In this week’s post, I would like to share my experience with paying the medical bills that accumulated during my illness. This is an important post, especially for consumers, as most have to pay a portion of their bills, and the amounts can be staggering.
Paying medical bills is not like paying your electric or Macy’s bills. Medical bills are complicated partly because most consumers are not familiar with medical billing, which is so different from the bills we pay on a routine basis.
In doing research for this article, it was learned that bankruptcies resulting from unpaid medical bills would affect nearly 2 million people —making health care the No. 1 cause of such filings outpacing bankruptcies due to credit-card bills or unpaid mortgages is another serious issue, according to Nerdwallet. Paying medical bills is challenging as most of the services charged may not be recognizable, thus making it hard for the consumer to evaluate. I hope this post will help healthcare consumers better understand how to tackle this challenging task.
Like most of us, I am not sure I ever really appreciated the healthcare insurance benefit I received from my employer until recently. When I saw the deduction taken from my paycheck for health care insurance, I would say: “I am healthy, and I never use this insurance…why do I have to pay for this every two weeks when I don’t use it? I often wished that I could pay for health insurance when needed.” Today, most people realize that having healthcare insurance is an important way to protect ourselves and offset costs when a healthcare event impacts our lives.
My healthcare event occurred on November 24, 2014, when I was diagnosed with a Central Nervous System Brain Tumor. I was never so glad to have health insurance as I was then. My insurance allowed me to see physicians that could diagnose, treat, and let me begin to recuperate from what could have been a terminal event. Today, I am improving thanks to my treatment at Sylvester Cancer Center, a leading cancer center in Miami, Fl, and Health South Rehabilitation Hospital. I am not 100%, but I am alive and continue to work to overcome my deficits as a result of the chemotherapy that eradicated the brain tumor.
The cost of my care was in the hundreds of thousands of dollars, most of which was paid for through my healthcare insurance policy. I consider myself very lucky and thankful to my former employer for taking the time to put together a comprehensive health insurance plan that covered most of the services needed to treat my condition.
Paying the Bills
One of the responsibilities of having health care insurance is ensuring that the services provided are appropriate. As I was the only constant on my team, I was able to help by reviewing the bills to make sure what was charged was provided. I felt this was my responsibility, as mistakes can and do happen as part of the billing process. Also, as we were responsible for a portion of the bills, we wanted to ensure we did not pay for services not provided.
So my husband and I took the time to review each bill as they came into our home and make sure (as far as we could tell) that what was billed was correct. This was easier said than done, as reading medical bills is a skill that even I, an experienced healthcare professional, was unprepared for. Some of the challenges we found were:
- Many bills were unclear about what had been done, so reviewing them was challenging.
- Understanding who the providers were was difficult because we often did not recognize the providers’ names or had never met them as they were behind the scenes.
- Some bills had only the amount to pay without explaining what services were provided.
- Bills that did have explanations on them many times had multiple charges for what seemed to be the same service, so deciding if they were duplications was hard
- It was sometimes hard to know when to pay a bill as we could not tell if the insurance company had paid or if we were responsible for the charge.
- In addition, as I was in a weakened state, having the stamina to review the number of bills coming in was sometimes overwhelming.
It is important to remember that bills should not be paid until they are reviewed and paid for by your insurance company. Many people think they have to pay a bill when it comes as you would with other bills, but this is not correct. You should wait for an explanation of benefits from the insurance company so you know what they paid of the bill and inform you what portion of the bill you are responsible for.
My husband took the time to sift through the mountain of bills that came in via the mail as well as through the two internet portals that Sylvester Cancer Center and our insurance carrier had in place. He put the bills into two piles. One pile was for bills with all the information we needed to do a review. The second pile contained bills that did not have all the information or needed follow-up.
The bills we had questions on required us to call the providers to ask them to resend the bill with an explanation of all of the charges. This took time for them to resend so it could be reviewed. Once the full bill was received, we reviewed it to see that the services provided were accurate. Then we had to wait for the Insurance Company to send the explanation of benefits so we knew the amount they paid and what we had to pay.
It was interesting to see what was billed and paid and how the services were explained. Every bill format was different and this made the process very tedious.
In many cases, if there was a balance to be paid, I called the provider to see if they would accept what the insurance company paid. Many providers had programs that could help offset some of the cost, but more paperwork was required to fill out to see if we qualified for the exemption. If your illness and money impact your life is tight, this is an important option, although it adds extra work.
I did have out-of-pocket costs initially, as I had not met my out-of-pocket requirements for my insurance policy. This meant I had payments for many of the bills that came in early. Once my deductibles and out-of-pocket requirements were met, we were not responsible for paying, as the insurance company paid their negotiated rates which was a relief.
Matching up the bill with what the insurance statements showed was paid is an important part of managing the bills. Please remember not to pay anything till you get notice of what your insurance company paid. Doing so can result in duplicate payments which is a nightmare to resolve.
On occasion, we had questions about the payment of certain bills, so we called the provider. Getting to the right person was not always easy and took persistence. Writing down the date, the time, who we talked to, and what they said was important to record who said what. I could get items taken off the bill a few times as they were inappropriate or mistakenly billed. Still, most of the bills were correct, especially after receiving a detailed explanation of services.
If a large payment was expected, I would call my case manager at the insurance company, and he could check to see if the insurance company had paid their portion of the bill. This was helpful when it came to knowing what our responsibility was. Again, documenting the information received over the phone was very important.
As an FYI, I was on a traditional commercial insurance plan. Still, if I had been on Medicare, it would have been important to make sure that Medicare, as the primary payer, had received the bill and paid what they were responsible for. Once they paid their portion, the bill would be sent to the secondary insurance company. Secondary insurance usually pays what Medicare does not pay, so keeping track of all of this is important.
Communication is critical
Communication with providers and the insurance company is important when reviewing medical bills. Both organizations hold information to help you understand the billing process and your responsibility. Don’t be afraid to ask questions.
Also, if you have a balance to pay and do not have the funds, ask the provider if they will accept what the insurance has paid. Sometimes they will do this if you can prove paying is a hardship. If they will not, you can ask if they will allow you to pay the amount due on a payment schedule that could be as low as $5.00 a month. Again, don’t be afraid to ask for these options. If you find charges you think were inappropriate on the bill, let your insurance company know. They can check this out for you.
Resources that Can Help
I wanted to include resources that might help you better understand the medical billing process in this section. Here are a few you can review:
Understanding your Medical Bills: This article will assist you in understanding your medical bills. Click here to read.
Professional Healthcare Billing Advocate Can Help: Patients with complex or catastrophic healthcare issues can rack up millions of dollars in medical bills, which can cause financial hardship. If you are having trouble reviewing your bills, are too sick to handle this task, are getting called by bill collectors, have questions regarding how much you have to pay, or need financial aid, some professionals can help you. They are known as Healthcare Billing Advocates. Click here to read an article on how a billing advocate can assist you.
Insurance Handbook: Your insurance handbook has a lot of good information about your policy. Review your insurance handbook to understand your policy, know what is covered, and your responsibilities. Many insurance companies are not printing these books but place them online for your review. Take time to read your handbook, and if you have questions, you can call the insurance company or talk to your human resource department.
Understanding and Recognizing Healthcare Fraud: Healthcare fraud costs you, payers, and providers millions of dollars. This article can help you to learn how to recognize fraud and what to do if you suspect fraud. Click here to read.
Human Resource Department: If you have healthcare insurance through your employer, your Human Resource Department can assist you with questions or refer you to someone who can help you. Again, do not be afraid to ask for help. Paying medical bills is a complex task that most people find distressing. Asking questions and getting clear information is important.
Individual Policies: If you have an individual policy that you pay for privately, you can call your insurance company and ask them questions. Most have good customer service departments that have access to all of the policies and can find answers to your questions. If you have a clinical question, they may refer you to a Nurse Case Manager who can assist you. Usually, this is not charged as these people work for the insurance company.
Web Portals: Today, many Hospitals or Health Systems have electronic portals you can access once you register. The systems contain hospital and provider bills, hospital records, and lab and diagnostic tests. In addition, the Portals allow you to make appointments and even communicate with your healthcare team if you have questions. These systems are usually easy to navigate, but you must register and have internet access. If you need help, the healthcare system usually has technicians who can help you set up your portal and show you how it works. This allows all of your information to be kept in one place.
Your insurance company may also have a web portal that you can access to see what bills have been paid and what bills need to be paid. This is where you will also find a copy of your Member Handbook. Again, you must register and have internet service to access these portals. If you have questions, they have technicians who can assist you.
Insurance Commissioner: Every State has an Insurance Commissioner who can be a resource for you if you have questions on health care bills or a complaint against your insurance carrier. Here is the link to find help in the Insurance Commissioner in your State https://eapps.naic.org/cis/fileComplaintMap.do
I hope this information helps you better understand your role in paying your medical bills. As a last bit of advice, try to keep up to date by paying your medical bills, as this will prevent them from accumulating and putting you into a deep hole. If you have trouble keeping up with your medical bills due to your healthcare challenges, the most important thing you can do is to let the various providers know that you are sick and will address the bills in due time and are not ignoring their request for payments. Also, do not hesitate to ask your family or friends for help.
Please email me if you have questions or comments. You can reach me via email at [email protected].