I’ve never had more to be thankful for this Thanksgiving – I have my whole family. Six weeks ago, I almost didn’t. My 4 year-old caught the flu last month and required a visit to our rural ER. Unbeknownst to us, he was in critical condition with a collapsed lung and a cascading list of complications. Ultimately, he required helicopter transport to a larger hospital where he was admitted to the Pediatric ICU and released 4 days later. Although I am sifting through over $150,000 in medical bills, this Thanksgiving I’m lifting praise and thanksgiving that we still have our son.
When surprise medical bills suddenly take dominance over your financial life, it quite literally pays to understand your rights and your payment options. I’d like to share with you the knowledge I’m employing to navigate our flood of medical bills. First, I have come to expect billings errors. I review medical bills closely and request an itemized bill if I have questions. Keeping accurate records will help if I need to file a billing dispute.
If you are covered under group or individual health plans, the No Surprises Act protects you from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance services. While my provider and my insurer work to settle the $46,000 helicopter bill between each other, I know that I am only required to pay up to my out-of-pocket maximum for the policy year.
To avoid exceeding my out-of-pocket limit, I pay medical bills in the order the claims are filed with my insurance company – not in the order received through the mail. Insurance companies process claims in the order they are filed. If I pay a bill out of order and jump ahead, my insurer can’t help and chances are I will have to fight the provider for a refund. You can log into your health insurer’s online portal to see a chronological list of claims. I keep that list, along with accurate records of the bills I receive, and those I have paid. As I approach my out-of-pocket limit, I may face a $1,200 bill, but only have $500 left to reach my out-of-pocket limit. At that point, I will contact my insurer to compare records. They will likely ask me to contact the phone number on that bill (and possibly all remaining bills) and request the provider to resubmit the claims.
In all cases, cash is king and gives you negotiating power. This can be helpful if you do have insurance, but don’t expect to reach your out-of-pocket limit for the year. I personally have saved thousands of dollars on medical bills for something as routine as childbirth, simply by contacting the billing department of the service provider and asking “What discount can you offer if I pay in full?” You may be surprised with a substantial discount.
Be mindful of the implications of medical debt on your credit. Most healthcare providers don’t report to credit bureaus; your bill would likely be sold to a collection agency before appearing on your credit report. After the bill goes to collections, the three main credit bureaus provide a 365 day grace-period to resolve the debt before the collection account appears in your credit history. Utilize that grace period to work out a payment plan with the provider that works for your budget, or negotiate with the collector who can typically offer steeper discounts than providers.
When considering the lifelong impact of surprise medical costs on your long term financial plan, knowing your rights and your options can save you tens, possibly even hundreds of thousands of dollars. A CERTIFIED FINANCIAL PLANNER™ professional can help you understand the nuances of health insurance and develop a plan to pay off all types of debt. If you believe you have been wrongly billed, you may contact the Department of Health and Human Services (HHS) at: 1-800-985-3059 or visit www.cms.gov/nosurprises to learn more about your rights and your options.
Published in the Victoria Advocate
Hannah Gohmert is a CFP® professional and the Chief Compliance Officer of KMH Wealth Management, LLC.