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How do you negotiate a medical bill that you can not pay?

Getting sick or hurt enough to go to the emergency room feels terrible enough. What is almost so bad is the fear and the fear of waiting for the inevitable medical bill – the one that could risk getting you into the financial equivalent of the intensive care unit, especially if you do not pay on time.

For many people, that's one reason why there is such a strong desire to just put everything on a credit card and take care of it later – and that's the number one mistake, Dr. Carolyn McClanahan, a Physician Who Has Had a Certified Financial Planner Life Planning Partner in Jacksonville, Florida

First, you still have to deal with this guilt in one way or another, and the delay increases interest rates. If you're under stress in dealing with your medical debt, try not to panic ̵

1; in fact, you're doing your best to keep your emotions out, advises Caitlin Donovan, director of public relations and public affairs in Washington, DC. National Patient Advocacy .

Even if you're one in three out of ten Americans who do not have enough savings to cover their debts, there are still steps you can take to keep them from falling into the red. You should start here if you receive a hospital bill that you can not pay.

Make sure your statement is correct.

"Medical bills are known to be wrong," says McClanahan. And these mistakes are rarely made in your favor.

Invoices often come in an unencryptable amount, so call and ask for a single statement. Services are often listed by so-called CPT codes. Googling can tell you what those text strings stand for, says Donovan.

First, look for obvious errors – duplications and procedures that you definitely have not received (eg, a breast exam or catheterization). Another common mistake is paying for medications you brought home, McClanahan says.

Because it's difficult to know exactly what happened to you when you were hospitalized, mark everything you have questions about. Call the hospital billing department and ask for an explanation for ambiguous items. They demand that bugs be fixed, McClanahan says.

Make a note of the name of the person you spoke to on the way, and ask about the time it takes to receive the new explanation. Set a reminder on this date in your calendar and call back if you do not receive it. "Follow-up because someone can ignore it – and ignoring the bill could lead to debt collection," says McClanahan.

Contact your insurance company.

Obviously, this only applies if you are covered. If you do not have insurance, go straight to step 5. But if you have a plan that does not work out as you see fit, there's probably a reason, says Donovan. You may have deemed your procedure to be non-medically necessary or provided by a physician outside the network.

Call the Customer Service Manager on your card and ask briefly, "What would it do? be covered? "Donovan recommends. Some similar procedures have different CPT codes, and the accounting department can make changes and submit them to your insurer again. A hint from your doctor could prove that you really needed a specific treatment. "If it was outside the network, if it was an emergency, talk about how this might be your only option, or you had no option and ask them to take care of it," she says.

All this may require some patience and perseverance – but if you save thousands of dollars with it, it's worth it. Stay calm: "Consider this a contract dispute. Try to use your target language and get as much backup as possible, "says Donovan.


If the insurance company does not refuse despite your legitimate wishes, you can file an official complaint. As a rule, you may file two internal remedies that are decided by a person within the insurance company and one external review by a neutral expert, says Donovan, and understand the laws in your state. These include sample letters and instructions on supporting information, such as test results, reviewed journal articles, and notes from your doctor.

This process can be overwhelming – but often outside help is possible. If you have a chronic condition, you may be eligible for personal assistance from a PAF caseworker. For details, see the website of . Your state may also have a consumer assistance program .

This type of program can also inform you about your rights, Donovan points out. Aside from rejecting insurance claims, there is another reason why people are receiving large hospital bills because they are referred to as compensation bills – if a hospital bills you for the difference, what they decide and what your insurance will reimburse. It is now illegal in many states so that repelling can completely erase your bill.

Stay away from the collections.

If you do not pay an invoice by the due date, you risk having your debt sent to a collection agency. Avoid this, if at all possible – calls can quickly become relentless and the process can ruin your balance. Fortunately, the hospital has an incentive to postpone the transfer, as the collection agencies only pay them back a few cents from the dollar, McClanahan says.

While you are working with your insurance company on requests or appeals, you should keep the hospital's payroll office in the loop. Inform them in writing that you deny the validity of the debt, and why.

If you are sent to the collections during the opposition or the trial, you pay nothing – this is a concession You owe the debt, McClanahan says.


If your appeal is denied or you have no insurance, you still have options. Contact the billing, financial assistance or financial support office directly. These might be the same or have some other staff, so call and ask.

Many hospitals offer a kind of utility program. Depending on your income and circumstances, you may not qualify – but you never know until you ask, Donovan points out.

If you do not have a program that works for you, you should start negotiating. Remember that hospitals are constantly cutting contracts with insurance companies and the government. "They will send you the list price, and nobody should pay the list price," says McClanahan. "It's like buying a car, but it's worse."

You can pay a certain price – such as the In-Network or Medicare rate recommended by Donovan. Or you can name your own price: "Say your bill costs $ 20,000. Lowball they say, "I'm poor, I can afford only $ 3,000 and see what they say," says McClanahan.

Even if you do not lower your price as much as you like, ask for one You may be able to pay a small amount every month without interest. "As long as they know you are trying, they will not report you to collections," she says.

Seek external help.

Next to the hospital itself There may be other organizations that offer financial assistance.When you have a particular disease like Cancer disease-oriented organizations will often pay part of your bills.PAF has an Online National Financial Resources Directory and an App which may point out appropriate options.

Your church or other charitable non-profit community may be willing to help. One thing to note: Se Even if you can not find help for your medical expenses, you may be able to find resources that can be used in other bills, such as: B. at the property or during transit, are helpful. Donovan says it can save some money, which reduces hospital costs.

If all else fails, there are always crowdfunding sites like GoFundMe costs. "We somehow think that it's a tragedy in general that there are people in the American system who have to go to GoFundMe for their medical bills," says Donovan. "But if you have a big bill, you should take every opportunity you possibly have."

Take action next time to prevent this.

Given the complexity and lack of transparency in the healthcare system, it is difficult to avoid surprisingly large bills completely. If your illness or injury is likely to make you go to the hospital again, it is a good idea to take preventative measures.

The largest bills usually come when you leave the network. So start with open enrollment – carefully review your options and choose a health plan that includes the physicians and hospitals you want, says Donovan.

If you have time for a test or procedure, ask your insurer time to ask what is covered and what is not. If they say something is obscure, write it down. In this way, if you later reject your application, you will have support for an appeal.

When you arrive at the hospital, emphasize that you only want to see providers who are in your network – including doctors such as anesthetists and radiologists. Your lab work will be sent to an In-Network facility.

"I've heard of patients," says Donovan, "making a sign with a pen and paper, sticking it to the door in the hospital and saying, 'Do not come into this room unless you are in a network on Aetna, Anthem or Blue Cross Blue Shield.

And if all this sounds ridiculous, try to make a bigger difference in the system. Bring particularly outrageous hospital bills to a local or national journalist as well as to your elected representatives. "I'd like to encourage everyone to call their agents five minutes a week and say, 'Repair our crazy health care system,' says McClanahan.

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