Best way to pay a medical bill
March 23, 2017 11:13 AM Subscribe
I received a bill for ~$4000 for a surgery I had 8 weeks ago. (After insurance was applied.) I was laid off a few weeks ago and while I could pay the amount out of savings, I'm wondering if it's better to set up a payment plan with the hospital. I have never done this.
I assume they'll ask me how much I can contribute every month. I have no idea what to say. I am getting some severance pay but that will stop in a few weeks, then I'll have to apply for unemployment. At that point I'll be about 1.5x of FPL (federal poverty level) and I will have to use savings to supplement that in order to pay my bills.
In addition, I haven't gotten a bill from the anesthesiology group yet and I have no idea how much it will be, or if they're in network (if they are, it will be "free" since I've met my max out of pocket). I'm trying to get contact info for them.
If I don't qualify for a payment plan, my options are:
If it matters, I'm on COBRA with the same insurance company that covered the surgery.
I assume they'll ask me how much I can contribute every month. I have no idea what to say. I am getting some severance pay but that will stop in a few weeks, then I'll have to apply for unemployment. At that point I'll be about 1.5x of FPL (federal poverty level) and I will have to use savings to supplement that in order to pay my bills.
In addition, I haven't gotten a bill from the anesthesiology group yet and I have no idea how much it will be, or if they're in network (if they are, it will be "free" since I've met my max out of pocket). I'm trying to get contact info for them.
If I don't qualify for a payment plan, my options are:
- pay it out of savings, which will greatly affect my liquidityI know I don't qualify for their Financial Assistance Program because my provider is not covered. This is very clear in their documentation.
- get a loan from my 401k
- use CareCredit (I have already qualified for this amount, it's 0% for six months and then ridiculous afterwards)
- use a credit card, 16% interest (I already know this is dumb, but it is an option)
If it matters, I'm on COBRA with the same insurance company that covered the surgery.
I'd call and at the very least explain that you lost your job and need some help. I have heard that certain medical groups in Milwaukee are generally amenable to working with patients on this, as they'd rather get some sort of payment than nothing. It is worth a call at least.
posted by sulaine at 11:25 AM on March 23, 2017 [2 favorites]
posted by sulaine at 11:25 AM on March 23, 2017 [2 favorites]
Response by poster: Wait, they charge interest on hospital payment plans? Then I would just pay it with the care credit, and if I don't pay that off before the 0% interest period ends, pay the rest with my savings. I don't see how I could qualify for a 0% credit card without a job. My credit score is under 700.
posted by AFABulous at 11:26 AM on March 23, 2017 [3 favorites]
posted by AFABulous at 11:26 AM on March 23, 2017 [3 favorites]
I set up a payment plan with medical providers basically any time I get a bill larger than a few hundred dollars. As far as I can tell, there is literally no downside to this, as it's always been interest-free.
There has never been any qualification process I'm aware of; I just call up and say I can't afford to pay the full amount right now, but I can pay X amount per month, they tell me when and how to pay each month, and that's all there is to it.
posted by anderjen at 11:27 AM on March 23, 2017 [20 favorites]
There has never been any qualification process I'm aware of; I just call up and say I can't afford to pay the full amount right now, but I can pay X amount per month, they tell me when and how to pay each month, and that's all there is to it.
posted by anderjen at 11:27 AM on March 23, 2017 [20 favorites]
Ring them and ask them what options they have for payment plans. Don't mention you could pay it out of savings, do mention you were recently laid off. My hospital set up an interest free payment plan simply because I rang and asked and we were both employed. My plan is currently interest free for the life of the plan as long as I don't miss a payment, and the monthly payment they offered was less than I'd budgeted to pay them when I rang, your hospital may of course have different arrangements, but as you have other options if they say no it can't hurt to ask.
posted by wwax at 11:30 AM on March 23, 2017 [4 favorites]
posted by wwax at 11:30 AM on March 23, 2017 [4 favorites]
I have HUGE anxiety about medical bills. When I had to call my local hospital to set up paymeng plans for about $1000 of bills for myself and my infant son, they were SO reasonable. I paid $25 a month for each account (three separate accounts, not sure why they set it up that way, but whatever). It took over a year to pay off one of the bills and it was fine. They never bothered me for more money, though they did get huffy if they decided I was taking too long to pay since there wasn't a set due date each month. The billing lady asked me what I could pay on each and I was like, "$25?" and she was like, "Sounds great." There was no interest.
I wouldn't offer to pay the whole thing, but if you want to go this route, see if they will give you a discount for paying the whole thing. In my experience, they are pretty happy if you're paying at all.
posted by Aquifer at 11:30 AM on March 23, 2017 [4 favorites]
I wouldn't offer to pay the whole thing, but if you want to go this route, see if they will give you a discount for paying the whole thing. In my experience, they are pretty happy if you're paying at all.
posted by Aquifer at 11:30 AM on March 23, 2017 [4 favorites]
If this was with Aurora, they will make an affordable payment plan for you. I owed five figures after a c-section and a NICU stay (thanks, Governor Walker, for your awesome reforms, you giant pile of turds) and I'm currently paying that off at $150 a month...when I have a six figure salary.
posted by notjustthefish at 11:31 AM on March 23, 2017 [1 favorite]
posted by notjustthefish at 11:31 AM on March 23, 2017 [1 favorite]
I've never, ever paid interest with a hospital payment plan.
If they offer you a percentage of the bill off right up front, take a minute to do the calculations to see if going that way is better than doing a monthly thing.
They do stuff like this all the time. Don't sweat it, they're used to it.
posted by cooker girl at 11:39 AM on March 23, 2017 [1 favorite]
If they offer you a percentage of the bill off right up front, take a minute to do the calculations to see if going that way is better than doing a monthly thing.
They do stuff like this all the time. Don't sweat it, they're used to it.
posted by cooker girl at 11:39 AM on March 23, 2017 [1 favorite]
The hospitals in Boston that I've dealt with were all interest-free payment plans, and when I owed about $3,000 I called up the billing office and asked to pay $100 per month and they were fine with it. I just set the amount really low in case I needed the room in my budget, but I paid it off in less than a year (I was not unemployed). I would ask for whatever you feel comfortable paying.
posted by clone boulevard at 11:40 AM on March 23, 2017
posted by clone boulevard at 11:40 AM on March 23, 2017
I wouldn't pay a dollar towards this bill until I was employed.
If $4k is enough of your liquid savings to even notice, then covering this bill will leave you one unexpected expense from Broke, and two from Totally Fucked. Your anesthesiologist's second Ferrari fund can wait on that money for a little while longer.
posted by The Prawn Reproach at 11:53 AM on March 23, 2017 [3 favorites]
If $4k is enough of your liquid savings to even notice, then covering this bill will leave you one unexpected expense from Broke, and two from Totally Fucked. Your anesthesiologist's second Ferrari fund can wait on that money for a little while longer.
posted by The Prawn Reproach at 11:53 AM on March 23, 2017 [3 favorites]
Response by poster: The Prawn Reproach, that's not an option because they will send me to collections. I've been in collections for a $30 bill.
In case it makes any difference, some of you are assuming this is in Wisconsin, but it's in Illinois. I still live in Wisconsin.
posted by AFABulous at 11:56 AM on March 23, 2017 [1 favorite]
In case it makes any difference, some of you are assuming this is in Wisconsin, but it's in Illinois. I still live in Wisconsin.
posted by AFABulous at 11:56 AM on March 23, 2017 [1 favorite]
Anecdotally: my sister had a huge medical bill she couldn't pay, asked the hospital to accept $25 a month and they said yes. It took years to pay off but there was no interest. As long as she kept paying the $25 a month they never hassled her in any way during that period except to keep sending a bill each month.
posted by BlahLaLa at 11:59 AM on March 23, 2017 [4 favorites]
posted by BlahLaLa at 11:59 AM on March 23, 2017 [4 favorites]
I would be shocked if you are charged interest.
I currently have a 5 figure medical bill that is kept out of collections by my sending $10/mth. It depends on the hospital - some will just tell you to pay something more than $0 every month, some more formal. Anecdotally if you offer to pay ~50/mth I've never heard of a request for documentation of need at that amount.
posted by PMdixon at 12:01 PM on March 23, 2017
I currently have a 5 figure medical bill that is kept out of collections by my sending $10/mth. It depends on the hospital - some will just tell you to pay something more than $0 every month, some more formal. Anecdotally if you offer to pay ~50/mth I've never heard of a request for documentation of need at that amount.
posted by PMdixon at 12:01 PM on March 23, 2017
I had a hysterectomy in Illinois in 2014 and had 24 months to pay off my hospital bill before they started charging interest.
posted by princesspathos at 12:02 PM on March 23, 2017
posted by princesspathos at 12:02 PM on March 23, 2017
And I paid $100 or more per month and always paid on time.
posted by princesspathos at 12:03 PM on March 23, 2017
posted by princesspathos at 12:03 PM on March 23, 2017
Here is my previous advice I've given here and to many of my stressed out family and friends who've been dealt serious medical bills:
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.
posted by HeyAllie at 12:19 PM on March 23, 2017 [9 favorites]
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.
posted by HeyAllie at 12:19 PM on March 23, 2017 [9 favorites]
Also, don't *just* ask about payment plans, ask if there are any discounts you might qualify for. I had a hospital give me a 30% discount if I could pay in full right away. For that kind of discount, I did!
posted by dbmcd at 12:22 PM on March 23, 2017 [1 favorite]
posted by dbmcd at 12:22 PM on March 23, 2017 [1 favorite]
Anecdotally: my sister had a huge medical bill she couldn't pay, asked the hospital to accept $25 a month and they said yes. It took years to pay off but there was no interest. As long as she kept paying the $25 a month they never hassled her in any way during that period except to keep sending a bill each month.
When I worked in a billing office, I had the power to set up plans of this nature- no interest, pay as much or as little as you want. Once I put a guy on a $5 a month payment plan for a debt that was around $600-700- he was amazed we were willing to do that, but we were. Taking $5 a month and getting paid in full someday beats writing off a balance you never collect or paying somebody else to chase it. Definitely call the hospital and ask if there's an interest rate and if you can pay (small amount) monthly.
posted by ThePinkSuperhero at 12:23 PM on March 23, 2017 [4 favorites]
When I worked in a billing office, I had the power to set up plans of this nature- no interest, pay as much or as little as you want. Once I put a guy on a $5 a month payment plan for a debt that was around $600-700- he was amazed we were willing to do that, but we were. Taking $5 a month and getting paid in full someday beats writing off a balance you never collect or paying somebody else to chase it. Definitely call the hospital and ask if there's an interest rate and if you can pay (small amount) monthly.
posted by ThePinkSuperhero at 12:23 PM on March 23, 2017 [4 favorites]
Definitely work with the hospital on a payment plan. Because unemployed, offer to pay as little as possible. They will negotiate up to whatever is acceptable. Next, check the state laws for credit reporting. In some states, medical debt is not reported to the credit bureaus. If your state is a no-report state, make the first payment on the plan only (assuming you have interest-bearing debt or household expenses to pay for).
When you get hired, call the hospital and tell them you want to make a lump sum payment out of your first month of pay and get this bill paid off...but you can't pay off the whole thing because you have obligations to other creditors (assuming, again, that you do). Typically the hospital will negotiate a lump sum payment that is less than the original total, sometimes 50-75%. If the payment is past 90 days (120 in some areas), the debt may have been sold to a debt collector. They are more difficult but will also settle on a reduced amount generally.
posted by Kalatraz at 12:30 PM on March 23, 2017
When you get hired, call the hospital and tell them you want to make a lump sum payment out of your first month of pay and get this bill paid off...but you can't pay off the whole thing because you have obligations to other creditors (assuming, again, that you do). Typically the hospital will negotiate a lump sum payment that is less than the original total, sometimes 50-75%. If the payment is past 90 days (120 in some areas), the debt may have been sold to a debt collector. They are more difficult but will also settle on a reduced amount generally.
posted by Kalatraz at 12:30 PM on March 23, 2017
Care Credit with an early pay-off is, I'd agree, your best backup plan, but first you should make the hospital an offer. A friend who had had a heart attack told the hospital they could have $25/mo for the rest of her life. They replied that they needed $50/mo, she countered that that was too bad for them because it wasn't going to happen, and then they accepted the $25. I have no idea if that's how it usually goes but, really, they have every incentive to let you pay them whatever paltry amount you can instead of them getting nothing. It's not like they can repossess your surgery, after all, and all they can do is say "no" to your initial offer.
Once you're on unemployment, or if you're already on foodstamps, make sure they know that. I've had old hospital bills that had gone to collections cancelled out when they realized I was Officially Poor, so I have to think it counts for something even with a payment plan in place.
posted by teremala at 12:48 PM on March 23, 2017 [1 favorite]
Once you're on unemployment, or if you're already on foodstamps, make sure they know that. I've had old hospital bills that had gone to collections cancelled out when they realized I was Officially Poor, so I have to think it counts for something even with a payment plan in place.
posted by teremala at 12:48 PM on March 23, 2017 [1 favorite]
Care Credit with crazy interest against an unknown total you don't even have yet is highly unlikely to be a better deal than a 0%, $25 - $100 interest-free payment plan, which they are likely to give you as you are unemployed and without income.
posted by DarlingBri at 1:36 PM on March 23, 2017
posted by DarlingBri at 1:36 PM on March 23, 2017
It literally cannot hurt to ask! I would start the conversation with saying you are recently unemployed and then ask what your options are. You don't need to disclose the exact amount in your savings account! If they ask how much you can afford to pay per month, give a low starting number like $25 or $50 and see what they say. Obviously every hospital has different policies since this is not a legal thing they are required to do, but when my sister was in a similar situation, they did not charge her interest and they were willing to take a relatively small payment (can't remember exactly how much, but I know it was something she considered fairly reasonable for her situation).
posted by rainbowbrite at 3:31 PM on March 23, 2017
posted by rainbowbrite at 3:31 PM on March 23, 2017
Be aware that if you do pay with Care Credit, if you have not paid off the total amount within the loan time period, and I'm talking not a damn day late, you will be assessed the entire interest that would have accrued on the original loan amount *From Day One* at the obscene % rate...... You will NOT be paying interest only on the amount of the leftover balance going forward.
I hope you are on the mend, and that things look up for you jobwise soon.
posted by Jazz Hands at 4:03 PM on March 23, 2017 [4 favorites]
I hope you are on the mend, and that things look up for you jobwise soon.
posted by Jazz Hands at 4:03 PM on March 23, 2017 [4 favorites]
Also inquire with the billing company and doctor if the charge is correct. You'd be amazed at how rampant paperwork errors are. I just had a $2000 bill removed when I simply asked whether it was valid.
posted by Pacrand at 4:18 PM on March 23, 2017
posted by Pacrand at 4:18 PM on March 23, 2017
As you noted, liquidity when you are unemployed is of paramount importance. It is your self insurance. If it were me, and I have negotiated hospital bills from three different surgeries, I would call them and ask if they can explain the bill and validate the claim. Then tell them that you are willing to pay $xx or $xxx dollars per month. I would not talk about your ability to pay, just what you are proposing to pay. I would also offer something around 25 cents on the dollar if you could find a way to pay it all off now. If they agree, ask them to send you a letter stating they will accept whatever it is in full satisfaction of your bill.
(I hope your recovery is going or went well.)
posted by AugustWest at 4:57 PM on March 23, 2017
(I hope your recovery is going or went well.)
posted by AugustWest at 4:57 PM on March 23, 2017
I have no data to support this, but: hospitals & medical providers are so used to patients (often with inadequate insurance) who face large bills way outside their ability to pay within 90 days, many of whom take a very long time or never pay, that these small payment plans with little interest, and discounted prices, seem common. There's often a wide gap between the standard billing and the unmarked-up cost that might be acceptable payment.
Not to say people don't regularly get ruthlessly treated in collections. But the testimony above suggests there's a lot of room for negotiation.
posted by lathrop at 5:08 PM on March 23, 2017
Not to say people don't regularly get ruthlessly treated in collections. But the testimony above suggests there's a lot of room for negotiation.
posted by lathrop at 5:08 PM on March 23, 2017
Another vote for "payment plan." I've done this with success. They'll let you go to a pretty low monthly amount as long as you pay it each month.
You should also ask the billing person what the actual allowed amount would be with insurance. There's the "list price" ($4000), but nobody with insurance ever pays that. Every insurance has a "contractual" amount that they'll agree to pay, and it's usually much lower than the list price. You could ask the billing person to write off the difference. Billing people have a lot of flexibility, especially if they feel sorry for you.
True story: I called the billing dept of a major hospital to ask about a line item on a bill that I didn't understand. When looking through my account, she saw a $400 charge that they had never billed me for from 3 years ago! They had just screwed up and forgotten to bill me. She just casually said that she'd write it off since she didn't think it was fair to bill me three years later.
Also, same hospital system, I had a $1000 MRI charge that couldn't pay all at once, and they agreed to $100/month for 10 months. I just went online every month and paid.
posted by radioamy at 7:59 PM on March 23, 2017
You should also ask the billing person what the actual allowed amount would be with insurance. There's the "list price" ($4000), but nobody with insurance ever pays that. Every insurance has a "contractual" amount that they'll agree to pay, and it's usually much lower than the list price. You could ask the billing person to write off the difference. Billing people have a lot of flexibility, especially if they feel sorry for you.
True story: I called the billing dept of a major hospital to ask about a line item on a bill that I didn't understand. When looking through my account, she saw a $400 charge that they had never billed me for from 3 years ago! They had just screwed up and forgotten to bill me. She just casually said that she'd write it off since she didn't think it was fair to bill me three years later.
Also, same hospital system, I had a $1000 MRI charge that couldn't pay all at once, and they agreed to $100/month for 10 months. I just went online every month and paid.
posted by radioamy at 7:59 PM on March 23, 2017
Response by poster: You should also ask the billing person what the actual allowed amount would be with insurance. There's the "list price" ($4000), but nobody with insurance ever pays that. Every insurance has a "contractual" amount that they'll agree to pay, and it's usually much lower than the list price. You could ask the billing person to write off the difference.
This is confusing to me. My surgeon billed the insurance $26,000. They negotiated down much of that. I had a $2000 deductible, they paid 80% of the rest, and ~$4000 is what is left.
I know for a fact that if I'd paid out of pocket for the entire surgery, not going through insurance, it would have been $9800.
posted by AFABulous at 8:48 PM on March 23, 2017
This is confusing to me. My surgeon billed the insurance $26,000. They negotiated down much of that. I had a $2000 deductible, they paid 80% of the rest, and ~$4000 is what is left.
I know for a fact that if I'd paid out of pocket for the entire surgery, not going through insurance, it would have been $9800.
posted by AFABulous at 8:48 PM on March 23, 2017
I'm late to this BBQ, but IMHO: HeyAllie and PacRand above both offer *great* advice.
In my limited experience with this kind of thing, it's like the process seems to go round and round for 2 or 3 cycles before the figures converge on a final price. So there's some advantage to not rushing to pay.
And talking over the bill with the hospital/whoever is almost always a good idea. It is apparently quite common for medical bills to contain errors. Some say the figure may be as high as 80%(!). Imagine you're in the checkout lane at the grocery story, and there's a sign that says "80% of our tickets are incorrect".
I'm not an economist so I'm not sure how to express this in rigorous language, but: there is value in possessing (and holding on to) money for as long as possible. I know that there are arguments about interest rates and such and how you're better off paying the entire bill off at once. But pragmatically, if you can arrange a 0% payback plan for something like $50/month - do it.
Good luck with this.
posted by doctor tough love at 1:18 PM on March 24, 2017
In my limited experience with this kind of thing, it's like the process seems to go round and round for 2 or 3 cycles before the figures converge on a final price. So there's some advantage to not rushing to pay.
And talking over the bill with the hospital/whoever is almost always a good idea. It is apparently quite common for medical bills to contain errors. Some say the figure may be as high as 80%(!). Imagine you're in the checkout lane at the grocery story, and there's a sign that says "80% of our tickets are incorrect".
I'm not an economist so I'm not sure how to express this in rigorous language, but: there is value in possessing (and holding on to) money for as long as possible. I know that there are arguments about interest rates and such and how you're better off paying the entire bill off at once. But pragmatically, if you can arrange a 0% payback plan for something like $50/month - do it.
Good luck with this.
posted by doctor tough love at 1:18 PM on March 24, 2017
My surgeon billed the insurance $26,000. They negotiated down much of that. I had a $2000 deductible, they paid 80% of the rest, and ~$4000 is what is left.
Sounds like you are already paying your part of your insurance company's actual allowed amount, so radioamy's advice would not apply in this situation.
posted by ThePinkSuperhero at 2:56 PM on March 24, 2017
Sounds like you are already paying your part of your insurance company's actual allowed amount, so radioamy's advice would not apply in this situation.
posted by ThePinkSuperhero at 2:56 PM on March 24, 2017
Yeah!!!! Negotiate it down! Then, ask them if they discount for paying up front. See what their options are. The USA medical industry has inflated pricing due to amortizing for non-payers, and therefore will often be thrilled to give you an adjusted rate if they know you're committed to paying.
posted by semaphore at 9:05 AM on March 26, 2017
posted by semaphore at 9:05 AM on March 26, 2017
Response by poster: My hospital bill is on hold for 45 days while they determine whether I am eligible for financial assistance (because I am unemployed). They may or may not write some of it off, but whatever the final balance is, I can still set up a payment plan.
My anesthesia team was in network, so I only have to pay $226.28, which I will just pay right away so I don't have to think about it. *kermit flail*
posted by AFABulous at 1:20 PM on March 28, 2017
My anesthesia team was in network, so I only have to pay $226.28, which I will just pay right away so I don't have to think about it. *kermit flail*
posted by AFABulous at 1:20 PM on March 28, 2017
Response by poster: Update: after sending them proof of unemployment and enrollment in SNAP ("food stamps"), I just found out that they wrote off the whole thing! It took a couple back-and-forths to get them everything they wanted, but most of that was via fax or snail mail. They were very pleasant on the phone.
posted by AFABulous at 9:42 AM on July 24, 2017 [2 favorites]
posted by AFABulous at 9:42 AM on July 24, 2017 [2 favorites]
Really delighted for you. People are so afraid of medical debt because the bills are so high, but in truth it really is the lest scary debt because unlike most other debt, it is so negotiable.
posted by DarlingBri at 9:54 AM on July 24, 2017
posted by DarlingBri at 9:54 AM on July 24, 2017
This thread is closed to new comments.
Or apply for a new credit card with a low introductory rate, such as the Citi Diamond Preferred (0% on purchases for 21 months), assuming you could pay it off before the introductory rate expires.
posted by kindall at 11:22 AM on March 23, 2017