For most people, healthcare is now unaffordable. In fact, a 2017 poll found that almost a third of Americans now have a tough time paying their medical bills, and 73% of them cannot afford food, clothing, and other basic household items as a result.
This problem is greatly amplified when patients are managing their health while also dealing with their finances. The immediacy of treatment and consequences of neglecting to get care are a clear priority when compared to maintaining financial health.
However, the reality of the healthcare industry in America is that financial health is often crucial for continuing to get the best results from treatment.
We believe that it should be easy for patients to reduce their medical costs. That's why we've have compiled several easy steps you can take to ease the financial burden and mental stress of medical costs. This guide is a compilation of my own experience along with countless online resources, and I hope you find it useful.
For more help on understanding and reducing your healthcare spending, check out what we're building.
Request financial assistance
Estimated time: 30-60 min
- Find contact information for your healthcare provider or insurance company. Call their member or customer services line and speak with a representative to explore your options for financial assistance. They will most likely put you on hold while they check your eligibility, which may include checking your bill balance, income, medical history, and a variety of other information. This can take anywhere from 10 to 30 minutes.
- If you qualify, ask them to explain how your coverage changes. Usually, they will reduce or eliminate the following: co-pays, prescription costs, deductibles, and outstanding debt. Keep in mind that this generally only applies to necessary care, so procedures such as cosmetic surgery and OTC items like drugs and medical supplies most likely won’t be covered.
- In the case that you don’t qualify, don’t give up hope. Explain your situation and your financial hardships, and ask if they can do anything to lower the cost of your debt or future care. There will almost always be some option that is preferable compared to your current one, such as a zero-interest long-term payment plan. Ask if they are willing to discount the bill if you pay down some money now. They will usually say yes, so don’t cave in here if they seem reluctant. Offer specific amounts and say you are willing to move the number up/down.
- If nothing works, turn to patient organizations such as the Medical Billing Advocates of America for further assistance. Make sure the organizations you call aren’t getting any personal information about you, especially from your bills. You can learn more about medical billing advocates here.
Look for mistakes
Estimated time: Depends on the amount of bills.
- Compile your medical history in one document or place. If you receive your bills through the mail, make sure to keep them and organize all the bills in one place by date. If you receive them through the mail or an online portal, try to organize them in a spreadsheet or some other way.
- Go through your bills and highlight anything that you don’t understand or seems repetitive. First, look to see if the name or cost of a specific procedure is repeated. There are often cases where you are billed twice for a procedure that only happened once, or where you are billed for a procedure or drug more expensive than what you actually received.
- Call your healthcare provider or insurance company and ask what those costs are for, and if you find any discrepancies let them know. Ask for an itemized bill that details every single procedure, test, and service that was performed during your visit. The bill you receive in the mail or online is simply a summary.
- Look at the costs you don’t understand or remember. Some of these may be mistakes on behalf of the billing department. For example, a free flu shot may accidentally be punched in as a $45 vaccination. Call your healthcare provider or insurance company and ask detailed questions about each questionable cost. Include any contextual details you remember to make sure you and they understand what each of the costs were for. If there are mistakes make sure they refund you the proper amount.
Re-process out-of-network bills
Estimated time: Depends on the amount of bills
- Similar to #2, compile your bills in one place and go through them, looking for out of network bills or suspiciously expensive bills.
- First, look at your out-of-network costs and recall the circumstances you were under. In most cases, if you explain that the situation was out of your control and you want the claim processed as in-network, they will oblige. There are also programs offered by insurance companies specifically for this issue, such as Service Beyond Borders so make sure to ask if any such programs exist for your insurance company or healthcare provider.
- Second, if these surprise out-of-network bills do get re-processed, make sure to keep tabs on the reprocessing, as the bill may end up higher than it should be. For example, let’s say you get an MRI. The imaging facility bills your insurance $500. Your insurance approves $400 of the $500 bill, pays 75% of that $400, and now $100 is left. So at this point, you should owe $100 for your MRI, but the bill you actually receive may say you owe the $100 as well as the other $100 that wasn’t approved by your insurance. Call your insurance to explain that the situation wasn’t in your control and request that they recalculate the claim.
Negotiate the bill
Estimated time: ~2 hours per bill
- Don’t think negotiating your medical bill is rude or awkward, as the payoff can be much larger than you expect.
- First, research costs for every item you want to negotiate on your bill. You can use various websites for this purpose, such as Atana, Healthcare Bluebook,and CMS. If you can show that you were charged 30% higher than the average cost of the same procedure from ten other hospitals nearby, then it is more likely that your bill will go down.
- Second, find the right person to talk to. Start by calling customer or member services, and if they can’t help you, ask who can. Don’t be afraid to ask for their supervisor, but do so in a calm manner. Make sure to get the names and reference numbers relevant in each conversation you have. Take notes on key points in the conversation, especially quotes that confirm some sort of discount.
- If they refuse to lower the bill, don’t get frustrated but don’t back down. Say that the bill is completely unaffordable and that you will most likely not use this company again. Sometimes mentioning that this negative experience will be shared online can move the needle, especially if you have already asked for the name of who you’re talking to.
Look for alternative savings
Estimated time: ~60 min
- There are many ways to get discounts. The easiest way is to simply ask your healthcare and/or insurance provider if they offer any discounts or reward programs. Some places offer discounts for paying in certain ways, or rewards for losing weight. Websites such as GoodRx have coupons for almost every single drug, so always check there before going to the pharmacy.
- If you are near a university or research facility, see if you can participate in clinical research or share your data for cash. Ask your employer’s HR department if any reward initiatives exist for healthy behavior.
Estimated time: Ongoing
- The best thing you can do to avoid overwhelming medical bills is to be informed. Before visiting the doctor or buying a drug, use online resources and mobile applications to make sure you are getting the best deal you possibly can. It can be much cheaper to visit out-of-network, out-of-state and even out-of-country providers for specific procedures.
- If your immediate response when you see a bill is shock or panic, call the provider as soon as possible to start the questioning and negotiation. The earlier you do this, the better. It is much harder to receive any sort of discount if the bill was due weeks ago, especially if your provider has tasked retrieving payment for the bill to a debt collector.
- Most importantly, stay financially savvy. Healthcare is a necessary part of your regular expenses, and you should also have a rainy day fund for potential emergencies. Use free software to keep track of how much you’re spending on anything medically related, not just on bills but even on transportation such as miles, gas, Uber, trains, etc. Compiling this information makes it much easier to file medical expenses as tax deductions on your tax return.
If you have any thoughts or advice regarding this article, please email firstname.lastname@example.org. We’re constantly working on ways to make the lives of patients financially easier, and would love to hear from you if this guide was helpful!