Episode 7
Today’s program: MEDICAL DEBT: THIS IS THE Seventh AND FINAL EDITION. THIS EPISODE WILL IDENTIFY THE TOP 6 MEDICAL DEBT SOLUTIONS.
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 TOP 6 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 expenses. Medical debt is different from other forms of debt, because it is usually unplanned, accidental, or faultless. Medical 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 treatment. Medical 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.
KNOW IT IS TIME TO DISCUSS GARY AND JAY’S TOP 6 MEDICAL DEBT SOLUTIONS
We have covered a number of solutions for the healthcare consumer to use to reduce their medical debt, some solutions are easier to implement while others require a deeper understanding of the solution process to implement. Since our team has an in-depth understanding of the solutions, we are going to develop a list of solutions from the easiest to the more complex. This approach will help the healthcare consumer start the process while gaining understanding and confidence.
We know this can be difficult and intimidating. Remember the following ground rules as you start:
- First and fore most, do not ignore the bill.
- Make sure you prepare as much information you can gather; Copy of your bill, amount you owe, your account number, If possible, the providers financial policies, reason for your call, etc…..
- It is your money, don’t be afraid to ask for help. The healthcare provider can either say yes or no. If they say yes, you win!!
- Most healthcare providers will engage and help you; take advantage of them.
- Always be confident and honest.
THE TOP 6 TIPS
- EPISODE 5: Do I qualify for any Healthcare Discounts?
- Prompt Pay
- Uninsured
- EPISODE 4: How to negotiate a Medical Debt
- EPISODE 5: How to document your conversation with a healthcare provider
- EPISODE 3: How to Use Medicaid and Charity Programs
- EPISODE 4: The No Surprise Act
- LASTLY, FUTURE HELP: EPISODE 7: The Medical Debt Forgiveness Act of 2024
YOU HAVE TO START SOMEWHERE; HAVING A CONVERSTION WITH YOUR HEALTHCARE PROVIDER STARTS THE BALL ROLLING. THE FOLLOWING IS A GUIDE FOR YOU TO FOLLOW:
THE ENVIROMENT:
. Medical debt is soaring in the US as healthcare costs continue to rise. A single trip to the hospital or any medical provider may cost thousands of dollars, and insurance – if you have it – doesn’t cover everything. When you are faced with overwhelming medical bills, it’s important to know that there are resources available and steps you can take to manage your debt and relieve the stress of your financial difficulties. They following is a guide for you to follow:
THE FOLLOWING CHECKLIST WILL GUIDE YOU THE MEDICAL DEBT NEGOTIATION PROCESS:
- Negotiate with Healthcare Providers: REFR TO EPISODE 4
Contact your healthcare provider’s billing department to discuss your situation. Have your billing statement in front of you when you call.
• Ask if they offer any Prompt Pay Discounts or financial assistance programs. REFER TO EPISODE 5
• Negotiate payment plans that fit your budget.
• If you have multiple bills with the same Healthcare Provider, ask if they will consolidate all the debt into one bill so that you can make one payment each month rather than payments on each bill.
- Document the person you spoke to, the time and date, the final resolution and request the outcome in writing. REFER TO: EPISODE 5
- Apply for Financial Assistance: REFER TO: EPISODE 3
• Some hospitals and healthcare providers offer financial assistance (Charity) programs to low-income individuals or those facing financial hardship.
• Inquire about their policies and apply if eligible.
- Explore Government Assistance: REFER TO: EPISODE 3
• Investigate whether you qualify for Medicaid or other state or federal assistance programs. Some organizations have financial counselors to assist consumers.
• These programs can help cover medical expenses if you meet their criteria. - Set Up a Payment Plan:
• Work with the healthcare provider to set up a payment plan that you can afford.
• Make consistent, on-time payments to reduce the debt. - Avoid Collection Agencies:
• Try to prevent your medical debt from going to a collection agency, as this may negatively impact your credit.
• Keep communication open with your healthcare provider about your situation.
What is hospital charity care?: EPISODE 3
The Internal Revenue Service (IRS) defines “charity care”, also known as “financial assistance”, as “free or discounted health services provided to persons who meet the organization’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services.”1 Depending on their eligibility criteria, hospitals may provide charity care to both uninsured and insured patients. Among other government regulations, federal law requires that nonprofit hospitals—which account for nearly three-fifths (58%) of community hospitals—provide some level of charity care as a condition of receiving tax-exempt status, and many state governments require all or a subset of hospitals to extend eligibility for charity care to certain groups of patients. Within the broad parameters set by government regulation, hospitals establish their own charity care policies, which vary in terms of eligibility criteria, application procedures, and the levels of charity care provided. While hospitals bear the direct costs of providing charity care, support from donors and federal, state, and local governments may cover some or all of these expenses. Estimates from one recent study suggest that the value of the tax exemption alone covered about half (50%) of the cost of charity care and other community benefits provided by nonprofit hospitals from 2011 to 2018.2
What is the Medicaid program: EPISODE 3
Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:
Pregnant Women
Apply for Medicaid if you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered.
Children and Teenagers
Apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family’s income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21.
Person who is Aged, Blind, and/or Disabled
Apply if you are aged (65 years old or older), blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.
Other Situations
Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under age 18 and have limited income and resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).
Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. To learn more, see: http://www.medicaid.gov/.
THE No Surprise Act; EPISODE 4
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.
Starting in 2022, there are new protections that prevent surprise medical bills. If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges. Here’s what you need to know about your new rights.
What are the new protections if I have health insurance?
If you get health coverage through your employer, a Health Insurance Marketplace®,[1] or an individual health insurance plan you purchase directly from an insurance company, these new rules will:
- Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).
What if I don’t have health insurance or choose to pay for care on my own without using my health insurance (also known as “self-paying”)?
If you don’t have insurance or you self-pay for care, in most cases, these new rules make sure you can get a good faith estimate of how much your care will cost before you receive it.
What if I’m charged more than my good faith estimate?
For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 higher than your good faith estimate and you file your dispute claim within 120 days of the date on your bill.
Healthcare Discounts; Episode 5
PROMPT PAY DISCOUNTS
The Prompt Pay Discount Policy is available for emergency and other medically necessary healthcare services . Certain services not deemed medically necessary are priced at packaged discounted rates with no additional discount and all payments associated with such services are expected prior to or at the time of service.
PROMPT PAY DISCOUNTS – INSURED PATIENTS:
A 10% -25%prompt pay discount may be offered at the time of service based on patient out of pocket expenses.
A 10% -25% prompt pay discount is offered on the patient balance after insurance payment. Receipt of full payment is expected within 30 days from first statement date.
PROMPT PAY DISCOUNTS – UNINSURED PATIENTS:
A patient who is uninsured and does not qualify for financial assistance, and does not have any governmental or third party funding sources.
Account will be eligible for a 25 % -40%discount.
A Self-pay discount may be offered at the time of service.
Receipt of full payment is expected within 30 days from first statement date
Under no circumstances will the ‘discount’ be applied to the patient’s account until AFTER the payment has been paid and the remaining balance on the account is the offered discount amount.
Patients with an up-front deposit will have the discount applied to the total billed hospital charges at time of discharge.
The Medical Debt Forgiveness Act of 2024 has several potential pros and cons: EPISODE 7
THIS ACT IS IN PROCESS AND HAS NOT BEEN PASSED BY THE HOUSE AND SENATE…..
Pros:
- Extended Time for Payment: By extending the reporting period from six months to one year, patients have more time to settle their medical bills without the immediate pressure of it affecting their credit score.
- Reduced Financial Stress: This additional time can alleviate financial stress for individuals recovering from medical procedures or dealing with ongoing health issues.
- Improved Credit Scores: Delaying the reporting of medical debt can help individuals maintain better credit scores, which can be crucial for securing loans, mortgages, and other financial products.
- Encourages Negotiation: Patients may have more time to negotiate payment plans or settlements with healthcare providers, potentially reducing the overall debt amount.
Cons:
- Delayed Reporting: Creditors may argue that delaying the reporting of medical debt could lead to less accurate credit assessments, as outstanding debts are not immediately reflected.
- Potential for Increased Debt: Some individuals might delay addressing their medical bills, leading to higher accumulated debt over time.
- Impact on Healthcare Providers: Healthcare providers might face longer delays in receiving payments, which could affect their cash flow and financial stability.
- Administrative Challenges: Implementing and monitoring the extended reporting period could create additional administrative burdens for both credit agencies and healthcare providers.
Overall, the act aims to provide relief and support to individuals facing medical debt, but it also introduces some challenges that need to be carefully managed. What are your thoughts on these potential impacts?
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.
This concludes our program MEDICAL DEBT SOLUTION PROGRAM, and we hope the program explained Medical DEBT and has answered some of your questions.