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Back to Basics: The Financial Aspects of Healthcare

Back To Basics: The Financial Aspects Of Healthcare

It’s no surprise that money is a leading driver of health care choices. From determining where you go for treatment to influencing when and if you decide to go for treatment, financial factors play a big part in shaping our health-related choices today. For most people, especially those who already have financial hardship, making these choices can be extremely stressful and confusing. In fact, the financial aspect of healthcare can even feel more painful than the procedures themselves.

For a lot of people, medical bills often seem impossible to pay off. Coupled with the rise in healthcare costs, many people don’t feel equipped to effectively deal with their medical bills. Unfortunately, inability to pay can sometimes be mistaken for noncompliance. Yet, we know that most patients actually want to pay off their bills, they just don’t know how.

To help spread awareness, we gathered our 20+ years of experience to put together a simple outline to help you understand your options. Why? We believe that everyone deserves access to good healthcare and we know that understanding your options can alleviate stress and improve both your physical and financial health.

So, next time you receive a medical bill, know that these options may be available for you:

Talk to the Hospital About Your Bill

Before you do anything else, make sure to check the accuracy of your bill. Even with the best intentions in the world, there may be a simple mistake on your bill. Make sure that you are only billed for the procedures you received (sometimes a procedure can be entered twice instead of once), or that tests that should be bundled together really are. Check the treatment codes entered to make sure it was not incorrectly entered, which can lead to insurance denial. If you get something denied that you feel shouldn’t be, talk to the hospital first to clear things up.

Ideally, go in person to deal with any issues with the bill. Going in person may get you more sympathetic treatment. If you don’t understand your bill, kindly ask the billing specialist to explain. This will help you understand it better and also increase the likelihood of mistakes being noticed and corrected. Make sure to ask for a copy of the bill with the CPT codes, which you can check on the American Medical Association website.

Public Benefits

When people talk about public benefits, it most often than not refers to Medicaid, a joint federal and state program that makes up the largest source of U.S. health coverage. According to its official website, Medicaid “provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities.” Generally, Medicaid covers 20% of low-income Americans.

Although Medicaid is selective and may not cover everything, it can make a huge difference in getting your bills paid. If you are eligible for Medicaid, apply as early and accurately as possible. A public benefits eligibility specialist can help you and the hospital determine your eligibility and help you file your application. Keep in mind that while you can do this yourself, having an expert on your side greatly increases your chance of doing it correctly and efficiently, thus expediting the reimbursement process.

Ask About Discounts

Did you know? Hospital bills can sometimes be negotiable. Believe it or not, healthcare providers do sometimes give a discount.

Early Out Discounts

Often, medical facilities will negotiate a discount for people who pay their bill upfront. This is called an Early Out Discount, which generally can save you anywhere between 5-20%. It is important to note, however, that healthcare facilities will usually only offer this discount if you pay in a timely manner, such as within 30 days.

If you are a self-pay patient, many hospitals also offer a discount for cash payments, especially on large bills.

Explore your options ahead of time and see what discounts may be available for you.

Charity Assistance

Federal and state laws require non-profit hospitals to offer Charity Assistance program which provide those of low income the opportunity to receive certain types of care at a reduced cost or even for free. Often, Charity Assistance covers treatments deemed “medically necessary,” such as emergency room visits.  If you have a low income, Charity Assistance may be an option for you.

Typically, the amount of financial assistance you may receive depends on your income as well as household size. If your household income is below a designated point, such as below 100% of the Federal Poverty Level, the hospital may completely cover your eligible hospital bill. However, if your household income is more than 100% of the Federal Poverty Level, the hospital may still offer you a reduced bill. In either case, you will have to provide documentation to prove your financial hardship.

Keep in mind that hospitals are very selective about who qualifies for their Charity Assistance program. In fact, each hospital has its own Charity Assistance guidelines. With that in mind, the amount of financial assistance given varies from patient to patient. Obtain a copy of the hospital’s Charity Assistance guidelines by visiting the hospital or directly calling the hospital to determine if you qualify.

Payment Plans

In general, most hospitals will allow you to set up a payment plan, and the monthly payments may be more affordable than you think. A payment plan generally breaks your medical bill into equal payments over a period of time until the total amount is paid. Setting up a payment plan can keep your account from going into collections and splits your balance into more workable amounts.

Before you enroll in a plan, make sure that the plan doesn’t have a pre-payment penalty if you are expecting money in the near future. Also ask about interest, billing charges, and fees to make sure it is reasonable. Often, hospitals will offer a low-interest, even no-interest, payment plan and will work with you to negotiate what your monthly payments could look like. Seeking assistance of a patient advocate can greatly help you choose the right plan to pay off your bills.

Let Us Help You

No matter how stressed you may be, don’t ignore your bill until it gets sent to collections. Instead, seek to resolve your balance, either by yourself or with assistance. Explore your available options and pursue the opportunities you may qualify for. Whether it’s through public benefits, early out discount, charity assistance, or payment plans, know that there are realistic opportunities to get your bills paid.

At The Midland Group, we have a desire to ensure that everyone has access to basic healthcare services. We strive to be a trusted advisor and business partner to our client hospitals as well as be a passionate advocate for their patients. Ask your hospital to see if they’ve partnered with The Midland Group and let us help you understand your bill and eligibility, explain your options, and empower you to navigate the financial aspects of healthcare so that you can focus on what matters.

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