Medical Debt Guide: How To Deal With High Medical Bills
North American Precis Syndicate
You may have more ways to pay for your medical care than you realize. (NAPS)
(NAPSI)—A comprehensive 2016 survey conducted by Kaiser Family
Foundation and The New York Times found that one in five (20 percent)
working-age Americans with health insurance and 53 percent of uninsured
Americans reported having problems with medical bills in the past year.
In fact, “being able to pay for the care I need” was the most
important characteristic of the health care system for 36 percent of the
respondents in the 5th Annual Transamerica Center for Health
Studies Consumer Healthcare Survey. In addition, nearly one in five (19
percent) Americans reported they were unable to afford routine health care
expenses in addition to their premiums.
Payments with Health Insurance
Patients are responsible for paying deductibles, co-insurance and
co-payments for health care services. Below are definitions of common terms
relating to cost-sharing for health care services including prescription drugs.
• Out-of-pocket costs: Expenses
for medical care that are not reimbursed by insurance.
• Deductibles: The amount
paid for covered medical care by the patient before the health insurance
provider begins to pay.
• Co-insurance: The
insurance company pays a specified percentage of medical care cost (often 70
or 80 percent).
• Co-payments: A fixed
dollar amount for covered medical care paid by the patient (often $15−$40
per service/prescription drug).
• Out-of-pocket maximum/limit:
The maximum amount the patient will have to pay for covered services in a
Health insurance plans with lower monthly premiums generally have higher
deductibles. Plans with higher monthly premiums generally have lower
In-Network vs. Out-of-Network
Health Care Providers
Health care providers are considered in-network if they have set rates
with the health insurer, which lessens costs for patient care. Providers that
are out-of-network have no contract with the health insurer. Check with the
insurance company to determine which providers are
in-network so the patient is not surprised with high medical bills for going
Under the Affordable Care Act, insurance companies are required to cover
out-of-network charges for medical emergencies. Insurance companies must
cover emergency care at the same cost sharing as at an in-network provider.
However, this can still leave the patient with large bills.
The following are common health insurance plan types:
• Exclusive Provider
Organization (EPO): Managed care plan with health care services covered
only when using doctors, hospitals and other providers within the plan’s
• Health Maintenance
Organization (HMO): Managed care plan that limits coverage to care from
doctors, hospitals and other providers who work for or have a contract with
the HMO. An HMO may require patients to live or work in its service area to
• Preferred Provider
Organization (PPO): Health insurance plan with lower costs when patient
uses doctors, hospitals and other providers in the plan’s network.
Out-of-network providers can be used without a referral but with additional
• Point of Service (POS):
A mix—like an HMO plan, the patient chooses an in-network primary care
physician who provides health care or referrals to specialists or other
providers. Like a PPO plan, out-of-network health services are permitted but
the patient pays more for those services.
• Fee for Service: A
traditional health insurance in which the health plan pays for medical
expenses based on fixed amounts or a percentage of cost. The patient chooses
the doctor, hospital or health service with no networks.
Options for Health Care Costs Without
Note that hospitals cannot deny care based on a patient’s inability
Care at a Federally Qualified
Individuals in need of primary or nonemergency
care who do not have insurance or may not have the ability to pay
out-of-pocket costs can seek care at a Federally Qualified Health Center
(FQHC). Nearly 1,400 health centers operate more than 11,000 service delivery
sites nationwide. Primary care services are provided based on ability to pay.
To find a Health Center, enter zip code at https://findahealthcenter.hrsa.gov.
Hospital Charity Care
Charity care can reduce or eliminate medical bills at a hospital if the
patient is unable to pay. There is typically an application process to
receive charity care and inability to pay must be proven through income,
assets and lack of insurance coverage, and it can be
applied for before hospital treatment.
Hospital No-Interest Payment Plan
Some patients may have an income that is too high to qualify for charity
care. However, if the patient still has high medical costs and is unable to
pay, the hospital may offer a low- or no-interest payment plan. This is an
alternative to using a credit card or borrowing money with a high interest
Ensure Bill Accuracy/Negotiate
Always check a medical bill for accuracy or billing errors before paying.
Call the billing department, usually listed on the bill itself, for
clarification. The hospital may also accept a lower amount for the bill if
the patient is unable to pay the full amount; patients are able to negotiate
a medical bill or the cost of treatment.
Medically Needy Medicaid Program
In some states, individuals who have high medical costs compared to their
income may qualify for the Medicaid Medically Needy program. The Medically
Needy program allows individuals to qualify for Medicaid (not Medicare)
coverage if they have high monthly medical expenses that reduce their income
to below their state’s Medicaid income limit. More information can be
found at www.TransamericaCenterforHealthStudies.org.
Asking friends, family and extended networks for help paying for medical
care can be expanded with websites like GoFundMe
and YouCaring. These crowdsourcing
websites let patients solicit donations for medical treatment online for a
fee of the amount that is donated (usually around 5 percent). Please note
that crowdfunding websites may not work for
everyone, with about 90 percent of donation campaigns failing to meet their
target amount. In addition, some churches and charity organizations assist
with medical expenses. Also, there are disease-specific charities such as the
American Kidney Fund and the Leukemia & Lymphoma Society.
Navigating health care insurance coverage and costs can be a daunting
process. Fortunately, there are various options available when it comes to
choosing coverage and paying for medical care costs.
health care insurance coverage and costs can be a daunting process. Fortunately,
there are various options available when it comes to choosing coverage and
paying for medical care costs. http://bit.ly/2utWVRv”
On the Net:North American Precis Syndicate, Inc.(NAPSI)