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Let’s talk about medical bills.
Medical debt is an enormous problem in today’s society, and it can hit very hard for seniors or those on a fixed or limited income. The Consumer Financial Protection Bureau says that one in ten seniors has medical debt. The elderly might suffer more financial consequences, as many rely on retirement funds and social security for income, without an opportunity to earn more money to pay down their debt.1
But why do seniors have medical debt if they have Medicare?
When it comes to coverage, Medicare is a strange beast. Though designed for those over the age of 65 (with some exceptions), Medicare doesn’t cover many of the conditions that are a consequence of aging. For instance, Medicare doesn’t usually cover dental care, vision care, or hearing issues. The expenses for those things tend to be out of pocket and that can add up very quickly, especially if there is a problem. So a sudden emergency like a root canal or tooth extraction could be a whopper of a bill that is tough to pay off.
But there’s another element that pops up for many of us and we don’t even realize it: inaccurate medical bills. According to the LBL Group, Medical Billing Advocates of America found that three out of every four medical bills they review contain errors. That’s 75%! And those errors can lead to hundreds or even thousands of dollars in wrongfully billed costs.2
You might be wondering what you can do about all this. It turns out that you might be able to do quite a bit to protect yourself from overbilling and medical debt. Here are some tips to help you review the bills, and if they are accurate, address paying off medical debt.
Review Everything
When you receive a bill that Medicare doesn’t cover, first make sure that’s true. It isn’t safe to assume that something isn’t covered. For instance, Medicare doesn’t generally cover vision care. However, if you have diabetes, part of your routine vision exam might be covered. Medicare covers one eye exam for diabetic retinopathy each year.3 And some Medicare supplemental plans offer coverage for some medical, dental, and vision issues that you might not find covered under original Medicare.
Reviews bills closely. If you simply get a bill saying what you owe but there are no details, contact the clinic or hospital that provided the service and ask for an itemized bill. This will give you a way to review the bill line by line. Look for any duplicate or erroneous charges. If you have an explanation of benefits (a requirement for private insurance companies), you can compare the bill to the explanation of benefits to make sure they match.
If things don’t match up, start by contacting your insurance company. Since they want to pay as little as possible, they will be quite interested in hearing about duplicate charges or other errors. They can review the situation and contact the original biller to resolve any problems. But always follow up with them. Insurance companies might not get back to you in a timely manner and the medical debt is in your name, not theirs. So be vigilant about keeping the process moving.
If you have Medicare, the rules are pretty clear-cut about what is covered and what is not. But if you aren’t sure, get in touch and ask someone to explain why a bill isn’t covered.
There’s another element to consider, and that’s surprise billing.
This often happens when you have private insurance. The insurance company might cover a hospital because it’s “in network” but then you are treated by a physician who is “out of network.” You expected that your care would be covered because you chose a place that was in your network but you had no idea that the treating physician wasn’t. The bill you get as a result might show that your stay was covered but your physician’s services were not. That’s surprise billing.
While it usually happens when you are dealing with an emergency, it can also happen when you are going through a planned medical procedure. For instance, your hospital and physician might be in network, but what about your anesthesiologist? What about the x-rays you need before the surgery? It could be too cumbersome to check on every single person who will be involved with your care, and even if you could do that, there could be a last-minute change in the people scheduled to treat you.
Fortunately, the No Surprises Act helps you avoid these surprise bills. The Centers for Medicare and Medicaid Services can help you understand your rights.4
12 Helpful Tips
Once you’ve determined that you do owe a big medical bill, and you know that the amount is accurate, you’re looking at some medical debt. If you can pay it off all at once as soon as you get the bill, great! But if you can’t, there are several possible options.
1. Negotiate the costs. This works best if you are shopping around before a planned medical procedure. Compare prices online to find out where the best deals are. One hospital might charge an extra $1,000 for a routine knee replacement, while another one might not charge extra for the replacement but does charge much extra for the use of the operating room. While this can help you beforehand, you can do the same thing after the fact. If you find that you would have saved a few thousand dollars by going elsewhere for the procedure, point that out to your provider and ask for a negotiation of costs.
2. Request a discount. Providers never want to send a bill to collections. They will only get a fraction of your payment if they do. It’s in their best interest to work with you to relieve the debt, so use that to your advantage. Give them a timeline – perhaps 90 days – and commit to paying the bill in full by that point if you can get a discount to make it more feasible for you.
3. Point out special circumstances. If you are getting a bill because you don’t have coverage for it and you are in the midst of serious financial hardship, be honest about that. Many providers will work with you to lower the bill and work out a payment plan that ensures they get their money and you get a break by not having to pay it all at once.
4. Request assistance. Depending upon the size of the bill, you might be eligible for medical bill forgiveness. Many hospitals have programs specifically to help those who can’t afford to pay the bill, such as those who have no insurance or those who are at risk of being homeless. Ask the hospital what they offer for your particular situation.
5. Get on a payment plan. Again, keep in mind that providers don’t want that bill to go to collections! A payment plan is a good option to keep you in the green and still make sure the providers get at least some of what they billed you. Many payment plans are interest-free and allow you to break the payments down over a period of time that is more comfortable for you. However, be sure to check for any additional fees, so there is no surprise when you see that “service fee” tacked onto the monthly bill.
6. Get it all in writing. Don’t rely on the word of a person you talked to over the phone. The plans you discussed might not be entered into the computer system properly or might not even be communicated to everyone involved – this is especially true for a small office that handles all paperwork in-house. Get the payment plan, forgiveness, or any other arrangement in writing so that there is no question later of what was agreed upon.
7. Turn to federal and state resources. If you are covered by Medicare, Medicaid, or a state-sponsored program of any kind, you might be able to find assistance through hardship programs or other services at the state and federal level. If you are a veteran, there might be even more options available to you. Check out Benefits.gov for more information.
8. Look to private organizations to help. There are many private organizations that help those who are underinsured or have chronic or life-threatening conditions. Look into the Patient Access Network Foundation and the HealthWell Foundation, as well as ask your provider’s billing office if they know of any local organizations that might be in a position to help you.
9. Consider your chronic conditions. Does your medical bill relate to a particular disease? The organization that focuses on that disease or condition might be able to help you. For instance, the American Kidney Fund might be able to help those who have kidney failure, while the American Breast Cancer Foundation can help with treatment and screenings for those who are underinsured or don’t have insurance at all.
10. Apply for Medicaid. Even if you have Medicare, you might still qualify for Medicaid. Medicaid can pay the bills that Medicare won’t cover. Though it might not be retroactive and thus might not help you with the medical debt you have right now, it can help prevent you from going deeper into debt in the future. This can be especially helpful if you have been diagnosed with a chronic condition that you know will progress in the coming years.
11. Talk to a patient advocate. Most hospitals have patient advocates on staff. It’s their job to work with you to find solutions to problems, including medical debt you might have incurred. They can work with the hospital, clinic, or provider, serving as a go-between to help you lower the bills.
12. Consider private medical billing advocates. These professionals charge a fee for their services, but that could be a much lower price than paying the entire medical debt. Keep in mind that many of these advocates work on bills before they are sent to collections, so make sure to get in touch with them early in the process. This could work well if you have a significant medical debt and complex bills that are difficult to understand.
If your medical debt is sent to collections, it could then affect your credit score, and that could make it difficult to afford other things you might need later, such as refinancing your home. However, even when a debt is sent to collections you still have some time to pay it down.
Talk with the collections agency about a break on the debt. What discount can they offer? Tell them how much you can comfortably pay and see if you can find middle ground.
Remember that the big three credit bureaus provide a grace period of 180 days before they add a medical debt to your credit report. That’s six months from the time it’s sent to collections to the time it potentially affects your credit score. So even it was a bill that you were somehow unaware of, when you get the collections notice you still have some time to work things out.
Avoid Medical Problems in the First Place
The best way to pay expensive medical bills is to not get them in the first place. Taking good care of yourself can help you avoid the more expensive costs of growing older. When you consider that falling down could easily lead to a broken bone or traumatic brain injury, which could then lead to high medical bills, choosing a medical alert pendant or wristband makes excellent financial sense.
That’s especially true if you choose a medical alert system with fall detection. A fall detection alarm can reach out to an emergency monitoring center on your behalf at the moment the tiny fall sensors inside the device recognize that a fall has occurred. You can be sure that you won’t lie on the floor in pain, hoping that someone will arrive soon to help you. You can get help right away.
Though we sometimes can’t avoid the accidents or emergencies that could send us to the hospital, every little bit of safety and security counts as we get older. A small, affordable cost of implementing aging in place solutions, like a personal emergency response system, can save a great deal of money later.