Is there assistance paying medical bills for people with insurance?
November 16, 2021 11:15 AM Subscribe
I have an extremely high deductible, which I just met. Now I pay 20% of the bills, instead of 100%. My medical situation will continue through to next year.
I'll need at least three surgeries. That means coming up with another high deductible, while still trying to cover the existing medical bills. I've looked to see if there are funds available, but it all seems to be for uninsured. I am fortunate and grateful to have insurance, but I was not prepared for this expense. I'm not in a situation financially where I have enough left over to cover these expenses and doubt I will be for quite some time. I am also grateful for the short term disability, but at this point I am getting 65% of my pay. My illnesses are covid-related, if that makes a difference, and my doctor calls it Long Haul Covid. Is there anywhere to get financial help? The stress of this, on top of medical issues, is just too much. Thank you!
I'll need at least three surgeries. That means coming up with another high deductible, while still trying to cover the existing medical bills. I've looked to see if there are funds available, but it all seems to be for uninsured. I am fortunate and grateful to have insurance, but I was not prepared for this expense. I'm not in a situation financially where I have enough left over to cover these expenses and doubt I will be for quite some time. I am also grateful for the short term disability, but at this point I am getting 65% of my pay. My illnesses are covid-related, if that makes a difference, and my doctor calls it Long Haul Covid. Is there anywhere to get financial help? The stress of this, on top of medical issues, is just too much. Thank you!
Have you spoken with the billing department of the medical provider you're working with? One of their jobs is to make sure things don't get to a point where you just stop paying your bills -- they likely have resources to assist such as payment plans or discounts, or like my current medical provider has a partnership with a bank for a loan to cover the service which can be paid over time (the assumption is you'll eventually stop having surgeries and then keep paying off the loan over years to come, at a not-great-but-not-horrible interest rate).
posted by AzraelBrown at 11:21 AM on November 16, 2021
posted by AzraelBrown at 11:21 AM on November 16, 2021
Have you spoken to the medical facility yet? Most have a ‘charity care’ program of sorts or at least a sliding scale based on your income. My parents have been in dozens of facilities over the past few years for cancer and all of them, big and small, had an income-based program and my parents qualified even with a decent income and insurance.
posted by youandiandaflame at 11:24 AM on November 16, 2021 [1 favorite]
posted by youandiandaflame at 11:24 AM on November 16, 2021 [1 favorite]
BTW, although this may be of only limited help, to the extent that your qualified medical expenses (this will usually exclude the actual insurance premiums paid pre-tax in an employer-sponsored plan) exceed 7.5% of your AGI, they are tax-deductible.
posted by praemunire at 11:52 AM on November 16, 2021
posted by praemunire at 11:52 AM on November 16, 2021
I agree that the best option, though not a great option in my experience, is to work with the billing department and/or charity care department at your hospital or provider.
Since you can anticipate hitting your deductible next year, (assuming at least 2 of your upcoming procedures will be in 2022) it may be financially advantageous to choose a low-deductible plan, assuming your employer offers one. It may also be worth looking on your state's ACA exchange even though you may not be eligible for subsidies if your employer offers qualifying coverage. Run your total costs through a couple of plans to see what has the lowest total out of pocket for you.
posted by gauche at 12:03 PM on November 16, 2021 [1 favorite]
Since you can anticipate hitting your deductible next year, (assuming at least 2 of your upcoming procedures will be in 2022) it may be financially advantageous to choose a low-deductible plan, assuming your employer offers one. It may also be worth looking on your state's ACA exchange even though you may not be eligible for subsidies if your employer offers qualifying coverage. Run your total costs through a couple of plans to see what has the lowest total out of pocket for you.
posted by gauche at 12:03 PM on November 16, 2021 [1 favorite]
OP mentioned "I've looked to see if there are funds available, but it all seems to be for uninsured." That sounds like they have indeed investigated charity care for their current provider.
In addition to looking into billing you might look into getting a second opinion on your treatment. There could be less expensive options somewhere else, or the same option but for a lower price (granted, getting an estimate for any kind of health procedure in the USA can be its own special hell). In that line have you investigated charity care options at other hospitals? When I was financially strapped and needed surgery I basically looked at the financial assistance and billing practices of every hospital within X miles and chose the most favorable one. Granted, this was in the pre-ACA era and I had no insurance, so I was not limited to in-network considerations nor did I have to go where a HMO directed me. But if shopping around is at all an option then do consider it.
posted by Anonymous at 4:04 PM on November 16, 2021
In addition to looking into billing you might look into getting a second opinion on your treatment. There could be less expensive options somewhere else, or the same option but for a lower price (granted, getting an estimate for any kind of health procedure in the USA can be its own special hell). In that line have you investigated charity care options at other hospitals? When I was financially strapped and needed surgery I basically looked at the financial assistance and billing practices of every hospital within X miles and chose the most favorable one. Granted, this was in the pre-ACA era and I had no insurance, so I was not limited to in-network considerations nor did I have to go where a HMO directed me. But if shopping around is at all an option then do consider it.
posted by Anonymous at 4:04 PM on November 16, 2021
This isn’t exactly an answer to your question, but have you looked at your out of pocket maximum? If you have a marketplace health insurance plan, the max should be around 8500; I believe most (all?) plans have an OOP max, though the amount may vary. Once you hit the OOP max, you pay nothing (except premiums) until it resets at the beginning of the next plan year.
Also, since your income is significantly lower at the moment, if you’re Medicaid expansion state, it’s worth looking at whether you now qualify for Medicaid. If you do qualify, you should be able to enroll immediately (no need to wait for open enrollment), and it may even be possible to get retroactive coverage of the past few months.
posted by insectosaurus at 5:16 PM on November 16, 2021 [1 favorite]
Also, since your income is significantly lower at the moment, if you’re Medicaid expansion state, it’s worth looking at whether you now qualify for Medicaid. If you do qualify, you should be able to enroll immediately (no need to wait for open enrollment), and it may even be possible to get retroactive coverage of the past few months.
posted by insectosaurus at 5:16 PM on November 16, 2021 [1 favorite]
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posted by cooker girl at 11:19 AM on November 16, 2021 [1 favorite]