Large medical bill uncovered by insurance
April 20, 2012 3:09 PM   Subscribe

I thought my medical procedures would be covered by my school's health insurance, but I was terribly wrong. Now I owe more than $4000. Please help me calm down and think about possible options.

Due to some stomach problems, I had some medical procedures and tests done in February, including a colonoscopy under general anesthesia. I was under the impression that these would be covered by my school's health insurance -- but I was very, very wrong.

I received some statements from the insurance company, and it looks like I owe $4103.47 total; I do not have this money. What should I do? I contacted the company, but they are closed for the weekend.

I know that there is nothing I can do right now, but I'm worried and panicking. I tend to be anxiety-prone anyway, and having to wait until Monday is driving me crazy. I feel stupid for not opening these statements earlier -- they were issued in late March. I feel terrible, stupid, and really scared.

I have no idea how any of these things work. Will I be expected to pay for everything upfront? Are there ways of reducing the charges? I'm in New York, if that matters.

Thanks in advance.
posted by tickingclock to Law & Government (33 answers total) 2 users marked this as a favorite
Haha, I can't stop worrying. If the payments were amortized somehow and I managed to save $100/month on my grad student salary, it would still take me more than three years to pay it all back. :-(
posted by tickingclock at 3:12 PM on April 20, 2012

Does your school have an emergency needs fund?
posted by Neekee at 3:12 PM on April 20, 2012

You often have room to negotiate both price and payment schedule on medical procedures. If it had been covered, my guess is that the insurance company wouldn't be paying anywhere close to $4K. Why should you? Plus, appeal your insurance company's decision.
posted by Good Brain at 3:17 PM on April 20, 2012 [6 favorites]

And make sure it really wasn't covered... talk to the insurance company directly. I had medical bills that were 100% covered by my insurance, and the insurance company had actually paid them, but there was some sort of a paperwork glitch where I was billed. It took me calling every month for three months and having my insurance company send letters about three times to get it cleared up.
posted by kimdog at 3:24 PM on April 20, 2012

First you need to call your insurance company. They're nicer than you think they will be, and they will try to help you as best they can.

Secondly, you call the place your bill came from. Often times you can negotiate down with them, and get put on an interest free payment plan. They want their money, even if it takes a long time.

If you let these medical bills go to collection (worst case scenario), it will not look great for your credit score, but you're young, and you will bounce back even from that. And maybe in a few years, you'll be able to consolidate your debt and pay off the collections agency for less than what the bills are for.

It's very very intimidating dealing with these things, but just know that there are a lot of people in your position and worse, and many of them just shove the bills out of sight and out of mind. You are at least trying to come up with a solution, which is a huge step in the right direction.
posted by katypickle at 3:35 PM on April 20, 2012 [1 favorite]

Okay, this was me a year ago, terrified, horrified - $90,000 in medical bills, of which I had to cover $9,000 myself.

First, BREATHE. Wait until you actually receive a BILL from the hospitals / doctors / whatever. You might receive statements, but that means nothing until you receive a bill that shows what the insurance covered and what it didn't. In my case, I seemed to receive bills for several months afterwards.

Contact each "vendor" individually. Explain that you are not in a position to pay anything in full. Be nice. Be kind. It's okay if you cry a little. Just don't scream.

Ask if they can work with you to bring the bill down. In my case, I was able to negotiate pretty easily anywhere from a 15% to 50% markdown. If you are nice and calm, you'll be treated nice and calmly as well.

In almost every single case, I negotiated a monthly payment. Some as low as $10 a month, some as high as $150 a month. As soon as I paid the smaller bills off, I rolled over that payment to the next bill. The bonus? All the payments were INTEREST-FREE.

I am happy to say that within a year I PAID OFF ALL MY BILLS. Not a single red cent went on a credit card. It was hard, there were months when I ate a lot of spaghetti, but oh my god, am I proud of myself. Memail me if you have any questions.
posted by HeyAllie at 3:41 PM on April 20, 2012 [25 favorites]

There may be something or nothing you can do--but right know I would work on decatastrophizing the event.No matter what you fear nothing terrible will happen--I would imagine the worst thing that can happen is you might get turned over to a collection company and your credit rating will be compromised. Realistically, healthcare providers are used to people not being able to pay their bills. On Monday call the insurance company and walk through the coverage, check the appeals process (if appropriate). For example, if the policy clearly excludes this type of procedure or you have a minimum deductible you will not be covered--if it was not an approved provider you might win on appeal. If it is reasonable clear that these services are not covered call the provider and explain the situation. They ( or their agent) will probably want to work with you. Even if you only pay $25.00 per month for two years and then increase payments they may work with you.Remember, it is not a matter of immediately coming up with $4,000.00 but a matter of working 10 hours a month at $10.00 per hour in a crappy job you hate. Do not panic and make agreements you may later regret ( for example--finance it through a second party loan etc.) Panic if you will but this is not the end of the world, the worst thing that will ever happen to you and on a cosmic level it is an inconvenience. This is a problem that can be solved with patience, information and focus. It is in every bodies self interest to solve this problem. Good Luck
posted by rmhsinc at 3:41 PM on April 20, 2012 [1 favorite]

I forgot to mention the obvious - the advice I got from Mefites here on that anonymous AskMe was invaluable. I owe you all a thousand hugs.
posted by HeyAllie at 3:42 PM on April 20, 2012 [2 favorites]

Forgot--Excellent point about negotiating bill. You charge is a retailcharge which the provider seldom collects. HeyAllie is right on target.
posted by rmhsinc at 3:43 PM on April 20, 2012

First, what HeyAllie said.

I received some statements from the insurance company, and it looks like I owe $4103.47 total.

Second, insurance statements are not bills, and they might be misinformed. The real bill will come from the medical provider's office. I'm guessing your statements from your insurance statements say something like "Your Responsibility: $4103.47" or something like that. Call up your insurance company and clarify, and then wait for the bill from the medical provider and see what it says. Then do what HeyAllie did.
posted by jabberjaw at 3:58 PM on April 20, 2012 [2 favorites]

Also, anesthesia is a big flag to me. Do you have United Healthcare by any chance? I do not understand it completely myself, but I had surgery a few years ago while under UHC and what I came to understand then was that all anesthesiologists were out of network for UHC. So they wouldn't submit their bill to the insurance; it came directly to me. Huge bill. But I just sent it to the insurance and the insurance in turn sent me a huge check to send to the anesthesiologist. Seemed like a big mess for nothing.

Then, the insurance sent me a letter a few weeks later saying they wanted their money back. That I had already sent to the anesth. ????!? When I called them, it turned out they had written me the check from the wrong dept or something, and they had to reissue it. I still don't know what the reason was. So I had to send them back a check, and they sent me another check. Cuz I had thousands of extra dollars sitting around while checks clear.

The morale of my story is that there is something goofy with UHC and possibly other ins. cos. and anesthesiology coverage, and insurance companies require ridiculous things. Resign yourself to this, rather than worrying about it. Take good notes when you talk to them on Monday and you will get through the ridiculousness of it all. Good luck; your health is worth all this garbage, but it's too bad you can't be healthy without it.
posted by Tandem Affinity at 4:00 PM on April 20, 2012 [2 favorites]

Hi Tickingclock. I "nth" what HeyAllie said. Please don't take the following as minimizing your situation - I just have another perspective to help you decatastophize it. I was in a similar situation, in the ER and misdiagnosed... long story short, charged $13,000 for that 15-hour ER visit with no real "procedure" done except a simple scan. The total bill put me waaaay over the edge of what I could afford monthly (and yes, I tried desperately to work it out with the hospital). In the end, I ended up declaring bankruptcy over it. At the time, I was unemployed & had no health insurance. In your case, $4,000 is very expensive to you, but as medical expenses go (compared to others on average) -$4K is not that bad.

I'm sure that the hospital will work with you, as will the insurance company. They are nicer than you think, in most cases - and if someone is rude, you can always call back and speak to someone else. I know how it feel to be buried in debt that you feel you can't get out of, but it helps to hear how others have struggled too. In my case, when I called the hospital to try to negotiate, the woman on the other end of the line was so sweet and understanding because SHE had experienced a similar situation - except HER bill was $27,000. In a weird way, knowing what her experience was helped me put it in perspective. Like, as in, "I'm not the only one who goes through this."

Rest easy if you can. My feelings around the high bill were shame and guilt over being sick and not being able to care for myself (i.e. not having health insurance). But at the end of the day, health care is a right not a privilege. You shouldn't have to starve to pay medical bills, or lose sleep over racking them up. Kudos to you for seeking the care you needed. As for the finances, trust me - it all works out in the end.
posted by luciddream928 at 4:13 PM on April 20, 2012 [1 favorite]

The worst case is you're like me and you let it go to collections. They send you collections demands for awhile. Then when you someday have enough money, you negotiate a much lower payment, and it goes on your credit for a little while, and then eventually, it disappears. No big deal. Don't panic. No one will hate you if it takes awhile--medical bill default is the most guilt-free of them all.

But of course, the mature thing to do is once it all settles out and the bills become clear, from your health care provider, you go in and negotiate payments. They will work with you.
posted by RedEmma at 4:32 PM on April 20, 2012

definitely talk to the hospital. the one we had to deal with had "poor people" number to call (i can't remember the name of it, but it was the different line you call when you're in dire straights and need assistance). with almost no hassle at all, our bill was reduced by 50% and we got a monthly payment plan.

it will be okay. i promise.
posted by misanthropicsarah at 4:33 PM on April 20, 2012

Nthing that you can likely get your total reduced by negotiating with each vendor. I had a procedure when I was unemployed that I absolutely could not even begin to pay the bill for. I called up the hospital, and they asked me to submit paperwork demonstrating my financial need. A while later I got a revised bill - for $0. The entire thing had been paid for under some scholarship (for lack of a better word). I am in Washington state, and I suspect that it was a state thing, as we tend to be godless commies here. I don't know about New York, but it's still totally worth negotiating. I think vendors would usually rather be paid *something* rather than having you go bankrupt and they get potentially nothing at all. So if that's a real possibility in your case, don't be hesitant to mention it to those you speak with.
posted by parrot_person at 5:02 PM on April 20, 2012

One other bit of advice: be sure you talk to the insurance rep about how this procedure was classified. Sometimes a procedure can be classified in one of several ways, and the classification may make all the difference when it comes to actual coverage.

Personal case in point: I had a cracked tooth and needed an emergency root canal. However, once the endodontist began performing the root canal he discovered that the tooth was cracked too deep to justify a root canal (i.e., it needed to be extracted, which meant a referral to different endodontist specializing in extractions) and he wasn't able to complete the root canal. And although my insurance provided for a root canal, they did not provide coverage for an unsuccessful (and thus incomplete) root canal. FML! It took a few go-rounds with both the endodontist's office and the insurance provider to find a way to classify the procedure so that the insurance provider would cover it under my policy. So reclassification of your procedure may be another avenue to explore if it comes to it.

Regardless, don't panic. The money aspect of this will work itself out, and the net cost to you will be a lot less than the gross cost you quote above.
posted by mosk at 5:10 PM on April 20, 2012

FWIW, my company has a benefits advisor or health care advocate that handles all questions like this. They act as my intermediary both to try to get things straightened out and to explain things so I can understand them. I don't know if your employer does, of course, but sometimes (such as my case) the advisor program will advise for my family also. Just a thought.
posted by forthright at 5:58 PM on April 20, 2012

This is going to sound lame, but insurance statements are goddamn confusing. It's very possible that this may not be what you owe. Do you have someone older and wiser who can go over these statements with you? Everyone struggles through this process for the first time.
posted by samthemander at 6:23 PM on April 20, 2012

In addition to talking to your insurance company and the providers, I'd recommend talking to whoever at your school handles the health insurance to try to get some help. That office might be part of the student health clinic or it might be separate, but they should be used to advising students in exactly these kinds of situations. Maybe try to talk to them first on Monday before you start calling doctors and insurance companies?
posted by zachlipton at 7:31 PM on April 20, 2012

Thank you so much for your replies, everyone. It makes me feel a lot better, knowing that other people have been in a similar or worse situation and have gotten out of it.

Looking at my statements again, I confirmed that:

1) They are, indeed, not bills.
2) There are summary tables on the statements that explicitly outline how much has been covered by the insurance plan, and how much is not covered. The $4k quote above is the sum of "Not Covered" fields -- so, I think I might actually owe that much. Still not 100% sure, though.

I think my current plan of attack is to:
- Find out if my university has a benefits advisor that I can talk to
   - Find out if I quality for my university's medical emergency fund (apparently we have one!)
- Call the insurance company and check that Not Covered indeed means that I owe that sum
- Wait until I get billed, then negotiate...
   - the amount owed
   - the payment plan
- Not panic [extra important]

One possibly complicating factor is that I am not a US citizen, and only moved here in September. I have no US credit history, so I'm not sure of what would happen if the bills went to collection. Will I start with a negative credit score when I do get a US credit card? Will I be thrown out of my program? Will I be thrown out of the country? The latter two seem unlikely, but I guess I just don't know what to expect.

I feel a lot calmer, and as though I can tackle this situation. Again, it's good to know that others have been in this situation and that there are options. Thank you.

Oh, and, HeyAllie, congratulations on paying off all your bills! Here is a giant Internet-stranger hug to you!
posted by tickingclock at 7:39 PM on April 20, 2012

Something to keep in the back of your mind as you dispute or negotiate is that, at least in the US, doctors are VERY patient about getting their money, as long as you are paying something. So don't just ignore the bills for fear of the big number at the bottom. I just finished paying off 3K in medical bills in $25 chunks, myself.
posted by Ys at 7:50 PM on April 20, 2012

luciddream928: But at the end of the day, health care is a right not a privilege. You shouldn't have to starve to pay medical bills, or lose sleep over racking them up.

I appreciate this. Earlier, I was beating myself up for having the tests done, when in the end, I turned out to be healthy and the symptoms mysteriously disappeared on their own. "Why didn't I just stick it out for a few weeks?" and so on. But now, I think that the results of the tests are irrelevant -- health care should be available, no matter what.

Thanks again.
posted by tickingclock at 7:57 PM on April 20, 2012

Probably a good idea to find out about the university emergency fund now, since it can take a while to get those things rolling, but I don't think I'd start calling the hospital or insurance until you receive an actual bill that says "pay this amount" ... And here's why:

Mom had a minor surgery two years ago in a hospital by a doctor who was not a part of the hospital staff. For months on end, we received statements from the hospital, the anesthesiologist, the doctor's office, and the insurance company with a wide variety of changing "you're responsible for" amounts.

Like you, we panicked when the first batch arrived, because some if the numbers were quite large. I called all the various offices and no one could really tell me much at all, because apparently the paperwork was still flying back and forth and nothing was settled on who was paying what (or seemingly what anything would end up costing in one case). Any information you are likely to get will either be the same as what's on the most current statement or it may even be completely different ... and still not be the amount you will end up being expected to pay.

Waiting for the final bill to arrive before trying to find out what you will need to pay (or before attempting to negotiate) may save you weeks of panicking needlessly.
posted by Orb at 8:02 PM on April 20, 2012

One possibly complicating factor is that I am not a US citizen, and only moved here in September. I have no US credit history, so I'm not sure of what would happen if the bills went to collection.

If you are on a payment plan, you will not go to collections and your credit will not be dinged. Don't worry about if the hospital will extend you credit because you have no credit history; they already have extended you credit by treating you, and they must and will negotiate a plan with you to get their money. Hospitals are very, very, very used to dealing with people in exactly your position, don't sweat it!
posted by DarlingBri at 8:13 PM on April 20, 2012 [1 favorite]

(Also, I know it's horrifying, but find some kind of perverse calm in knowing that this is in fact not a large hospital bill; it's a relatively small one as these things go. You'll be fine, they'll be fine, it will all eventually get to fine!)
posted by DarlingBri at 8:15 PM on April 20, 2012

Most hospitals in CA have patient assistance programs. I would call the hospital after you clear up everything with the insurance and get the bill lowered. You fill out an application and explain why you need the help, being a student and a foreigner has to count as extenuating circumstances. My bill was cut 50%. I bet this is true for most hospitals in most states.

Being sent to collections for medical bills is not really that big a problem. Just make them do everything in writing if it gets to that point. You don't want to have to repeatedly deal with them on the phone. They can be assholes. Offer them what you can truly afford to pay and no more. The reason I mention being sent to collections is because my experience with owing a large medical bill was that even though I had a payment plan I was sent to collections after six months because the vendor sold the debt.
posted by cairnoflore at 9:06 PM on April 20, 2012

In my experience with student insurance, it is routine for your insurance to deny full coverage for a large bill, at least once, maybe twice, before they actually pay it. You'll need to be very patient and make a lot of calls and spend a lot of time on hold and ask a lot of questions and then make a lot of follow up calls, but it may work out that you don't actually owe any of this money. Two summers ago my student insurance denied a claim for $25,000 for a hospital visit. I thought my life was over. But a YEAR later, it was all worked out and I ended up owing about $85 total. Good luck!
posted by sunnichka at 8:46 AM on April 21, 2012

Insurance companies absolutely do deny claims that they should cover. All of the time. It's happened to me repeatedly with several different companies; it's an industry-wide problem. It could just be sloppy accounting, or it could be a deliberate attempt to get you to pay more than you should owe. The health insurance payment process is byzantine on purpose; the insurance companies are in the business of making money, not helping people; they want their customers to get confused and scared and give up and pay more than they owe.

So follow everyone's advice and call the insurance company and make sure they did not make a mistake. Don't trust what the first person you talk to says. You should read whatever information you can get on what your plan covers and be armed before you call with as much evidence as you can muster in your favor. You may have to call four or five times. You may have to send a written letter.

The doctors you saw will absolutely expect that there will be problems with your insurance because this happens all the time -- all the time. So call them too and explain that you are disputing the insurance payments. Hopefully they will be nice about it. As others have mentioned, they may even be willing to negotiate a discount on your bill. Medical bills in the U.S. are in fact artificially inflated by hospitals and doctors on purpose because the insurance companies are so awful about paying well and on time. But usually doctors who charge $50 for a needle or $5 for a single alcohol wipe are trying to stick it to the insurance companies, not patients who can't really afford to pay.

In addition to your school's emergency medical expenses fund, if some of your procedures were done at a hospital, there may be a charity fund there you can apply for aid from.

I know this is awful, but you will get through this, even if you're stuck with the full bill. You're not likely to get kicked out of the country. I don't know many natural born American citizens who have made it to middle age without at least once having been faced with a big fat ugly medical debt.

I myself had my student insurance fail to pay for emergency surgery when I was a totally broke (like, literally, working two jobs, no support from parents, couldn't afford a car, regularly going hungry broke) 21-year-old college student. I was faced with a $25,000 bill. At the time it seemed so overwhelming that the first thing I said when I saw the bill was "I wish the hospital had just let me die!"

But that was a stupid thought. I survived the bills and you will, too. Just keep reminding yourself that this system is fundamentally broken, this debt is not your fault, and your health is worth fighting for.
posted by BlueJae at 9:12 AM on April 21, 2012

Some hospitals have programs, for people who are low-income, that will pay for everything. Check to see if your hospital has a program like that.
posted by cass at 9:19 AM on April 21, 2012

2) There are summary tables on the statements that explicitly outline how much has been covered by the insurance plan, and how much is not covered. The $4k quote above is the sum of "Not Covered" fields -- so, I think I might actually owe that much. Still not 100% sure, though.

I get this on mine too. Here is basically how it works: the procedure is billed at $4000. The insurance company says they will pay $1500. You get a "bill" that says you owe $2500. But it's not really a bill. When you actually get the bill, there will be another line that subtracts out some portion of that $2500, and you'll maybe owe say $500. So you send them $25 a month and don't sweat it. My basic rule of thumb is that I never pay the first bill I get for medical stuff. They are almost always lower the next month.

The most freeing thing I learned is that the only bills that you absolutely HAVE to pay in full are loans and credit card minimums. Not paying the right amount on those will get you into trouble fast. But everything else is fair game. As long as you make regular payments and don't let the balance trend upward over time, you will be fine. They might asses a late fee, and you use the cost of the late fee to determine which one to pay the most on.

So after all the negotiating and begging is done, just pay them something every month and you will be fine.
posted by gjc at 9:24 AM on April 21, 2012

Do not even begin to worry about owing this money until and if a) you have received a bill, b) the bill establishes that the procedures weren't covered, c) you have appealed the denial of coverage in consultation with the person in charge of managing insurance coverage for your school (who may know secret ways to recode and resubmit the claim so it will go through, or who may just bully the insurer into accepting the claim as the administrator of a large subscriber), and d) the appeal has been denied.

THEN you move on to negotiating with the hospital or clinic. But first try to get the insurer to pay.
posted by Sidhedevil at 9:42 AM on April 21, 2012

And the chances are that someone coded the claim wrong, particularly as it was a colonoscopy. There are different codes for prophylactic colonoscopies and doctor-ordered colonoscopies. It would be unlikely for an insurer to pay for a prophylactic colonoscopy for someone under 50, but a diagnostic colonoscopy ordered by a doctor on the basis of troubling symptoms absolutely should be covered (I don't mean morally "should be," here, but "is likely to be.")
posted by Sidhedevil at 9:49 AM on April 21, 2012

Seconding gjc: in my experience, the "not covered amount" shown on the explanation of benefits (EOB) from the insurance company is not the amount you personally owe.

On EOBs I have received from various insurance companies over the years, the "not covered amount" appears to be the difference between the provider's list price for the procedure and the amount that insurance company allows to be charged for it.

When the provider issues an actual bill to you, it will show the list price, minus the insurance company payment, and also minus some kind of discount/write off amount due to the agreements the provider made with the insurance company when they signed up to accept that insurance.

Also, if the EOB you have is like the ones I am familiar with, there is usually an amount labelled "patient responsibility" (or something like that), which is the actual amount the insurer expects the provider is going to bill you for. If that amount is high, still no reason to panic, because as others have noted, there are many reasons it can be in error, and even if it is correct, you have many options.
posted by superna at 4:33 PM on April 21, 2012 [2 favorites]

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