I wrote a guest post at FrugalNurse.com titled, 3 tips to prevent surprise medical bills. It has some good info in there to help prevent patients from receiving a surprisingly large medical bill in the first place.
A dear friend of mine shared an article with me recently about getting out of medical debt. It gave good advice, many things I would also recommend doing, but one thing it does not touch on is time.
I consider my time to be the most valuable asset that I have, so how I spend it is very important to me. Which is also why my wife and I can’t go grocery shopping together anymore.
My lovely bride is the top chef in our family and enjoys looking at ingredients and takes her time in the store. I, do not do that. I walk in, go exactly where I need to go, buy what I need to buy, and hit up the self-checkout line. I don’t think grocery shopping is a great use of my time, so I make it go as quick as possible. Which obviously doesn’t work well for my wife and I.
But since we value that task differently, we assign a different value of time to it. Neither is wrong or
Which is why I think it’s worth reviewing how much time getting out of medical debt will take. Because when you add it all up, it will for sure take weeks, most likely months, and possibly years before it’s a thing in your past.
To get a better idea on that whole process, I’ll break down each step given in the article on how to get out of medical debt and how that translates to the real world.
How long does it take to Check the Charges?
If your bill from the provider comes without an itemized statement, it may take a few days for that information to get to you if it has to come via snail mail. Perhaps longer depending on where you live.
But before you request via snail mail, i would ask if there was an online option. A lot of places are providing this service now and being able to view it online could save you time right off the bat.
Now let’s say you identify a double charge on your statement. You dispute it with the billing office, it may take a few days for a decision on that. Then, they will probably have to rebill the claim to your insurance since the claim needed corrected. Add another few weeks for that to be processed. You’re now at a month you’ve been working on this and we haven’t even determined what you’re going to owe yet.
How long do negotiations take?
Good news, you figured out how much you actually owe. Bad news, it’s a lot of money you don’t have. Next step they recommend is trying to negotiate a lower price.
It’s recommended you call and ask around to get an idea of what others are charging for the same service. My advice would be to skip this step entirely. I don’t think it’s a good use of your time – and this is coming from someone who decides to accept a lower payment from a patient. I don’t care what other places charge compared to ours. I think this advice is better served prior to having the service (if you have the option of choosing).
Asking for a reduced rate can work if you’re willing to pay your share that day. For example, let’s say you owe $20,000 and you offer to pay $10,000 in a one time payment. Depending on the facility, they may accept that. I would start the negotiation at 50/50 and go from there. I don’t think this strategy is nearly as effective though for any amounts under $5,000.
If you’re able, try and make the 50/50 offer during a face to face appointment with the billing office. Whether that’s at the hospital or the provider’s office.
How long does it take for financial aid?
If they’re offering financial aid, you’ll most likely need to qualify. In order to qualify, you’ll need to provide records proving you need the aid. This could be bank statements, paycheck stubs, recent W2’s, and completing a form. Tracking down those statements and filling out the form all take time. How long depends on how organized you are. For some, it could be hours, for others, it could be weeks.
If you do end up qualifying, there may be different levels of charity available. Meaning that your financial aid may be 50% up to 100% assistance. That is certainly a question I would ask when applying so you have an idea of the possible outcomes. This process could also take weeks to be completed. It will be dependent on how often the deciding members of the charity review team meet to review these requests.
Once you have completed the financial aid process, you know are ready to pay your share.
How long will this take to be done?
I have seen it happen so often now I’ve become desensitized to it all, but it’s not uncommon for medical debt to take months of your time just to figure out what you actually owe. And this process doesn’t begin until the claim is originally processed – which doesn’t happen until after a few weeks from the actual date of service. It could be 6 months or longer from your date of service before you finally know how much you’ll need to pay. We haven’t even started making payments yet, which depending on the size of your debt, may take years!
Ain’t nobody got time for that.
Which is why I am a very big advocate of having patients prepared to prevent these billing nightmares from happening in the first place. In my opinion, it is worth spending the time upfront being prepared instead of spending years paying off your debt.
Until next time.
Medicare is the red, white, blue card. That’s how I describe it to some patients. Most people receive Medicare due to their age, 65, but you can also become eligible due to a disability or by having end-stage renal disease.
Medicare is unlike any insurance you have ever had. But today I’m going to focus on just one topic, assigned and unassigned claims.
Why should you care about this?
Money, of course.
If you see a doctor who is a participating provider with Medicare, that means they accept Medicare assignment. Accepting assignment means that the provider accepts Medicare’s payment, it literally gets sent right to them, and will only charge the remaining 20% co-insurance amount.
For a real world example, think of it this way. Your dad turned 65 in January of this year and Medicare became his primary payer. He will continue to see his same family doctor, who he learns is a participating provider to Medicare. When your dad receives his doctor’s bill, you’ll see the approved amount for the visit was $100. Medicare is going to pay 80% of that amount directly to the doctor’s office. And patient would then be responsible for the remaining 20% or $20. If you had a medigap policy, your claim would be sent to them to pick up the remaining 20%.
As one might guess, a non-participating provider (non-par*) of Medicare does not accept Medicare assignment. When they do not accept assignment, the limiting charge for the service is 115% of Medicare’s approved amount. Oh, and you will start receiving checks now too.
Thank you! Until next time.
Just kidding. Here’s what all that means.
Let’s use the same example as above, only this time your dad’s family doctor is non-par. Medicare’s approved amount was $100. But since the provider is non-par, their limiting charge, or max the doctor can legally charge is 115% of that. So, the bill from a non-par provider, for the exact same service, is 15% more, or $115.
Now, what’s also important to know is that because the provider chose to be non-par, the payment from Medicare will now be mailed to the patient. So, you can expect Medicare to still pay their 80% ($80), but that check will be sent to the patient’s mailing address.
If you were unsure whether a provider was accepting assignment or not, a good way to know is if your dad has been receiving checks. Friendly reminder…
DO NOT SPEND THIS MONEY. IT’S MEANT TO PAY FOR YOUR MEDICAL SERVICES.
It’s important enough to repeat.
DO NOT SPEND THIS MONEY. IT’S MEANT TO PAY FOR YOUR MEDICAL SERVICES.
Your dad has received the check for $80 and the claim has now been sent to the medigap policy to pick up the rest. BUT, depending on what type of plan you purchased, they may only pay up to the 20% co-insurance amount. That means, that extra 15% they were charged now needs to be paid out of your pocket. Imagine if that 15% was during a hospital stay. It can add up quick.
But, all is not lost on the insurance front either. There are some medigap policies that cover “Part B Excess Charges” which would include that extra 15%.
What’s the answer?
Like most things in healthcare, the answer is going to depend. I would say if your primary goal is to save money, only seek out participating providers of Medicare. If you main focus is what provider you see, then go wild. Just remember to keep those Medicare checks someplace safe because that money already has a home.
If you have any additional questions on this, let me know in the comments below.
Until next time…
*The remaining “ticipating” takes up too much time…it’s true. It does.
Today I’m doing something I’ve never done before here…I have a guest poster. Jon at PGM Billing, reached out and asked if there was an opportunity for a guest spot.
After a few emails, Jon presented this well written article geared towards Medicare beneficiaries. I thought it was perfect because I have been working on a Medicare post and this guest spot is motivating me to get it done. So, without further ado, and thank you Jon for reaching out, I want to introduce you to Jon Clark at PGM Billing.
10 Rights of All Medicare Beneficiaries
Medicare is a health insurance program developed to help the elderly people in the U.S. meet their hospital, medical and other health costs. It is available to most individuals 65 years of age and older.
Medicare is run by the Centers for Medicare & Medicaid Services, often referred to as CMS. It is a branch of the U.S. Department of Health and Human Services, or HHS, which is also the federal agency that runs the Medicare Program and monitors Medicaid programs offered by U.S. states.
Medicare has also been extended to persons under age 65 who are receiving disability benefits from Social Security or the Railroad Retirement Board, and those having end-stage renal disease.
While there are a number of different ways to become a Medicare beneficiary, there are special rights and protections guaranteed once you receive Medicare coverage. These rights and protections are designed to accomplish a number of objectives, including protecting Medicare beneficiaries when they receive healthcare, ensuring they receive the healthcare services that the law says they can receive, protecting them against unethical practices and protecting their privacy.
Here is a list of some of the different right and protections for all Medicare beneficiaries.
- No discrimination. All companies and agencies working with Medicare cannot treat you differently because of race, color, national origin, disability, age, religion or sex.
- Protection of personal and health information. By law, Medicare is required to protect the privacy of your personal medical information. Medicare is also required to inform you of how Medicare may use and give out (i.e., disclose) your personal medical information held by Medicare.
- Receive information you understand. Any information you receive from Medicare, healthcare providers, and, under certain circumstances, contractors must be presented in a manner that you understand.
- Receive information to help make healthcare decisions. You have a right to receive clear and simple information about Medicare that helps you make educated, informed decisions. This information would include a description of what services are covered by Medicare, what Medicare pays for those services, how much money you are responsible for paying for services and directions on how to file a complaint or appeal, if necessary. Proper medical billing can reduce billing mistakes. However, it is not uncommon for errors to occur that may require you to take action if you want to ensure you pay what you rightfully owe and not a penny more.
- Receive answers to questions about Medicare. You have the right to have your questions about Medicare answered. To do so, you can visit www.medicare.gov, call 1-800-MEDICARE (1-800-633-4227), call your state health insurance assistance program or call your plan if you have a Medicare Advantage Plan, other Medicare health plan or a Medicare Prescription Drug Plan.
- Access healthcare providers. You have a right to access physicians, specialists and hospitals.
- Learn about your treatment choices. You have the right to participate fully in all your healthcare decisions. Information about your treatment options must be provided in a clear language that you can understand. If you cannot fully participate, you have the right to ask a family member, friend or someone you trust to help make a decision about the treatment that is best for you.
- Receive services in an emergency. If your health is ever placed in danger because of an injury, sudden illness or illness that quickly gets worse, call 9-1-1. You have the right to receive Medicare-covered emergency care anywhere in the United States.
- Receive a decision about healthcare payment, service coverage and prescription drug coverage. When you request coverage for items or services, or a claim is filed for items or services you received, you will receive a notice from Medicare or be notified by your Medicare Advantage Plan, other Medicare health plan or Medicare Prescription Drug Plan informing you of what is and is not covered. If you disagree with the decision, you have the right to appeal.
- Be treated with dignity and respect. If this is ever not the case, you have the right to file a complaint (sometimes called “grievance”). Different from an appeal, which concerns issues with a plan’s refusal to cover a service, supply or prescription, a complaint concerns the quality of care or other services you receive from a Medicare provider. Learn more about how to file a complaint here.
Mia Taylor wrote a very informative and important piece over at TheSimpleDollar.com titled, “What’s a Patient Advocate – and should you have one?” She explains what kind of advocates are available, including their average cost and what services they can provide.
I was fortunate enough to share my .02 on the section that covered how one can find a good advocate. I feel advocates are under utilized in today’s health care system on both sides, medical and billing. When I do see advocates, particularly on the billing side, they are usually brought in when the situation has already gotten out of hand…
That’s why with this blog my plan is to have patients better prepared so they can prevent the really complicated stuff from happening (as best as they can).
And you’re off to a good start…I mean, you found this blog. 🙂
My oldest nephew is in 8th grade this year. I’ve lived across the country for more than 5 years now and every time I’m back home and see him, he’s changed. He’s getting taller, he’s putting on some muscle, his voice was cracking, but now it’s just lower. He’s going through puberty, which is around the time parents have “the talk” with their kid.
You know which one I’m talking about. The one that has been played out in movies and books for generations. That uncomfortable conversation you have with your once child, but soon to be teenager. Some call it the “birds and the bees”, but whatever name you provide it, awkward is usually how it’s described.
But what many forget, or perhaps they’re simply unaware, is that there is a second talk that occurs later on in life between children and their parents. And this conversation is not any less awkward, because the question you need answered is going to stir up some emotions.
How do your parents want to die?
We don’t like to talk about death. Some say it’s morbid or perhaps they don’t want to tempt anything, but how to die decisions are just as important as how to live decisions.
Need a real life example? Watch the short documentary Extremis on Netflix.
This film is under 30 minutes, and follows an ICU floor with terminally ill patients. It’s raw and captures the emotional drama of an ICU. It provides a glimpse at the decisions the staff and the patient’s families have to make in those end of life situations.
I would recommend everyone to take the time and watch this film. And while you are watching it, ask yourself these three questions…
Does my family know what I would want?
Who do I want to make decisions when I can’t?
If I’m lucky enough to have a say, how do I want to die?
It may feel weird to think about this, and trust me, I know a lot of people do not. But, when you suddenly receive a call from a hospital and you’re being told by a doctor, “We need you up here immediately, there’s been an accident…”
Are you ready to make those decisions? Is your family ready to make them? The point being, if you’re not prepared, it can become an impossible situation to manage. So do yourself, and tu familia a favor and take the steps needed to make this part of life a little less hard. If you’re curious on what that would entail, use this next section as a guide.
Living Wills and Medical Power of Attorney
Remember that first question I told you to ask yourself when you watched Extremis? It was, does my family know what I want? One way to take out the guesswork is with something called a living will.
A living will is a legal document that informs the medical staff of your healthcare wishes if you were ever incapacitated. This document should contain information on topics like resuscitation, a desired quality of life, and end of life treatment. You should be as specific as possible, but know going in you can’t cover everything.
If you’re not sure where to start, I would contact your primary care doctor with any questions. Your local hospital will most likely have forms there as well. A quick Google search brings back a lot of links with information too. Basically, there’s no excuse NOT to have one. And when you think about the peace of mind it could provide to your loved ones, it’s a no brainer.
But of course, a living will cannot cover every possible scenario. Which is why I asked you to think about a second question, who do I want to make decisions when I can’t?
The living will is created so YOU have a say, but when something falls outside of the living will, you’ll need a medical power of attorney (POA) to make those decisions. It’s important to remember, your medical POA can NOT contradict your living will. They are there to fill in when something is not covered in your living will.
As I mentioned above, every hospital will probably have their own living will (aka healthcare directive aka advanced directive) forms available. Most hospitals will have a notary public on staff as well so you can have them notarized on location.
But let me provide a quick cautionary tale about waiting until the last second and doing everything at the hospital.
I, myself, am a notary. I am commissioned by our state to perform the role of witnessing signatures and confirming identities of the signers. And I have been asked on more than one occasion to a patient’s room to notarize documents.
Let me tell you something, when you’re in a patient’s room and the patient is unresponsive or confused, and you are being asked by their family to notarize a document (like a POA or living will) – that makes me really nervous. And is a guaranteed “no”.
I have worked with other notaries on staff who had to give a deposition in court cases after the patient has passed away. That doesn’t sound like fun. And we really want to honor the patient’s wishes, but if they can’t communicate that to me, I don’t feel comfortable putting my name on that document.
So don’t put someone in a position to say “no”. Take care of this stuff before you even come to the hospital, then next time you are there, give them copies of your living will and POA. They’ll be happy to keep those in your medical record.
The final question I asked you to think about was this, how do I want to die? At your home? In a hospital? On a machine? I don’t think there is a right or wrong answer, it’s just that you have one and have shared it with people you love. If you have 20 minutes to spare, I recommend you check out this TED talk by Dr. B.J. Miller, a palliative care physician. His talk is about end of life treatment and what options we have and why it can influence how we live. It’s fantastic in that makes you think about life kinda way. Which are thoughts I think we spend entirely too little on today, but that’s another post.
(If you enjoyed the TED Talk, check out his interview on the Tim Ferriss podcast here)
One of my favorite artists once said, “It’s always easier to leave, than to be left”, and that quote has stuck with me ever since. When losing a loved one, the focus at the end should be on love, comfort, and finding peace. Do your part to help your loved ones out and make sure your wishes are clear and known. Easiest way to do this is by having a living will and medical power of attorney. Eliminate potential family disputes, but most importantly have a say in your life, even at the end. Plus, it shows your family how to responsibly handle this part of the journey, so be the example.
And adult children of today, your loved ones will be approaching you one day asking these same questions. Practice what you preach and have it prepared for them. Death is a guarantee in this world. There’s literally no way getting around it. We can still help during that part of our life, but it takes a little action today.
Until next time…