One of the most significant stressors in healthcare is patient bills. Many sick people will put off care for fear of getting bills they can't afford. This is a scary and actual scenario.
The inability to afford medical tests and treatment, a perennial concern in the United States, began emerging as a much more striking issue last year. Nearly four of 10 Americans said they had put off care in 2022 because of cost, the highest number since Gallup started asking people about delaying care more than 20 years ago. The percentage reporting they or a family member delayed health care because of cost rose to 38 percent from 26 percent in 2021.
With the prices of prescription drugs, hospital stays, and other treatments expected to increase significantly this year and next, some doctors expect families to have an even harder time affording medical care. A recent report from the Commonwealth Fund found that 29 percent of people with employer-based coverage were underinsured because they had such high out-of-pocket costs even with insurance. The coming rollback of health coverage under the state-federal Medicaid program will very likely lead many people to become uninsured.
Source: NY Times
So what are some things that you can do if you get a large bill?
Do not panic. Medical bills have up to an 80% error rate. Even if they say "pay at once" or threaten to send you to collections, there are things that you can do.
Call the hospital accounts receivable and ask for an itemized bill. This is your right. This bill will have treatment codes and associated costs called #cpt codes. Look them up in Google and make sure that these procedures were done. Most doctors do not even know these codes. They are input by technology and associated with diagnosis codes. There can be errors, and some insurance companies will decline them because there are either similar descriptive codes (duplicative) errors or the price is way too high, and you need to audit this. I have seen bills for 3 hours of doctor face time when it was more like 10 minutes. I have also seen 30-dollar Motrin and procedures that were not done. CPT Code Lookup: https://www.aapc.com/codes/cpt-codes-range/
Make sure that you understand your health insurance coverage benefits. If you do not, contact the broker or company that sold it to you and have them explain it. If it is from your employer, contact your benefits manager. You are paying for this in your premium. Use the service.
Contact the healthcare facility accounts receivable and ask for a #settlement amount. For example, if you have a $ 5,000.00 bill, tell them that you need financial assistance and ask them what they will take as a one-time payoff amount. The lowest reduction that I have seen is 50%. It may take you some work to get there, meaning you may have to call more than once and speak to different people to get there, but stay at it. It will ultimately cost them more to bill you monthly than to settle and write off the loss.
Never pay a medical bill on a credit card. If you agree on a payment plan, the hospital will make one with you at zero interest.
Any nonprofit hospital needs to offer financial assistance to keep its nonprofit status. This means if you fall below a certain income, the entire amount will be written off.
How do I know if I qualify?
Who is eligible for required financial assistance?
Federal law does not specify the criteria hospitals should use to determine who is eligible for financial assistance, but several states have laws and regulations that do.4 State law eligibility requirements vary widely. For example, Washington State requires hospitals to develop financial assistance policies allowing patients with family incomes below 100% of the federal poverty level (FPL) to receive free care, and patients with family incomes up to 200% of the FPL to receive care at a discount.5 In some states, such as New Jersey and Massachusetts, the income threshold for free care eligibility is 200% of the FPL. New Jersey law also specifies that financial assistance is available to low-income residents with no health insurance, or with health insurance that pays only part of a medical bill, or for patients ineligible for private or government-sponsored coverage. New Jersey law also specifies the fraction of the bill that patients are responsible for as a function of their incomes.
The IRS sets the charity care rules for nonprofit hospitals Internal Revenue Service code 501(r) requires nonprofit hospitals to:
Have a policy that tells who qualifies and how to apply
Post the policy information on their website, signs in the hospital, and bills
Give patients at least 240 days (about 8 months) to apply after they get a bill
Give patients a chance to fix incomplete applications
Pause sending a bill to collections while they are reviewing the financial assistance application
Send the patient a letter with the final decision and reason
Some states have laws that require all hospitals to offer financial assistance. These laws can change the rules for nonprofit and for-profit hospitals. Check out our state charity care law summaries for more.