Whether you’re undergoing tests and appointments for a new medical diagnosis, coping with the aftermath of an unexpected health condition, or managing a long-standing illness, the bills that arise from any of these scenarios can be stressful.
In the United States, where there are wide disparities between health care costs and payment processes depending on your insurance company, insurance plan, and provider, it can seem especially difficult to plan ahead. and manage health expenditures.
“Patients can leave their primary care provider’s office or a hospital thinking they’ve paid for all their expenses, only to receive an overwhelming number of residual medical bills from every provider involved in their care,” says Brandy Porche, a licensed professional counselor who provides marriage and family counseling in McKinney, Texas.
The difficult to predict nature of medical bills, coupled with the fact that their totals can range from hefty to crippling, creates a lot of financial stress.
And often, that adds to the stress of living with a health condition in the first place. “Having a chronic condition requires mental adjustment and reframing,” says Porche. This is especially true for newly diagnosed patients.
Every condition is different, but in many cases there is an ongoing need for medication and doctor visits, chronic pain or fatigue, and the extra time and effort needed to do things most people don’t. without chronic disease do without a second thought.
“The added stress of financially paying for your state’s expenses can be debilitating at times,” says Porche. Questions may arise such as: Can I afford to pay for the medications and care I will need? How much of the cost will my insurance cover, and will that amount change over time? What will I have to sacrifice or give up to be able to pay these bills? And what if I just can’t?
Unlike many other expenses you might be able to cut back on when you’re financially strained, lowering your medical bills isn’t always possible, Porche says.
In addition, medical billing can be confusing. Even if you have insurance, there can be surprise costs, and the price of visits and medications can vary from provider to provider and fluctuate over time without warning, says Michael Botta, PhD, economist at health and co-founder of Sesame, a health marketplace that helps people find the best price for out-of-network medical care.
Even if you call your insurance company and health care provider before a visit, there is no guarantee that you will be able to find out (or schedule) the actual cost of that visit in advance.
That said, there are ways to stress less about medical bills. Here are some expert tips.
1. Ask about payment plans
If you receive a massive medical bill, Porche recommends being proactive by asking for a payment plan. “When you get the bill in the mail, call the billing office and set up payment terms if you can’t afford to pay it in full,” she says, adding that sometimes those terms can split a bill. in payments as low as $10 per month. .
“Do what’s affordable for you,” Porche says. “Decide on a total amount per month that you can spend on medical bills, then divide that total between all of your current and unpaid bills.” Knowing how much you owe and having this type of payment plan is very helpful in relieving financial stress.
2. Take advantage of the HSA or FSA options available to you
“Talk to your employer about a Health Savings Account (HSA) or Flexible Spending Account (FSA), which you can fund with pre-tax dollars from your paycheck,” says Dr. Botta. “When unpredictable expenses arise (often things like emergency care or hospital stays), you can apply money from your HSA or FSA to any medical bill.”
An HSA or FSA can take the worry out of unexpected expenses because you know you already have at least some money set aside to pay for them. “If your employer doesn’t offer one, create one yourself or talk to your employer about sponsoring one for employees,” says Botta. “Companies like HSA Bank and Health Savings Administrators offer individually funded HSAs, and you can set up a regular contribution from your salary.”
Yes, you will still pay the same amount for your care. But regular contributions to these accounts mean you’re saving for future health care expenses, which can soften the blow when they arise.
3. Get a Good Faith Estimate
To minimize your chances of getting a surprise medical bill afterwards, Porche recommends calling your provider before making an appointment and asking about the cost of any procedures or medications. “Remember to ask, ‘What potential costs can I expect from vendors or third-party vendors?’ too,” says Porch.
If you do not plan to use insurance to pay for medical services, providers are required by law to give you a good faith estimate before your visit. This is a new requirement that came into effect on January 1, 2022, as part of the law with no surprises.
The Centers for Medicare and Medicaid Services (CMS) explains that a Good Faith Estimate must include an itemized list with expected charges for services and items related to your care. And, if you receive an invoice that is at least $400 more than your good faith estimate, you can dispute that invoice.
4. Call your insurance company before a medical visit to ask what is covered
Unfortunately, the No Surprises Act only applies to out-of-network providers, so it doesn’t protect against unexpected costs associated with copayments, deductibles, or other charges you may owe, even when your insurance company covers something. thing.
If you want to know what those costs will be, ask your provider (or, more likely, their billing department) if they’ll verify your benefits with your insurance company and let you know how much you might owe.
“Providers can confirm eligibility and benefits with health [insurance] plans for the services they plan to provide,” says Robert Julavits, executive director of external communications at Athena Health, a medical practice management software company that offers medical billing services. They can check with your insurance company and then tell you which services will and will not be covered.
For example, your insurance company may cover the cost of an intrauterine device (IUD), but not the cost of the in-office procedure to place the device in your uterus. Your provider (or their billing department) should be able to confirm this information with your insurance company and then share this information with you so you can decide whether or not to go ahead.
If you decide to verify your own health insurance coverage, Julavits recommends that you inquire about your deductible, co-pay, coinsurance, and any other financial obligations you may have for a given procedure, as well as any prior authorization or baseline requirement. “Patients should also check that there are no limits to payments in the event of complications and check whether the full range of care – from pre-procedure or service visits to follow-up or rehabilitation – is covered. “
When verifying coverage with your insurance company, you can ask your provider for a script to use to ask about coverage for a certain procedure or type of care, Julavits says.
5. Allocate time to think about (and process) medical bills
All of the aforementioned steps take time, especially those that require phone calls (and waiting for the next available representative). Be realistic that those calls and those things to do on your list won’t happen in five minutes at the end of your day.
“Allocate some time to strategizing about your medical debt,” suggests Rosario Chacón, Certified Financial Planner and Financial Behavior Specialist based in Oakland, Calif.
Depending on the amount of your medical bills or medical debt — or the scope of your issues — you can schedule an hour or two each week, month, or quarter to assess them and research the best ways to manage them.
6. Ask for help
Chacón recommends looking for helpful resources, whether it’s a financial planner that fits your budget, a payment plan option like Porche suggested, or something else.
“A financial planner or financial therapist can give a more objective perspective on paying current bills and strategizing for future ones,” says Chacón. They can help you develop a specific debt repayment plan, guide you through budgeting, and explore any loan refinancing options that might reduce interest on your debt.
You can also ask for help from a patient advocate (sometimes called a “health advocate”). These professionals specialize in insurance and medical billing assistance. There are many types of patient advocates, and they can help with everything from medical decision-making to navigating long-term health care, says Adria Gross, author of Solved! Solve your medical insurance problems and a lawyer specializing in medical insurance billing.
Like some other medical billing advocates, Gross has worked for health insurance companies. “Now I help clients manage all of their medical bills and negotiate medical care costs,” she says, explaining that medical insurance advocates can help with things like medical bills; denied, overcharged or out-of-network claims; denials of long-term care policies; and combating the loss of insurance coverage in a rehabilitation facility that a patient physically cannot leave.
To find a medical billing attorney, go to the Umbra Health Advocacy Directory.
If you have health insurance coverage through your employer, someone in your human resources department may also be able to help you navigate your benefits and resolve any disputes that arise with your company. insurance. But Gross says most HR professionals aren’t trained to navigate the medical billing system, so they might not be able to help with more complex questions.
7. Give yourself grace
Along with taking the necessary steps to reduce medical debt, Porche says it’s important not to blame yourself for your situation. In the United States, medical care is difficult to access and the expenses related to a chronic illness or a medical emergency are often beyond everyone’s control.
This doesn’t mean you can ignore medical bills, but it can help combat any shame you may feel about debt or the complexity of understanding the payment and insurance process.