Feeling Crushed by the Weight of Medical Bills?
Although health insurance should pay the bulk of your medical bills, even with the best coverage, co-pays are usually hefty. This is Part One in a series of articles that will advise you how to reduce or eliminate co-pays when financial circumstances leave you unable to pay. This article gives an overview of your options. Subsequent articles will delve into further details.
Medical providers will bill your insurance company first, and after contractual deductions for reasonable and customary charges and the amount paid by your insurer, you will receive an invoice for the remainder. Most healthcare providers expect payment within 30 days. While there are several ways to get financial assistance, the process can be difficult and time-consuming. Here is a guide to help make things less stressful. I suggest checking into all possibilities.
Contact your healthcare providers and explain your situation. When financial hardship is the reason, providers may be willing to waive or reduce your co-pay and extend the amount of time you have to pay by spreading out payments, often on a monthly payment plan. Be proactive! If you ignore the bills, eventually they will be sent to a collection agency, likely damaging your credit if they report your non-payment to the major credit bureau.
Sources of Financial Aid
Hospitals and some medical clinics, especially nonprofit facilities, often have charity care programs to help cover or reduce medical bills. Eligibility is usually based on income. Advertising for these programs is often minimal or non-existent, so you will need to actively seek them out.
Numerous charities offer health care for free or at a reduced price. The number and types of services offered by charities will vary widely. It will depend on the applicant’s household income, the assets they have in their name, the type of illness or disease the patient has, and also it will depend on the current funding of the non-profit agency. Charity care programs usually cover primary and some specialty care and prescriptions, while most also cover inpatient care and emergency room use. Keep in mind that for charity care assistance, you’ll likely need to provide documentation that demonstrates your inability to pay your medical bills. For more information and to apply, contact your hospital.
Medicaid and Medicare Savings Programs If you meet income qualifications, you may be eligible for medical bill assistance through Medicaid or Medicare. These programs are able to back-date your coverage three-months, allowing 100% of your medical bills to be paid within that timeframe. Visit Medicaid.gov to find your state’s website; each state has unique eligibility rules and covered services.
Crowdfunding is the practice of raising money for a specific goal or cause from a large number of people, usually via the Internet. More and more Americans are turning to crowdfunding for help paying medical bills. Crowdfunding sites offer users the opportunity to explain to potential donors why they need donations, which are then collected online and sent directly to the person in need. Popular crowdfunding sites focusing on fundraising include GiveForward.com, GoFundMe.com, YouCaring.com and Fundrazr.com.
National Human Genome Research Institute, part of the National Institutes of Health, is composed of U. S. Government biomedical research institutions has resources that may help in finding information on financial aid for medical treatment. Visit the following website frequently for new information as it becomes available. http://www.genome.gov/11008842
There are a large variety of grants available to meet the needs of patients. To secure a grant, you must learn to spot the correct grants tailored to your needs.
I discovered the Patient Advocate Foundation (PAF) among a rack of brochures in my surgeon’s waiting room. This non-profit organization seeks to inform and empower patients. They have compiled a diverse list of valuable resources that address several topics which help patients find assistance with medical debt, insurance access, job retention and many other medical related issues. Following is a list of some of the services they offer and contacts:
PAF (800) 532-5274
Case Management Professional Case Managers are available to assist patients, caregivers and their providers who face debilitating, chronic or life threatening disease. Each patient is assigned to a manager who provides one-on-one assistance to help resolve healthcare issues. Both English and Spanish speakers are available to assist.
Specialized Programs Through supported grants, partnerships and targeted donations, PAF operates additional dedicated programs to meet the needs of specific groups of patients, caregivers, and providers. This team can assist with understanding insurance policies and appeals, providing educational resources and researching clinical trials. These case managers can also assist with facilitating referrals to co-payment programs, finding financial assistance resources and providing guidance to the uninsured patients to learn how to access necessary care and apply for public and charity assistance as needed.
The MedCareLine is a division of Patient Advocate Foundation staffed with a team of nurses and case managers who provide individualized case management services to specific types of patients.
- Aetna Clinical Appeals CareLine is a patient and provider hotline to help Aetna patients with insurance navigation issues as well as denials associated with off-label medication use, pre-existing health condition, non-covered benefit or benefit exclusions, experimental/investigational denials or not medically necessary, out-of-network benefits, and coding or billing errors.
(877) 401-3944 aetnaclinicalappeals.pafcareline.org
- Heart Valve CareLine, designed to help patients, providers and caregivers who need assistance navigating the insurance world and accessing needed health care when dealing with the complications of a valvular condition. In addition, CareLine staff may be able to connect heart valve patients to a one-time $1,000 grant program that helps to cover expenses associated with heart valve treatments and transportation costs getting to and from treatment.
- Hepatitis C CareLine, experienced case managers serve as a direct resource for Hepatitis C patients assisting them with benefit coordination, educational and financial resources, help to access the latest available treatment, navigation through the appeals and reimbursement processes, as well as other patient services.
(800) 532-5274 hepatitisC.pafcareline.org
- Narcolepsy CareLine provides personalized case management assistance to solve medical access issues for patients diagnosed with Narcolepsy.
(866) 538-7617 narcolepsy.pafcareline.org.
- Financial Aid Fund Division This independent division of Patient Advocate Foundation provides small grants to patients who meet financial and medical criteria. Grants are provided on first-come first served basis and are distributed until funds are depleted. Qualifications and processes for each fund may differ based on fund requirements. Patients must apply individually for assistance under this division.(855) 824-7941 or 866-318-7892?Co-Pay Relief Program Operating as an independent division within PAF, the Co-Pay Relief program offers copay assistance for Insured applicants meeting disease and income eligibility guidelines to help patients afford the cost of pharmaceutical medications and treatments. Co-Pay Relief patient assistance is purely donor-funded and money is dispersed to qualified patients while funds are available for each disease.(866) 512-3861, Option 1
- National UNInsured Resource Directory & Financial Resource Since “ObamaCare,” the Patient Protection and Affordable Care Act (PPACA), went into effect, fortunately, most citizens now have health insurance. However, if you are currently without healthcare coverage, this online directory will point you in the direction of resources to fit your individual circumstances, and addresses medical debt crisis, financial assistance, charity assistance programs, and job retention related programs.http://www.patientadvocate.org/NURD/index2.php?application=uninsured
- National UNDERInsured Resource Directory & Financial Resource, uniquely tailored to meet your individual situation encompassing financial resources, disease-specific resources, location-based services, employment aid and general care resources for patients that are not fully served by their current insurance. This resource also contains a list of sample questions that can be used when speaking to your providers or insurance representatives.http://www.patientadvocate.org/NURD/index2.php?application=underinsured
- National Financial Resource Directory This resource aids patients seeking financial assistance.Patient Advocate Foundation’s Patient Guides
PAF’s informational brochures & patient guides, including “A Greater Understanding” pamphlet series, are all written by a team of case managers to provide you with needed information.http://www.patientadvocate.org/resources.php?p=749social relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children’s resources. National resources that can help, as well as programs in your local area, are listed.
- Patient Programs for Drug Manufacturers
As more patients find themselves struggling to meet the out-of-pocket expenses associated with their medication and pharmaceutical needs, many pharmaceutical manufacturers have set up patient assistance programs that serve as resource centers for patients. The pharmaceutical manufacturer of your prescribed medication is a great place to start when looking for assistance and this page will connect you with many of the major manufacturers and their support programs.http://www.patientadvocate.org/index.php?p=1000
Disease-Specific Information links to websites by category.http://www.patientadvocate.org/index.php?p=17
- Direct Donations are Accepted, You can contribute to Patient Advocate Foundation Donation options may be found at http://www.patientadvocate.org/index.php?p=207.Healthwell Foundation http://www.healthwellfoundation.org/diseases-and-medicationsMichigan State University http://staff.lib.msu.edu/harris23/grants/3medema.htmhttp://www.ehow.com/way_5762634_financial-people-heart-problems.html
Medical Bill Loans If you cannot get financial assistance from the government, your health care provider or from the hospital, you may want to consider a loan. Your borrowing options include a personal loan from a bank or credit union, a home equity loan or home equity line of credit (HELOC), a peer-to-peer lending loan, a 401(k) loan and more.
Credit Cards are a quick and easy option, however, you will incur huge interest charges over time.
Turn to your Savings
Roth IRA Distribution There are no income taxes or penalties due when you cash in a Roth IRA, with age and investment time exemptions. If this is an option you may wish to pursue, read this article: http://www.marketwatch.com/story/taxes-on-roth-ira-withdrawals-2014-02-25
Traditional IRA Distribution is subject to income taxes and if you are under 59 1/2 years old, you will also be subject to a 10% penalty. Fortunately, if this distribution is used to pay your unreimbursed medical expenses, the penalty on up to 10% of your gross income may be waived. See IRS rules at http://www.irs.gov/Retirement-Plans/Plan-Participant,-Employee/Retirement-Topics—Tax-on-Early-Distributions
Debt Settlement Services
Hospital Ombudsperson If you suspect your bill contains an error, many hospitals have special advocates or ombudspersons who help resolve billing disputes between patients and hospitals. Ask your hospital if this is a service they offer.
Hire an attorney who specializes in debt settlement services to negotiate with your creditors and lower or eliminate the amount of debt you owe. Attorneys might also be able to stop creditors from harassing you if you are late on payments. Make sure any attorney you hire charges you based on the savings or results she achieves, as opposed to charging an upfront fee. This gives the incentive to reduce your bills as much as possible. You can find the right lawyer for your needs by asking someone you know and trust, searching online and checking reviews for local attorneys, or contacting your local and state bar associations.
Nonprofit Credit Counselors help you sort through your bills, establish a budget, and set up payment plans with medical providers. The Department of Justice maintains a list of approved credit counseling agencies near you. http://www.justice.gov/ust/list-credit-counseling-agencies-approved-pursuant-11-usc-111
Medical Billing Advocates are private companies or individuals for hire that work with medical providers on your behalf to reduce bills. They help you find errors or overcharges in your medical bills, appeal coverage denials with your insurer, or negotiate lower fees with your medical provider. Although medical advocates can be expensive, often charging 30% of costs they recover or an hourly fee of $100 plus, in some cases it’s money well spent. The first consultation should be free and, then, the fee arrangement should be detailed in a formal written contract. To find medical billing advocates in your area (or by specialty), contact the Medical Billing Advocates of America at www.billadvocates.com.
Support Groups If your medical bills are related to a particular medical condition or disease, contact local support groups. Members of these groups (for example, cancer or diabetes support groups) often have lots of information on where to get financial assistance and how to navigate the complex health care system.
Filing bankruptcy may be an option to consider, however, do so very carefully; it will lower your credit rating for several years. And if you don’t qualify for the “clean slate” that Chapter 7 bankruptcy can provide, you may need to file for Chapter 13 bankruptcy. In that case, you’ll likely need to make payments towards a portion of all your debts (including medical bills) under a Chapter 13 “reorganization” plan. If you are considering bankruptcy, educate yourself about the pros and cons of filing and the differences between Chapter 7 and Chapter 13 bankruptcy
Healthwell Foundation http://www.healthwellfoundation.org/diseases-and-medications
Michigan State University http://staff.lib.msu.edu/harris23/grants/3medema.htm