How to Reduce Health Insurance Headaches and Hassles
IF THERE IS ONE The number one reason people are frustrated with healthcare costs is because we think healthcare is 99% of what we buy. The price is the price. A trip to the hospital is no different from a trip to the pharmacy. I strained my back over the weekend, Advil is the cure and a bottle of 100 pills is $10.29. But the reality is that paying for health care is more like buying a car. It’s a negotiation. Here’s how to negotiate your way through some of today’s biggest health insurance headaches.
What to do when you don’t have time
And it probably isn’t: it takes an average of 22 phone calls to a healthcare professional to resolve a billing dispute.
The headache: You don’t have the time you think it will take to sort out the tricky billing problem you’re facing.
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Who can help: A Patient Advocate.
The solution: You share your information with a medical billing advocate and they take over, researching options to lower your bill and doing much of the legwork. Some non-profit organizations offer this service for free; there are also for-profit advocates, such as those listed in the AdvoConnection Directory. Some benefit packages include access to companies like Wellthy, which offer patient advocacy services.
The headache: Your bill is on its way to a collection agency because it has been overdue for too long.
Who can help: You, or a patient advocate.
The solution: It takes some nerve — and a willingness to risk getting your credit bleed — but if you let a medical debt linger long enough to go into collection, you might be able to negotiate a better deal. “The older it gets, the more the billing office will want to get rid of it,” says Linda Michelson of the Medical Bill Advocate. When you hear about collections, make a data-backed settlement offer: Research prices through the nonprofit FAIR Health. Note: The three major credit bureaus have made some big changes, and you now have one year — instead of six months — before medical debt in collection hurts your credit. Additionally, repaid debts will now be removed from your report.
What to do when someone has made a mistake
It’s quite likely. About 50% of bills encountered by the National Patient Advocate Foundation contain an error. (Other estimates are higher.)
The headache: There is an error in your invoice. For example, a few stitches on your arm were billed as a Tommy John operation.
Who can help: Your insurer.
The solution: Call your insurer and let them know about the problem so they can work things out with the providers – after all, your insurer pays most of the bill, so they have a strong incentive to make sure everything is correct. Note: Thanks to the unsurprising new law, all hospitals are now required to treat emergencies as in-network services. (Major exception: Ambulances can still bill as out-of-network, so consider Ubering if you can afford it.) And you can’t get an out-of-network bill for services you had no choice. For example, if your in-network gastroenterologist has you registered by an out-of-network guy before a colonoscopy, your bill should also show the price of in-network anesthesia.
The headache: Your insurer refuses you coverage after an intervention.
Who can help: Your doctor.
The solution: Each insurer offers an appeal procedure which essentially amounts to pleading your case against the reasons for the refusal. You want to gather as much evidence as possible to explain why your care was needed – think authoritative sources like medical journals and, most importantly, a detailed written explanation from your doctor as to why your situation necessitated the procedure.
What to do when you have no money
More than 3 million Americans owe more than $10,000 in medical debt.
The headache: You chose to pay for a procedure out of pocket, but it turned out to cost a lot more than you were told.
Who can help: A government arbiter.
The solution: Under the No Surprises Act, which took effect in early 2022, if you pay out of pocket for a service, you should receive a good faith estimate of its cost in advance. If the bill exceeds that estimate by more than $400, you can submit a claim to the US Centers for Medicare & Medicaid Services (see how at cms.gov/nosurprises/consumers), and an arbitrator will determine what is fair.
The headache: The bill is ok, but more than you can afford right now.
Who can help: The hospital billing department.
The solution: You have options depending on how inaccessible the expenses are. Some hospitals offer a “quick pay” discount: if you can put it all on your credit card on the spot, they could knock off up to 10%. And if you have a deeper need, most hospitals offer payment plans or financial assistance for patients below a certain income threshold. The details of the application should be on its website.
When trouble is the principle of the thing
The headache: You have been wronged, pure and simple. Remember the story of a person who paid $199 for a Covid test out of pocket and his friend used insurance at the same place and received a bill for $6,408? Like that.
Who can help: The media.
The solution: Show proof that you have unfair and exorbitant bills to a journalist. If the story breaks, your provider will be under a lot of pressure to give in, or a sympathetic audience could help out with something like a GoFundMe campaign. “It seems to have by far the best track record for making people’s bills disappear, if you have a good enough story that someone can cover it,” says health economist Loren Adler.
This story originally appeared in the September 2022 issue of Men’s health.
Kevin is a writer and editor living in Brooklyn. In past lives, he’s been an economist, computer salesman, mathematician, barista, and college football equipment manager.
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