a major life event.
Sign up for public insurance if you qualify. If you’re uninsured but need health care, you might qualify for public insurance like Medicaid or Medicare. Ask the provider or hospital if they can help you check your eligibility before you commit to a care plan — and then stay with providers who participate in those programs.
Check whether the specifics of your care are covered. After your doctors map out your treatment plan, check whether all the providers you need to see are in-network and whether any part of the treatment needs to be preauthorized. Ask lots of questions of your insurance provider, doctor’s office, or hospital, especially for planned procedures, said Joy Dockter, a lawyer at Central California Legal Services, a public interest law firm. “‘Are my authorizations in place? What are my copays going to be?’ Find all that out beforehand, if you can,” she said.
Additionally, said Mark Rukavina, a program director at health equity advocacy group Community Catalyst, if the drug you want isn’t covered by your insurance, ask whether the drugmaker has a patient assistance program; many do, though eligibility requirements vary.
Get a cost estimate. If you’re uninsured, ask for a cost estimate in advance. Rukavina noted that the federal No Surprises Act, which took effect in January, requires providers to give uninsured patients “good faith” estimates of what planned care will cost.
Find out whether you’re eligible for financial assistance — and come prepared to make your case. Almost every hospital offers some form of financial assistance, or “charity care.” Each hospital sets its own eligibility requirements but typically will waive or discount bills for patients earning less than two to three times the federal poverty level. (Three times the federal poverty level for a household of four in 2022 would be $83,250.)
People who are employed often still qualify for a discount, if not for free care, said Jared Walker, founder of Dollar For, a nonprofit group that helps patients secure charity care. His group developed a database of hospital charity care policies and has an online tool that allows patients to check their eligibility.
Even if you’re not sure whether you qualify, it’s worth trying. Gather up documents such as pay stubs or income tax returns. Do not expect this to be an easy process. For example, Walker said, health care providers often require documentation to be faxed. “One of the most common refrains I heard from experts: Persistence pays,” Walker said.
If you’ve already qualified for government benefits like the Supplemental Nutrition Assistance Program, or SNAP, that may streamline applying for a hospital’s financial aid.
If you’re not a U.S. citizen or legal resident, check whether your state bars the hospital from considering immigration status, as is the case in New Mexico and Maryland.
Check for other forms of financial assistance. Ambulance services, which can lead to huge bills, might offer charity care programs, so ask whether you qualify. Also ask your medical providers if they know of other charitable programs that would cover costs for things like rides to medical appointments.
During Treatment or Soon After
Ask for line items of the costs for every service, prescription, or treatment you receive. Keep an eye on costs as they come up, said Louisville cancer patient Lori Mangum, who is now chief operating officer of Gilda’s Club Kentuckiana, a cancer support group she relied on. Ask a family member or a support group to help you keep track, she said. And never assume that just because insurance covers one part of your treatment, that goes for everything else.
Scrutinizing your care can help you avoid costs. Mangum said she realized too late that she could’ve taken her own Tylenol, instead of paying “exorbitant” markups on the same medicine at the hospital. She said self-advocacy begins with pressing for answers about how much each service, treatment, and medication will cost — in advance, if possible.
Check whether providers are in-network. Consumer protections in the No Surprises Act should help limit out-of-network charges. That law bans “surprise” billing for most emergency care, as well as for some routine care with out-of-network providers. It also limits what providers can bill for out-of-network doctors, Rukavina said, and gives patients greater ability to dispute charges.
Make sure all your providers — including an anesthesiologist, for example — are in-network for your insurance. If it wasn’t disclosed to you in advance, that charge may be worth appealing.
Rukavina noted that if you are not insured or not using your insurance and asked for an estimate in advance, you can dispute bills that exceed the estimates by $400. For patients seeking more information about the No Surprises Act and what it covers, Rukavina recommended calling the government’s No Surprises Help Desk at 1-800-985-3059. For patients with complaints, he recommended filing an online complaintwith the Consumer Financial Protection Bureau.
Check for double billing. Go through each item on your bill. Mangum said that “it’s not infrequent for something to be double-billed.” Even if you’ve already been discharged and gotten behind on payments, it is worth checking to make sure you weren’t overcharged.
Negotiate with the hospital directly. Consumer advocates said people mistakenly think medical costs are fixed and nonnegotiable. That was the case for John DeAnda, who fainted while working as a cleaner at a New Mexico hospital. Doctors couldn’t figure out what was wrong with him after four days of tests, but the hospital billed him for $8,000, which he’s still trying to pay off, with interest, nine years later.
“I actually didn’t realize you could negotiate,” said DeAnda. “What I would’ve done differently is I would’ve talked to the hospital first, to see if they could work out a deal with me” before the bills were sent to collections.
If you know you cannot pay the bill, negotiate with the hospital administration or billing department. “That’s almost always possible” because hospitals want to avoid the costly administrative burden of sending bills to collections, said Ge Bai, a professor of accounting and health care policy at Johns Hopkins University.
Ask repeatedly about any other forms of financial assistance the hospital might offer. Negotiate the terms of payment to a monthly level that is affordable for you. This also saves the hospital the administrative headaches of unpaid bills, and it might help you avoid having bills sent to collections.
Prioritize paying for food and shelter over medical bills. Financial institutions and lenders treat medical debt differently than unpaid consumer bills. People choose to take a loan to buy a car; they don’t choose to get ill or injured. So just because people have medical debt does not mean they are unreliable or less likely to pay their bills in general. The three major credit-rating agencies recently agreed that unpaid medical bills will not affect people’s credit scores for a year. Once a bill is paid, it should come off your credit report immediately. Starting in 2023, unpaid medical debt under $500 should not appear on reports either.
That means you should focus first on paying for life necessities — rent or mortgage, gas to get to work, and food, said Marceline White, executive director of the Maryland Consumer Rights Coalition.
Do not sign up for credit cards that offer to pay medical bills for you. Experts warn against using credit cards offered by dentists, hospitals, and doctors’ offices to pay medical charges. Once you take out credit cards, personal loans, or second mortgages, the debt will get lumped in with any other form of consumer debt — the same as if you overspent on clothes or a luxury SUV. That’s one reason medical debt is often underreported; a lot of it masquerades as other forms of debt. Once you convert a medical bill to a credit card or personal loan, it’s more likely to hurt your credit score and therefore your ability to borrow in the future.
If You Are Already in Debt or in Collections
Try to qualify, even after the fact, for charity care. Hospitals sometimes overlook or fail to screen patients eligible for their financial assistance programs. Nonprofit hospitals are required by law to offer charity care and other community benefits. This is where self-advocacy can make the biggest difference. Sometimes hospitals will retroactively qualify patients and write off their debts. Volunteers at Dollar For will help patients push for that.
Dispute your bill if it is inaccurate. Rukavina said that under the Fair Debt Collection Practices Act, debt collectors are required to provide a written notice, within five days of contacting a patient, detailing the amount owed, the name of the creditor, and how to dispute the bill. Patients can dispute inaccurate bills if they respond within 30 days. Rukavina said even patients whose bills are in collections can tell bill collectors they wish to apply for financial assistance if they haven’t already. If the patient qualifies, the collector cannot charge more than what the patient would’ve had to pay.
Contact free legal aid services. Lawyers around the country will represent consumers free of charge to resolve legal cases, including medical debt cases. They often have experience dealing with hospitals and third-party collections companies and might be able to argue your case on your behalf, especially if one or both have violated your state’s consumer protection laws.
Do not ignore the issue. The impulse is understandable, but it will not help and will likely make the debt even more complicated to address, said Rukavina. As daunting as it might be, try to keep advocating for yourself and your family and get help.
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Truth-in-Doctoring, legislation that cries out for passing in the wake of the progress of No Surprise Billing.
Include transparent pricing, examples like the following:
Comparison of plans and options to allow apples-to-apples views
Premiums
Deductibles
Co-pays
Inclusions
Exclusions
Hospital charges
Pharma, too
Medical debt should not exist. Period. End of discussion.
In a civilized society, it wouldn’t.
Of course it shouldn’t exist. I was pretty certain that the gist of the article would be: “get out of the US”. What else would the the real answer be?
That was my thought: Move to a civilized country.
I do live in a society where it doesn’t exist, but I still wouldn’t call mine civilized.
@Polar:
It’s true in Canada we don’t have the kind of problems related here. However we do have many people who are overwhelmed by prescription drug costs. Despite overwhelming support for a national public drug plan (“Pharmacare”) at 85%, the Trudeau government has given in to Big Pharma and US government pressure and not implemented a plan.
With respect to “civilised”, I would say there are varying levels of civilisation. In Canada the treatment of indigenous peoples is appalling (no drinking water, horrible poverty, hunger, discrimination, etc), also the treatment of the poor is bad, minimum wages are low, etc. However we do have existing programs that support people (e.g. parental leave at 60% of wages for one year) and new programs currently being implemented that are pretty good (childcare at $10/day/child, dental plan for most people). Compared to progressive European countries our programs are mediocre but they compare well to the US.
Illness shouldn’t exist either. Wars shouldn’t exist. Why is this planet so frequently a horror show? Some say it’s all physics and evolution. Otherwise I’ve heard plenty of bizarre mythologies. Either way if everyone chose to try and make it better, it probably would be.
This is the planet of suffering and redemption. None of us are getting out of this alive, but death is the Phoenix of consciousness.
As madam Yves Smith has noted several times, the United States has one of the worst systems for providing care to its citizens.
From documentation/records retention to the rapacious middlemen insurance, to the criminal provider cartels, its all a fleecing from start to finish.
Another bit of advice regarding debt (medical or otherwise) collections: if you receive a notice from a debt collector stating that you owe money to them, send them a certified, return receipt letter asking for documentation that their claim to a debt against you is valid, and that all future correspondence needs to be in writing (and whatever you do, do not acknowledge that you owe the debt). A lot of debt collectors are really, really bad at paperwork and often will fail to do the due diligence of providing the documentation they’re required to to debtors. And failure to follow protocol can lead to their claim, and ergo the debt, being nullified.
All good advise. But remember the doctor, the lab and the facility each bill.
I also used to keep a copy of my SS card and later my Medicare card with this handwritten on it on the advise of a lawyer “If I am unable to make medical decisions, I do not consent to pay any medical provider at a rate greater than the authorized Medicare reimbursement rate.” That kills the “Implied consent” if you show up at the hospital unconscious. And they still have to treat you
Ask for line items
Check for double billing
Negotiate with the hospital
Dispute billing
etc, etc.
What a barbaric system we have.
People should be able to focus on getting well. That should be their entire focus.
Sometimes one cannot avoid being abused despite research and billing vigilance. My wife died in 2019 after years of cancer treatments and by that time we had spent everything that could be converted to cash and had long stopped spending on anything else. Our “good” insurance repeatedly denied obviously standard care as medically unnecessary or experimental so that our remaining out-of-pocket responsibility was hundreds of thousands of dollars. Her only investigational treatments had been provided free under compassionate experimental drug use. It was more than a year after her death that insurance agreed to pay a portion of the charges and providers agreed to reduced amounts – there was no way we could pay more. Our story is very common and friends have had worse. If one pays bills the first years there’s nothing left for bankruptcy to protect at the end.
Garden breads, I’m so sorry you had to go through that. Rather, I’m so sorry we live in a society in which you and your wife did go through that.
Another way to be aware of if you have some sort of musculoskeletal pain or mental issues or stress or anything else is to file a worker’s comp claim. Then your treatment is fully covered if it is found to be even minimally work aggravated.and attorneys have their own doctors who will so testify in writing. The judges are very liberal since they come from the plaintiff bar. My business has several people who have been off work for years with carpal tunnel in one case and back pain in another who remain on disabiliy on my payroll since the insurance charges me back for years. And we have had cardiac cases as well. Even cancer can be covered at no cost to the patient. The big 80 million dollar Roundup case, for which scientific evidence is poor, is alleged to have occurred due to exposure on the job. And personal injury like a slip and fall leads to full coverage care but this normally is done through a lawyer. The lawyer fees on the personal injury side are about 1/3 of the final settlement and they get a portion of the temporary disability. Since settlements are at least three to four times the medical and often much much higher depending on the jury you can see why our lawyer supported democrats have little interest in a national health care system and have no problem with outlandish billing. That would put the PI and workers comp attorneys out of business. The obvious solution is to do what England did and just copy their national health service and fund it better. There all the doctors and nurses are on government salary and the hospitals and medical facilities are all government in nature. There is no incentive for unnecessary care or milking the bill. We still would come out way ahead. And by copying them we could avoid having to reinvent the wheel since they have had 80 years to make mistakes and correct them over time. But the legal and medical professions are tied to fee for service because without it they would have to accept a lower standard of living. Don’t forget Biden and the democratic administration briefed the Supreme Court a couple of weeks ago to discourage them from reviewing the Roundup case and they were about to do it based on the justice department of the Trump administration. If any case deserved a review this one did so we could get some clarity on causation. Biden and the justice department saw the risk of injecting some rationality into the system as too great. So whatever ails you file a workers comp claim and you might be pleasantly surprised financially. And if you have a lawyer it is going to be hard for the insurance company to reject it out of hand. If a lawyer does not want to take the case, of course, that means that it might not be worth pursuing but that is not often. Just be sure everything is on contingency.
Thank you for this article. I’ve mentioned our medical billing and health insurance issues from the birth of our son last year (BOTH of us were insured through employers), and we *just* received a new bill for $2500 for a related minor procedure done as part of the delivery. Going to fight it.
Pre-pandemic, I was regularly traveling internationally and I would get as much medical and dental care as possible outside the country. Even with a round trip flight to Mexico, it would be vastly cheaper.
If you can do it, that is still the best way to avoid medical debt, if you’re not risking covid.
I looked at Aeromexico’s website and the mask policy is ambiguous. They say masks are required but then there is a special notation for Canada and Spain, so maybe they are only “required” to and from the US? Also, sadly Mexico tends to attract some of the most obnoxious MAGA types. I wonder how to find reviews for this?
Also, I wonder if some bad people have found a way to take advantage of the system by using fake documents to sign in? Like the SS number of a dead person? This would of course be dastardly beyond the pale badness and should of course be severely punished and I would not recommend anyone contemplate doing so, but I wonder how often it is being done and if there is any movement/mutual help group around this.
I just wanted to add that I realize this is not an option for some people, like people with a chronic condition that requires regular care that cannot wait for an international trip, or for emergencies, or if you are too sick to travel…well, a lot of people who are most vulnerable to the healthcare mafia.
And please avoid tourist/retiree areas like Cancún, Lake Chapala, etc. because the private hospitals in those places are almost as scammy as in the US. If you can hire someone who speaks Spanish to coordinate with you, much better.
Let me just say: Hospitals and health professionals not known personally should not be considered your friend. They know how the medical system works. They choose to perpetuate it.
One thing left out of these suggestions is that the financial aid that hospitals have often come with serious strings attached.
I incurred a 90k debt (no insurance, unemployed) and the “plan” offered mentioned liens against property that I was required to sign before I even knew how much they would pay. And of course once signed you can’t go any other route.
So I bailed on that and am planning bankruptcy
Great system huh?
Is there anyone here in the commentariat, who has insurance beyond Medicare, and would like to say a few good words about it? We’re ignoring at least a half dozen cold calls a week as I approach 65 (Nov.), each hoping to pitch a Medicare Advantage insurance to us. If I’ve read this room correctly, no one really likes those insurances. Is there one you do? And if so, why?
Count me as another one who is closing in on 65. And, like Lexx, I am a November baby. (Hint: I share a birthday with the United States Marine Corps.)
I’ve been getting all sorts of spam calls from people wanting to sell me a Medicare Advantage policy. Ditto with the mailings. There are times when I feel like my mailbox is under assault.
What does the relentless pitching of Medicare Advantage do for me? Well, it triggers my spidey sense. Anything that is being sold this hard probably isn’t that good for my physical, mental, and financial health.
I’m likely to go the traditional Medicare route with one of those supplemental policies and a payment to the drug protection racket, aka Medicare D. I take no prescription drugs whatsoever and I avoid our so-called health care system like the plague.
So, consider me one of those people who isn’t in the target market for these Medicare Advantage peddlers.
I was completely healthy when I turned 65. Never had a any prescriptions. Did the traditional Medicare for 2 big reasons. 1) no such thing as a preexisting condition and 2) you can select any medical provider. I was told if you do advantage and want to come back to regular, they can designate preexisting conditions.
Long story short, last year, I had a cough that would not resolve and it left me gasping for air so bad I’d end up in the emergency room. Nothing else, never a fever. 6 months of my local healthcare system could not help (getting appointments was difficult), so I went to the Mayo. It was uncontrolled asthma. In 2 weeks with a simple inhaler treatment, the cough was gone.
My supplemental costs me much, much less than the ACA policy that I had (with $6,000/yr deductable) and very low deductible and no “in” network to worry about. Everyone should have this all the time, every age.
I’ve read that the Advantage plans are a rip-off. I got the “Gap” coverage – Plan G from Aetna – and have been pretty happy with it. I haven’t had a whole lot done, but have had an emergency room visit and have had the radioactive bead prostate procedure, which is apparently pretty costly. Unless there are a lot of late bills that haven’t gotten here yet, almost everything was covered.
Real Medicare is on the verge of being privatized and f**ked under the Trump/Biden “ACO REACH” scheme. But until then, it’s vastly superior to for-profit “Medicare Advantage.” Advantage’s business model is to not pay claims; that’s how it gets a price advantage.
You can tell how badly those in power want to deny you real Medicare by the set of trap doors that drop you permanently out of it and into Medicare Advantage at any point. You have only a 6-month window surrounding your 65th birthday to sign up for real Medicare, supplemented by Medicare Supplement (aka “medigap”) insurance. By all means, act at the front end of that window and take it.
I will reply, a personal story. In Jan 2021, I experienced a catastrophic medical emergency. I woke from restful sleep, and low and behold…a disk in my lumbar region ruptured spontaneously overnight. A bone broke, and pushed the S1, nerve root, into the spinal cord. 100k+ in emergency surgery expenses, not including my current, ongoing care. I had, and still have: Original Medicare and a BC Supplemental Plan G. Yes, expensive. Yes, worth it. The ongoing care is expensive. The advantage plans would have been a nightmare. Carry on. Retired RN,MS.
I have been very happy with Kaiser Permanente. But you must live in an area that they cover.
Lexx, the Medicare/Advantage Plan issue has been covered at NC relentlessly. Search the NC archives. Commentor “Flora” will appear often. She is prolific with her depth of knowledge.
Advantage Plans are promoted relentlessly and purchased by many (who don’t do their homework) and discover their Advantage Plan works fine—until they try to use it for their medical needs!
As the Post above these Comments indicates: get as much medical insurance as you can. The slightly higher premiums of a “Gap” plan is worth the freedom of medical choices it gives you. There is much homework to do—start now! You’ll learn the lingo and be better for it.
I’ve bee using standard Medicare and a Gap plan (N) for 10 years. CMS (Medicare) takes upto 90 days to pay your medical provider, but they all understand the process and most medical providers accept Medicare parients.
PS. Lambert Strether has covered the Medicare program in depth. It has its flaws (Nationalized healthcare would be better). But, even a flawed Medicare is better than an Advantage Plan.
I went on Medicare 2 years ago – and did take a local Advantage plan – costs $59 extra a month. (Sutter – Alignment plan – (Central Coast, California)).
I’ve ran into several medical problems this year – broken bones in hand – needing surgery, then Covid – then a rare auto immune disease (triggered by Covid, most likely). It means frequent blood testing and expensive monthly infusions. Except… it’s all being covered: there are modest co-pays.
This Medicare Advantage plan has honored their commitments – and without a hassle… or bullshitting/stonewalling me – the way my Anthem/Blue Cross insurance did pre -2015 (an ACA – not Medicare plan then).
I was worried, naturally, how it would go, if I would be stuck with huge bills? – but no. Just the $20 co-pays.
The Gap plans for traditional Medicare enrollment are curated/supervised by CMS (Medicare). The ACA does no such thing for your Anthem/Blue Cross medical insurance. The ACA simply provided “affordable access” to medical insurance while leaving the insurers (A/BC) to continue to impose access/restrictions on medical care in the private insurance sphere. Medicare Gap plans are different; but you still need to read the contract to see if it meets your needs!
As I said in a prior comment: Medicare is better than the private insurance market, but a national healthcare system would be even better.
My question was is there any plan in addition to Medicare they liked and why. It would be difficult to miss the derision toward the Advantage plans. My husband has access to the HP retirees blog on the subject as well, so we’ve been going over those comments. I just thought I’d cast a wider net among those I find knowledgeable and listen to what they have to say.
We have Aetna now. Doctor’s offices hate Aetna; they can take months to pay. We’ve received our portion of the bill up to 8 months after the last visit.
We have supplemental insurance through AARP, it’s United Healthcare. We will be learning a lot about claims etc as I had an “episode” last month; EMT + trip to ER + one night + imaging
Dr thinks was probably dehydration not a stroke…
A week later wife had abdominal pain. Called her doctor, couldn’t get an appointment until September… called the practice and got another doc in a day. “Probably constipation, take miralax “ 3 days later, worse. Called back ( on a Thursday). “Let’s do an ultrasound, can schedule in two weeks “
Weekend worse, swing over to urgent care. Closed, everyone has COVID so can’t staff it. Monday, call Stanford (120 miles away but we are still in their system)
Can get into urgent care Tuesday morning
Doc thinks probably cyst but let’s do imaging, can get it at 6
After, we are driving home, doc calls at 7:30 “head to the ER, appendix is ruptured “
Admitted , CT confirms, abscess the size of Rhode island (well 4” by 2”), can’t operate, can’t drain it. 5 days on IV antibiotics. Now home a week on oral antibiotics. We will check the situation with the surgeon Wednesday…
So far have been billed $53,000 but I suspect Medicare will cover something…
Once your fight is over, Yves, please write up what you learned for the rest of us. I hope you succeed.
What’s changed in the last 50 years or so and why?
Advantage of Medicare. No thanks.
Gap, food first. no gap.
Doctor. Do what.
It is all going to plan.
ESAD.
social security at 62.
made it to 65.
would like to avoid the latest scam.
automatic sign up.
cuz the grifters got to grift.
please people, there is no care in this.
grow up.
we have two MIC’s
military and medical.
Namaste
Whenever I had medical debt, I just walked away from it. I never acknowledged or replied to any mailings or phone calls. Eventually it all disappeared.
Of course, my credit tanked. I had to pay cash for everything, but that meant being very frugal, which, for me, is a good discipline. It also meant that I had to have no shame or embarrassment about being in debt.
If you wait long enough, the debt will age out and disappear from your credit record.
A few suggestions:
Negotiate with your doctor and others, not just hospitals, especially if uninsured. If poorly insured, ask about discounts as well, or if it may be cheaper without using the insurance. Many will discount in some manner, especially if it means you will get better care. If they refuse care for lack of cash, have them put it in writing (which sometimes brings more flexibility, especially if you are an established patient or it is emergency care). If they demand you sign up for their credit card before provision of care, also get that in writing and offer an alternative downpayment if feasible.
Most in-network participants are contractually disallowed to bill patients until after the insurance has paid, or the biller has confirmed the proper discount. If they bill the entire amount before discount, question it before paying. If they get threatening, get it in writing. Providers do not like it at all, when patients complain about a provider’s billing practices, to their insurance company. Keep good records – phone calls, wait times, dates and names come in handy for disputes.
Credit policies differ by state. In some cases, steady minimal payments make sense. In others, that keeps credit alive for XX years after the last payment. Some disallow billing after XX years. Credit consolidation agencies should be familiar with these rules and may give a free consult.
Buying the best insurance you can afford is expensive. If you could tell the future, buying the cheapest insurance with reasonable emergency and catastrophic coverage, until the year you need the better insurance, favors the patient. In many cases, people buy better insurance when young and able to work at higher income, giving up savings. When they retire or get ill, and can no longer afford it, they switch to cheaper “coverage” with high deductible, high percent and very limited networks. Then the med problems hit. Consider this if you are in a situation where you can change back and forth annually.
Best insurance is not just low payments – it is the mix of wide choices in doctors, hospitals and all care (even if deductibles are high) and the summary of deductibles/percent (one for docs, one for inpatient, one for outpatient, one for studies, one for meds, one for durable medical equipment…). Then the hassle factor – exemptions and responsiveness. Most states have one insurer who has a near monopoly, and then the rest. The rest may be trying to increase market share and more amenable, so ask around. Some states have an Ombudsman who can assist patients or may have stats about complaints. Coverage company X may perform well in one state, and poorly elsewhere.
Sometimes doctors are better paid if they write a prescription, due to coding rules, even if benefit is marginal. Doctors may be paid less or none for discussing alternatives/preventatives, even if it takes a long time. Over time this disparity influences the “standard of care” they have to meet for malpractice/insurance, even when the benefit is unclear. Easily measured care/coding guidelines can introduce bias, and serve marketing more than patients. If given a prescription, ask about lower cost alternatives you could try first, and the potential associated risk. Many screenings are of questionable or no overall benefit for low risk/asymptomatic groups – ask or check if other countries use the same recommendations.