You Tube Medical Debt Episode 6 Using Provider Discount to Manage Medical Debt

EPISODE 6

 

Today’s program:  MEDICAL DEBT: THIS IS THE FIFTH EDITION FOCUSING ON SOLUTIONS.  1. Healthcare Discounts,  2. Do you qualify for Social Security Income/Social Security Disability Income and 3.  How to document your conversation with a healthcare provider.

I’m Gary and I’m Jay and we will be hosting today’s program.

  • We are not Clinical people.
  • We are experienced in the Business of Healthcare with over 50 years of combined experience.
  • We bring an Insiders view of how healthcare works.
  • Our goal is to share our knowledge with consumers.

GP:  Career in spans managing hospital and physician revenue cycle operations that include

Pt Admission, Precertification, Ins verification, billing and medical collections

 

JH:  Chief Financial Officer for several large healthcare systems

 

Here we go with today’s program:  IDENTIFYING MEDICAL DEBT SOLUTIONS

 

First, let’s recap:  What is Medical Debt?

Medical debt is debt incurred by individuals due to health care costs and related expensesMedical debt is different from other forms of debt, because it is usually unplanned, accidental, or faultlessMedical debt can have negative impacts on households, such as reducing their spending on other essential items, or preventing them from seeking needed medical care or treatmentMedical debt can also lead to bankruptcy.

Do you have a Medical Bill?

 

If yes, medical debt can indeed be a significant financial burden for individuals and families. When someone incurs medical expenses that are not fully covered by insurance or you do not have insurance, you may end up owing money to healthcare providers. This debt can accumulate due to various factors, such as high deductibles, copayments, out-of-network charges, or uncovered services.

 

LET’S START WITH:

Prompt Pay Discounts and Self Pay(No Insurance) Discounts

INTRODUCTION

Paying for healthcare services is similar to buying a new car; all is negotiable.  Many consumers may be surprised to learn that healthcare services are negotiable. As patients grow increasingly savvy about researching healthcare prices, they’re more likely to ask providers for discounts that apply to anything from hospital visits, radiology services to surgeries and dental procedures. The following will guide you through the process.

 

What are “PROMPT PAY” DISCOUNTS IF I HAVE HEALTHCARE INSURANCE

Prompt Pay discounts are offered by hospitals and doctors if the balance is paid in full within 30 days after the health insurance has paid.  The following are tips and advice on how to negotiate your healthcare bill.

ANY HEALTHCARE PROVIDER BILL

For most of us, when we receive a bill from a provider we pay it.  In fact, we can ask for a discount if we are savvy consumers.  What do I mean? The following is a step by step process consumers can follow to secure a discount.

  1. You receive a bill from the provider after your health insurance as paid and you want to pay the balance off now.
  2. Within the first 30 days after receiving the bill, call the providers Business Office and ask for a “Prompt Pay” discount. Most providers offer and sometimes advertise this discount on the billing statement you received.  The discount can range from 10% to 20% or higher.
  3. If the Business Office associate says yes, we offer a discount, find out the amount of the discount. (Any discount offered is a bonus since you do not have to pay the full amount) If you are satisfied, secure the Business Office associates’ name and confirm the amount of the discount and how much you are required to pay after the discount is applied against your account.  If the Business Office associate says no, ask them why.  Tell them you are willing to pay the bill in full now.  If they still say no again, ask for a Manager and go through the same discussion.  It can’ t hurt; it’s your money. SEE THE LAST SECTION OF THIS PRESENTATION
  4. Most providers accept credit cards via the telephone. Pay the bill immediately; this will ensure you receiving your discount.

Why do providers offer prompt pay discounts:

  1. They want the cash flow now
  2. Payment plans cost hospitals’ money to manage; the longer the payment plan the higher the probability of defaulting on the payments
  3. It costs the hospital $.85 to $1.00 per statement sent to you a billing statement
  4. Personnel costs are reduced

Use the arguments above when discussing “Prompt Pay” discounts with provider personnel.  They will know you are an educated consumer.

DOCTORS

Doctor bills are significantly smaller than hospital bills.  Since they are, “Prompt Pay” discounts are harder to receive.  Generally, if you have healthcare insurance, the out of pocket payment to the Doctor is what called a co-payment; a fixed amount per doctor visit.  Co-payments can range from $10 to $50 per office visit usually based on the specialty of doctor you are seeing. Co-payments are usually collected from the consumer either before or after the office visit.  Receiving a discount is worth a try; the following are the steps

  1. When the receptionist is asking you to pay your co-payment amount, ask her if this office offers “Prompt Pay” discounts. You may be surprised.
  2. If not, pay the amount and see the doctor. Nothing ventured; nothing gained.

 

DISCOUNTS IF I DO NOT HAVE HEALTHCARE INSURANCE

The vast majority of us have some type of healthcare insurance.  The typical types of insurance plans are offered through where we work, through the Federal Government or insurance plans we purchase ourselves.  There are, however, about 30million people living in the United States that do not have healthcare insurance.  This population segment is at full financial risk for paying for their healthcare services. .

As some consumers know, healthcare insurance companies do not pay 100% of the amount billed to them from the hospital or doctor.  Insurance companies negotiate a discount with providers and doctors.  If a consumer does not have health insurance, why should they 100% of the bill when insurance companies pay significantly less.  They should not.  Use this as an argument when talking to hospitals or doctors.

Most Doctors and providers offer discounts to consumers who do not have healthcare insurance.  Discounts can range from 20% to 50% or higher.  Always be proactive; better you are controlling the conversion than the provider or doctor.  The following is a step-by-step guide to securing your discount.

HOSPITALS

  1. If your doctor has ordered services at the hospital, prior to receiving healthcare services consider using the following process:
    1. Contact the hospital Business Office and explain to them your doctor has scheduled healthcare services and you have no insurance.
    2. Ask the Business Office associate what is there no insurance discount amount. It should be in the 20% to 50% range or higher.
    3. Ask the Business Office associate what are the terms for you to receive the discount; Payment in full at the time of service, Payment plan over what period of time or other terms offered by the hospital.
    4. If a discount is offered only if you pay the full amount at time of service, ask if they are willing to make payment plan arrangements. If they are, see steps  below, if not pay the full amount.
    5. If a discount is offered and the hospital is willing to accept payments, this is a very good arrangement since most hospitals do not charge interest. Best use their money not yours.
    6. Make sure you receive all terms in writing from the hospital and secure the associates name.
  2. If you received emergency services and did not talk to the provider prior to the service, consider using the following process:
    1. Always be proactive; if you can go to the provider Business Office the same day of service do so and discuss your situation; you have no insurance. If you can’t go to the hospital Business Office, call them 5-7 days after you receive the service.  It takes the hospital that long to gather all the charges in order to bill you.
    2. Use the same process as outlined above.

Doctors

Like hospitals, most Doctors will offer some type of discount if you have no insurance.  The consumer can consider using the following suggestions:

  1. Prior to scheduling a visit with the doctor, discuss with the doctor’s practice manager discount options if you do not have healthcare insurance.
  2. Make sure you reply to the practice manager that most insurance companies do not pay 100% of the doctor bill and you would like them to match the discount.
  3. Offer to pay at time of service; be very proactive.
  4. Always try to secure the arrangement in writing.

Out Patient Services: Laboratory, Radiology, Physical Therapy, etc….

As like hospitals and doctors, these services providers will probably offer the consumer a discount if the consumer does not have insurance.

Use the process outlined above.

 THIS CONCLUDES THE DISCOUNT DISCUSSION.  WE HOPE THIS HAS GIVEN THE INFORMATION AND CONFIDENCE TO BE PROACTIVE WITH HEALTHCARE PROVIDERS.

 

OUR NEXT SECTION DEALS WITH PROGAMS YOU MAY NOT BE AWARE OF.

How to apply for Social Security Disability Insurance (SSDI)

 

You can apply online for Social Security Disability Insurance (SSDI). You may want to assemble all the documents you need ahead of time; Social Security provides a handy, and lengthy, checklist.

You can also apply by telephone at 800-772-1213 or in person at your local Social Security office. If you want a Social Security representative to assist you with your application, contact your local office to schedule an appointment.

For your SSDI application to be approved, you must demonstrate severe or total disability: an injury or condition that prevents you from engaging in “substantial gainful activity” (i.e., most work) and is expected to last at least one year or result in death. Social Security maintains a detailed list of impairments with additional information on how it evaluates disability claims.

If you believe you may qualify for SSDI, get the process started as soon as possible. In 2023 the average time to get an initial decision on a disability claim was more than seven months. Many claims are denied at first, and the appeals process can take months, even years, due to a huge backlog of cases.

Keep in mind

  • If you want to apply online, you must not have had a claim for disability benefits denied in the previous 60 days, and you cannot already be receiving any Social Security benefits on your own earnings record.
  • Unlike with retirement benefits, there is no minimum age to collect SSDI. If your disability claim is approved, your payment is calculatedas if you had reached full retirement age (the age at which you can receive 100 percent of the benefit you are entitled to, based on your earnings history).
  • “Substantial gainful activity” is defined by a cap on work income that changes annually based on national wage trends. In 2023 the limit is $1,470 a month ($2,460 a month for the statutorily blind). Outside oftrial work periods and other programs designed to help SSDI recipients get back into the labor force, you cannot collect disability if you are earning more.

When can I collect Social Security?

 

The earliest you can start collecting retirement benefits is age 62. You can apply once you reach 61 years and 9 months of age.

However, Social Security reduces your payment if you start collecting before your full retirement age, or FRA. (FRA is 66 and 6 months for people born in 1957 and is gradually rising to 67 for those born in 1960 or later.) Only then do you qualify for 100 percent of your basic monthly benefit, which is calculated from your 35 highest-earning years.

Your payment will increase even more if you wait until age 70 to apply, as you’ll be accruing delayed retirement credits. (You can apply later than 70, but it doesn’t change your benefit.)

The starting age can differ for other types of Social Security benefits.

Spousal benefits: These can begin at 62, as long as the spouse on whose work record you are claiming them is already receiving retirement benefits. Spousal benefits are reduced if taken before FRA.

Survivor benefits: You can apply for benefits on the record of a deceased spouse or ex-spouse at 60; 50 if you are disabled; or any age if you are caring for the deceased’s under-16 or disabled child. These benefits are also reduced if claimed prior to full retirement age, which is calculated differently for survivors: It’s 66 and 2 months for survivors born in 1957 and is gradually rising to 67 for those born in 1962 or later.

Social Security Disability Insurance (SSDI): No age requirement, but you must have spent some time in work in which you paid Social Security taxes. The amount of time increases with age, but you may qualify for SSDI with less time in the workforce than you need to collect retirement benefits. You must also demonstrate that your medical condition meets Social Security’s strict definition of disability and show evidence that it prevents you from working.

The Social Security Administration (SSA) is facing a large backlog of disability claims that significantly grew during the COVID-19 pandemic. The agency reported to Congress in October 2023 that the number of pending applications for disability benefits had reached “an all-time high,” topping 1 million for the first time. That’s up by more than a third since the start of the pandemic in March 2020, when the backlog stood at about 747,000, according to data from the SSA’s Office of the Inspector General. (Those figures include applications for both SSDI and Supplemental Security Income, or SSI, the other benefit for people with disabilities that is administered by Social Security.)

Keep in mind

  • The question of when you can receive benefits is separate from a more important question: When should you claim benefits?The answer is complicated and depends on your job situation, family circumstances, and financial and physical health.
  • There is no minimum age for dependent childrento receive benefits on the earnings record of a retired or deceased parent. These can begin at any time but in most circumstances end at age 18.
  • Parentswho were financially dependent on a son or daughter who dies can collect survivor benefits from age 62.

 

How to document a call to a Medical Provider: Documentation and Provider Call List

 

Getting an answer to your billing questions could be very challenging.  When talking to your provider, always do the following:

  1.  Always document the person, date and time of you call
  2. Document all conversations results if any
  3.  Document messages you left without a returned call
  4. Document all arrangements you negotiated with the provider
  5. Follow up in writing or email to the provider

The following is the call list you should follow:

Hospital Doctor
Patient Representative: Telephone number will be on your monthly billing statement Patient Representative: Telephone number will be on your

monthly billing statement

If you were not satisfied with the answers, ask to speak to:

1.  The Billing Manager

2.If unsuccessful; The Billing Director

3.Then: The Department Director

4.Then:  Vice President Revenue Cycle

5.Then: Chief Financial Officer

If you were not satisfied with the answers, ask to speak to:

1.The Billing Manager

2.If unsuccessful; The Billing Director

3.Then:  The Office Manager

4.Then: The Doctor

 

          HCNC is your healthcare partner that offers healthcare consumers information to navigate the healthcare maze via our website.

The program and take away information of the program will be available on our website www.healthcareconsumernavigatorcenter.com.

REMEMBER:  THIS IS OUR  4RD YOUTUBE PROGRAM IN THIS SERIES, SEVERAL MORE TO FOLLOW

Our next program topic will be:   MEDICAL DEBT        

This concludes our program MEDICAL DEBT SOLUTIONS, and we hope the program explained telehealth care and has answered some of your questions.

 

 

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