Medical Debt Guide: How To Deal With High Medical Bills

Thursday, March 1, 2018

Medical Debt Guide: How To Deal With High Medical Bills (NAPSA)—A comprehensive 2016 find a Health Center, enter zip code at survey conducted by Kaiser Family https://findahealthcenter.hrsa.gov. Hospital Charity Care Foundation and The New York Times found that one in five (20 percent) Charity care can reduce oreliminate medicalbills at a hospital if the patient is unable to pay. There is typically an application process to receive charity care andinability to pay must be proven working-age Americans with health insurance and 53 percentof uninsured Americans reported having problems with medicalbills in the past year. In fact, “being able to pay for the care I need” was the most important characteristic of the health care system for 36 percent of the respondents in the 5th Annual Transamerica Center for Health Studies Consumer Health- care Survey.In addition, nearly one in five (19 percent) Americans reported they were unable to afford routine health care expenses in addition to their premiums. Payments with Health Insurance Patients are responsible for paying deductibles, co-insurance and co-pay- mentsfor health care services. Below are definitions of commontermsrelating to cost-sharing for health care services in- cludingprescription drugs. + Out-of-pocket costs: Expenses for medical care that are not reimbursed byinsurance. + Deductibles: The amount paid for covered medical care by the patient before the health insurance provider beginsto pay. + Co-insurance: The insurance com- pany pays a specified percentage of medical care cost (often 70 or 80 percent). + Co-payments: A fixed dollar amount for covered medical care paid by the patient (often $15-$40 per service/ prescription drug). + Out-of-pocket maximum/limit: The maximum amount the patient will haveto pay for coveredservices in a plan year. Health insurance plans with lower monthly premiums generally have higher deductibles. Plans with higher monthly premiumsgenerally have lower deductibles. In-Networkvs. Out-of-Network Health Care Providers Health care providers are consid- ered in-network if they have set rates with the health insurer, which lessens costs for patient care. Providersthat are out-of-network have no contract with the health insurer. Check with the insurance company to determine which providers are in-networksothe patient is not surprised with high medicalbills for going out-of-network. Under the Affordable Care Act, You may have more waysto pay for your medical care than you realiz er. However,this can still leave the patient with largebills. ‘Thefollowing are commonhealth in- surance plan types: + Exclusive Provider Organization (EPO): Managedcare plan with health care services covered only when using doctors, hospitals and other providers withinthe plan’s network. +Health Maintenance Organization (HMO): Managedcareplan that limits coverage to care from doctors, hos- pitals and other providers who work for or have a contract with the HMO. An HMO mayrequirepatients to live or work in its service area to obtain coverage. Preferred Provider Organization (PPO): Health insurance plan with lowercosts whenpatient uses doctors, through income,assets andlack ofinsurance coverage, andit can be applied for before hospital treatment. Hospital No-Interest PaymentPlan Somepatients may have an income that is too high to qualify for charity care. However, if the patientstill has high medical costs and is unable to pay, the hospital may offer a low- or no-interest paymentplan. This is an alternative to using a credit card or borrowing money with a high interestrate. EnsureBill Accuracy/Negotiate Amount Always check a medicalbill for ac- curacy orbilling errors before paying. Call the billing department, usually listed on thebillitself, forclarification. ‘The hospital may also accept a lower amountforthebillif the patient is unable to pay thefull amount;patients are able to negotiate a medicalbill or the costoftreatment. Medically Needy Medicaid Program hospitals and other providers in the In somestates, individuals who have high medical costs compared to their + Pointof Service (POS): A mix—like to qualify for Medicaid (not Medicare) plan's network. Out-of-network providers can be used withouta referral butwith additionalcost. an HMOplan, the patient chooses an in-network primary care phy- income may qualify for the Medicaid Medically Needy program. The Medically Needy program allowsindividuals coverage if they have high monthly sician who provides health care or medical expenses that reduce their income to below their state's Medicaid viders. Like a PPOplan, out-of-net- found at www.TransamericaCenterfor referrals to specialists or other pro- work health services are permitted but the patient pays more for those services. + Fee for Service: A traditional health insurance in which the health plan pays for medical expenses based on fixed amounts or a percentage of cost. The patient chooses the doctor, hospital or health service with no networks, incomelimit. More information can be HealthStudies.org. Crowdsource Fundraising ‘Asking friends, family and extended networks for help paying for medical care can be expanded with websites like GoFundMeand YouCaring. These crowdsourcing websites let patients solicit donations for medical treatment online for a fee of the amountthatis do- nated (usually around5 percent). Please Optionsfor Health Care Costs note that crowdfunding websites may not work for everyone, with about 90 percent of donation campaignsfailing to meettheir target amount.In addition, Center tionsassist with medical expenses. Also, there are disease-specific charities such Without Health Insurance Note thathospitals cannot deny care based ona patient's inability to pay. Care at a Federally Qualified Health Individuals in need of primary or nonemergency care who do not have some churches and charity organiza- as the American Kidney Fund and the Leukemia & LymphomaSociety. insurance companies are required to insurance or may nothavethe ability to pay out-of-pocket costs can seek care at a Federally Qualified Health Center ical emergencies. Insurance companies erate more than 11,000 service delivery Navigating health care insurance coverage and costs can be a daunting process. Fortunately, there are vari‘ousoptionsavailable when it comes to are provided based onability to pay. To ical care costs. cover out-of-network charges for med- mustcover emergency care at the same costsharingasat an in-networkprovid- (FQHC). Nearly 1,400 health centers op- sites nationwide. Primarycare services choosing coverage and paying for med-

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