Medical Bills and Debt Collection

 $88 billion of outstanding medical bills are currently in collections - affecting one in five Americans. 

My own academic research at Utah State University and that of University of Utah Economics Ph.D. Levi Pace revealed that medical bills were a major cause of personal bankruptcy filings in Utah. Similar research in other states confirm our findings.

Medical bills can be confusing and overwhelming and often come at a time when you may already be in distress. You might feel like you’re navigating a winding maze of information just to understand what you owe, to whom, and by when.

Help is available from the U.S. Consumer Financial Protection Bureau https://www.consumerfinance.gov/.

• Know your rights and protections when it comes to medical bills and collections
• Find out if you are getting the help with your medical bills you are entitled to?
• Understand how to navigate medical bills

The White House also released a fact sheet on The Biden Administration’s new actions to lessen the burden of medical debt and increase consumer protection.

Medical billing, collections and credit reporting can hurt people when they are already struggling with a health crisis. The CFPB is on your side to make sure you are treated fairly.

Learn more about how the CFPB is working to stop unfair medical debt collection and coercive credit reporting practices.

 The Consumer Financial Protection Bureau has a LOTS of other helpful consumer information on its website: https://www.consumerfinance.gov/.

 

 

What is a fair price to pay for health care and hospital bills? What if you are a victim of overcharges?

 You may have heard stories of how hospitals charge vastly different prices depending on whether a patient is insured or not and who their insurance company is. You may also have heard that cash payers can negotiate LARGE reductions in prices if they pay cash up front. It's all true and it's all symptomatic of our absurd, unfriendly to consumers health care system. 

In his book Never Pay the First Bill and other ways to fight the health care system and win, author Marshall Allen explains how to shop for hospital prices for elective procedures before hand and how to fight extremely overpriced hospital bills after the fact. Two websites Allen recommends:

HealthCare Bluebook: https://www.healthcarebluebook.com

Explore the quality and cost of healthcare:  search for and compare the quality and cost of nearby providers.

Help lower medical benefits spend and improve the quality of care.

and 

Fair Health Consumer: https://www.fairhealthconsumer.org/

Estimate your healthcare expenses.

Get essential information on costs for thousands of procedures and learn insurance basics.

Search for Medical and Hospital Costs

Search for Dental Costs 

Find cost estimates for common services that you can schedule in advance at hospitals and hospital systems

What if you are facing unreasonable or unaffordable medical bills? There are companies that will help you challenge bills and when they succeed in saving you money they take a percentage of the savings. 

Medliminal https://medliminal.com/ is "Leading the Charge Against Medical Billing Errors"

"Over 90% of medical bills contain overcharges, costing the US an estimated $67 billion. At Medliminal, we specialize in medical cost containment. Our clients get focused and innovative solutions and services that reduce healthcare costs for all payers."

The Leading Edge of Medical Cost Containment:

"Companies and employees are both overspending on healthcare due to billing errors. Medliminal helps all payers identify and negotiate down inflated medical costs."

Medliminal will review charges ahead of payment as well as identifying overcharges and  helping you get reimbursed after payment.

Other resources from Marshall Allen's book: 

 "Paying too much for health care? Use Clinic Price Check to save hundreds to thousands by comparing prices of medical services at local health providers." https://www.clinicpricecheck.com/

National Association of Health Care Advocacy: https://www.nahac.com/ 

Find an Independent Health or Patient Advocate or Care Manager to improve your outcomes from the health care system. https://advoconnection.com/

A Podcast: An Arm and a Leg: A show about the cost of health care that's more entertaining, empowering, and occasionally useful than enraging, and terrifying and depressing.  https://armandalegshow.com/

 

Never pay the first medical bill and how to negotiate the billing system

Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

Never pay the first bill : and other ways to fight the health care system and win

by Allen, Marshall (Journalist), author.

ISBN:9780593190005

Abstract:

"From award-winning ProPublica reporter Marshall Allen, a primer for anyone who wants to fight the predatory health care system--and win. Every year, millions of Americans are overcharged and underserved while the health care industry makes record profits. We know something is wrong, but the layers of bureaucracy designed to discourage complaints make pushing back seem impossible. At least, this is what the health care power players want you to think. Never Pay the First Bill is the guerilla guide to health care the American people and employers need. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen shows how companies and individuals have managed to force medical providers to play fair, and shows how you can, too. He reveals the industry's pressure points and how companies and individuals have fought overbilling, price gouging, insurance denials, and more to get the care they deserve. Laying out a practical plan for protecting yourself against the system's predatory practices, Allen offers the inspiration you need and tried-and-true strategies such as: Analyze and contest your medical bills, so you don't pay more than you should; obtain the billing codes for a procedure in advance; write in an appropriate treatment clause before signing financial documents; get your way by suing in small claims court. Few politicians and CEOs have been willing to stand up to the medical industry. It is up to the American people to equip ourselves to fight back for the sake of our families--and everyone else"-- Provided by publisher.

 

My nephew was hit by a pickup truck in South Carolina while on a bike tour. Luckily this driver stopped and had insurance and admitted fault. The hit and run driver in Raleigh, N.C. never stopped. Luckily my nephew wasn't seriously hurt by the hit and run driver but sustained extensive damage to his bike which delayed his trip and cost him out of pocket. The South Carolina accident put him in the hospital. He has medical insurance but as part of the saga I'm learning a lot about how our medical billing system works. My nephew has engaged an attorney on a contingency basis to deal with his hospital bills and expenses of repairing his bike and transportation cost back home. 

Listen to an interview (47:28) with the award winning author: https://www.kalw.org/show/your-call/2021-09-23/never-pay-the-first-bill

Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, and investigative health reporter who most recently covered the health care industry at ProPublica. Marshall teaches investigative reporting at the Newmark Graduate School of Journalism at CUNY 

Additional Resources for Consumers to determine the fair cost to pay for medical services: 

HealthCareBlueBook: https://www.healthcarebluebook.com

FairHealthConsumers: https://www.fairhealthconsumer.org/

 

Home Modifications Covered by Medicare and Medicaid

"Walk-in tubs, hospital beds and wheelchair ramps are among the many home modifications and devices keeping seniors safe. They don’t come cheap, but government programs such as Medicare and Medicaid can defray the cost."

"Medicare is extremely strict about what it covers, but seniors who show medical necessity qualify for up to 80% coverage. Seniors using their hospice care benefit don’t have to pay anything for covered equipment. Meanwhile, a few Medicare Advantage plans offer limited support for home modifications."

"Medicaid is more flexible, with many programs routinely offering medication dispensers and personal emergency response services."

Get the details at: https://www.theseniorlist.com/research/medicare-benefits-home-improvements/

 

Losing your privacy through medical data smart phone apps

As a Wall Street Journal reader I am reminded almost daily of the loss of privacy linked to the use of computers, smart phones, and other technology. Facebook is one of the worst offenders.
But now Natasha Singer, writing in The New York Times reveals the perils of smart phone apps for medical data.

"Americans may soon be able to get their medical records through smartphone apps as easily as they order takeout food from Seamless or catch a ride from Lyft."

"But prominent medical organizations are warning that patient data-sharing with apps could facilitate invasions of privacy — and they are fighting the change."

The American Medical Association is warning that patients "who authorized consumer apps to retrieve their medical records could open themselves up to serious data abuses. Federal privacy protections, which limit how health providers and insurers may use and share medical records, no longer apply once patients transfer their data to consumer apps."

So think twice before signing up to get your medical info on your smart phone. 

Get help paying for prescription drugs

"Consumers are powerless to control spiraling medication prices, but low-income, uninsured and under-insured individuals can often get help paying for their drugs.
The help, in the form of subsidies or prescription price reductions, comes from four sources. The first is exclusively for seniors on Medicare, but the rest are available to everyone."
1. Medicare’s Extra Help program
2. Price discounts in an app
3. Drug company discounts
4. Pharmacies will negotiate prices  
Get the details from the Squared Away Blog:
https://squaredawayblog.bc.edu/feature/drug-discounts-other-help-available/

Change in medical expense federal tax deduction for 2018

The threshold for claiming the medical-expense deduction is 7.5% of adjusted gross income for 2017 and 2018, potentially letting more people qualify.   Sarah O'Brien explains

• A taxpayer with adjusted gross income of $50,000 would need a minimum of $3,750 in medical expenses to reach the temporary 7.5 percent threshold. That compares with $5,000 — $1,250 more — at a 10 percent floor, which will be in effect in 2019.
• About 8.8 million taxpayers used the deduction in 2015, saving themselves an aggregate $86.9 billion.
• Some qualifying expenses are more easily overlooked, including the cost of getting you and your dependents to doctor's appointments and the like.

BUT... and this is a BIG "BUT" due to the increase in the standard deduction, far fewer taxpapers will itemize their deductions.  For 2018 the standard deduction has nearly doubled for all taxpayers. The 2018 standard deduction for married couples filing jointly is $24,000, up from $12,700 in 2017. So, unless the total of all deductions exceeds $24,000, there is no benefit to itemizing. And even if your deductions exceed the SD, you only benefit from the amount in excess of the SD. And with lower tax rates of 10-12% for most taxpayers, the amount you save by itemizing is lower than in the past.
Read full article at: https://www.cnbc.com/2018/03/20/the-medical-expense-deduction-is-lower-for-2017-and-2018.html

Inpatient or Outpatient? The classification really matters!

A "patient can be in a hospital for several days under observation, without being formally admitted by a doctor. The stay is considered outpatient care and can include emergency department services, observation services, outpatient surgery, lab tests, X-rays and other various hospital services." The difference in cost between being formally admitted to the hospital or considered "outpatient" can be huge, according to Karen Demasters.
"If a patient is admitted to a hospital for at least three days, the subsequent costs of any nursing home care, including rehab or therapy, is covered by Medicare Part A for the first 20 days and most costs are covered for another 80 days." However, if considered an "outpatient," costs are covered by "Medicare Part B, which only covers 80 percent of most medical expenses. In addition, any subsequent nursing home stay is not covered at all."
While Demaster's article focuses on Medicare-eligible patients, younger persons can also face uninsured medical expenses if they are treated as outpatients. get the details at: https://www.fa-mag.com/news/beware-of-being-in-a-hospital-for--observation-36368.html

Medical Bills Are the Biggest Cause of US Bankruptcies

With Republicans vowing to repeal (and replace?) the Affordable Care Act, the headline that "Medical Bills Are the Biggest Cause of US Bankruptcies" was no surprise to this researcher who devoted many years to the study of consumer bankruptcy.  Dan Mangan wrote in 2013: "Bankruptcies resulting from unpaid medical bills will affect nearly 2 million people this year—making health care the No. 1 cause of such filings, and outpacing bankruptcies due to credit-card bills or unpaid mortgages, according to new data." But here is the real kicker: "even having health insurance doesn't buffer consumers against financial hardship." http://www.cnbc.com/id/100840148
According to the federal government's Office of Personnel Management, https://www.opm.gov/healthcare-insurance/healthcare/ federal employees, including members of Congress, "retirees and their survivors enjoy the widest selection of health plans in the country" through The Federal Employees Health Benefits (FEHB) Program. So your Senators and Congress members don't have to worry about access to health insurance. So repealing the Affordable Care Act is OK with them.

Housing, Health Are 1/2 of Elderly’s Costs

As I transition from employer-subsidized health insurance to Medicare I'm reminded that not all expenses decrease in retirement. My (and husband's) health care premiums are going from $43/month to about $300/month.
Medicare Part A (hospital insurance): most people don't pay a premium because they've paid taxes while employed.
Medicare Part B (outpatient insurance): $121.80/mo. (for most people; some pay more)
Medicare Part C (Medigap to cover the gaps):
Medicare Part D (prescription drug coverage): cost varies by plan with higher income enrollees paying additional premiums AND you still pay deductibles, copayments, and/or coinsurance. See: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4811
or Part A & B plus Medicare Advantage (supplemental insurance): https://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html
And... once you've figured out the best plans, you need to go through this process every year as insurers change coverage and premiums!

Medicare costs: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
The Squared Away blog shows how Americans' spending changes as they transition from work to retirement. Of course, individual spending varies but the pie charts help by showing the averages. See: http://squaredawayblog.bc.edu/squared-away/housing-health-are-12-of-elderlys-costs/
Read the Medicare Advantage Primer (but note it was published in 2015 and Pat B premiums have gone up to $121.80 in 2016); http://squaredawayblog.bc.edu/squared-away/medicare-primer-advantage-or-medigap/

Health Websites are NOT Confidential!

Beware of using health websites as a new study (reported in Money, April, p. 20) reports that many health websites "leak information about your health concerns."  The study was conducted by a doctoral student at the University of Pennsylvania who found that on 91% of the websites third parties could access information on users! 70% of the websites revealed information that could be used by data brokers who sell information to marketers. To thwart this breach of confidentiality, use browser extensions such as Ghostery and Adblock Plus.

Save on medical bills

According to research by the Commonwealth Fund, employee share of medical expenses is 9.6% of income due to higher premiums, deductibles, and coinsurance. This is up from 5.3% in 2003. Maybe it's time to invest in health insurance companies that are making these profits.
Ways to save:
if you can't get to your doctor, go to an urgent care clinic rather than a hospital ER. Try phone or telemedicine if your insurer provides this service.
Comparison shop for services such as imaging; don't just go to the local hospital.
Challenge bills! Many hospital bills contain numerous errors. Need help disputing bills? Try Medical Billing Advocates of America at: http://billadvocates.com
Most billing dispute services take a % of the amount they save you on your bill. Thanks to Money magazine, April 2015, p. 19.

Medical Debt Harms Credit Reports

"In May 2014, the Consumer Financial Protection Bureau (CFPB)  released a research report that found consumers’ credit scores may be overly penalized for medical debt that goes into collections and shows up on their credit report. According to that study, credit scoring models may underestimate the creditworthiness of consumers who owe medical debt in collections. The scoring models also may not be crediting consumers who repay medical debt that has gone to collections."

The CFPB  offers consumer tips on how to deal with medical debt, both before it gets on a credit report and after. "Consumers should ask for an itemized bill and review each item on the bill to see if it is for a service that they received. Consumers should act quickly to resolve or dispute the medical bills that they receive. If consumers need to dispute a bill, they should send a written notice and include a copy of all relevant documents, such as records from doctors’ offices or credit card statements."

The advisory can be found at:
http://files.consumerfinance.gov/f/201412_cfpb-7-ways-to-keep-medical-debt-in-check.pdf

7 ways to keep medical debt in check

Medical expenses are one of the leading causes of personal bankruptcy, even for families with medical insurance. Many insurance policies have high deductibles and high coinsurance limits and on-going medical expenses can mount up to unaffordable levels. The U.S Consumer Financial Protection Bureau (CFPB). even for the insured medical debts they may not be aware of can cause serious financial problems. About 43 million consumers with an account in collection have medical debt. To avoid problems the CFPB suggests:

1. Review medical bills carefully

2. Get documentation

3. Check your health insurance policy and make sure your provider has your correct insurance info

4. Act quickly to resolve or dispute the medical bills that you receive

5. Negotiate your bill

6. Get financial assistance or support

7. Don’t put medical bills on your credit card, if you can’t pay it

Details at: http://www.consumerfinance.gov/blog/consumer-advisory-7-ways-to-keep-medical-debt-in-check/?utm_source=newsletter&utm_medium=email&utm_campaign=20141211+2Boa

 

 

 

 

 

 

 

Free medical & dental clinic, Cache Valley, Utah

Cache Valley Community Health Clinic 272 1/2 North Main Street Logan, UT 84341 (435) 716-5410 week days/business hours (435) 752-7060 Tue/Thur Evenings

The Cache Valley Community Health Clinic provides medical assistance for local residents without access to health insurance. This service is possible thanks to dedicated volunteers and generous financial support. Each year, on average, clinic providers see more than 2,100 patients, and volunteers collectively give over 1,600 hours of service.

http://intermountainhealthcare.org/hospitals/logan/communityresources/Pages/communityclinic.aspx