JustCare

Tag: Collection agencies

  • If you’re billed for a Medicare procedure, you likely should not pay

    If you’re billed for a Medicare procedure, you likely should not pay

    Phil Galewitz reports from Kaiser Health News on Thomas Greene, a patient with Medicare, whose anesthesiologists billed him directly  for a procedure because Medicare would not pay the bill. But, as a general rule, if you have Medicare and your treating physician performs a service, you are not responsible for the cost, even if Medicare does not cover the service. So, if you’re billed for a Medicare procedure, you likely should not pay the bill.

    Medicare rules protect you from almost ever being liable for the majority of the cost of medical services you receive. There’s always 20 percent coinsurance for medical care in Traditional Medicare. But, if you have supplemental coverage, you usually have no out-of-pocket costs.

    If you’re in a Medicare Advantage plan, you should also have most of your medical costs covered with a copay.  But, even if Medicare ends up denying coverage, if an in-network provider delivers a treatment, you are not liable for the cost.

    With Medicare, the only time that you’re responsible for the cost of a service your doctor provides is if the physician tells you in advance that Medicare won’t pay for the service, and you sign a written waiver agreeing to pay for the service yourself.

    Notwithstanding the rules, some providers might bill you anyway for services. For example, in the Kaiser Health News story, a large private-equity owned anesthesiology group billed Greene, the Medicare patient, for its services because it had billed Medicare too late to get paid for the services. When Greene didn’t pay, it sent the bill to a collection agency.

    For months, the patient had to fend off notices from collection agencies and law firms. They refused to relent. But, Greene’s Medicare statement showed he was not liable for the cost of the services.

    Fortunately, Greene called a free Medicare hotline in his state and was advised that he should not pay the bill. The counselor then contacted the collection agencies that were billing the patient and explained that they had no right to bill him. Since then, he has not received a collection notice.

    If you receive a bill for a Medicare-covered service you had no reason to believe would not be covered, don’t pay it. Contact your State Health Insurance assistance Program or SHIP for free help or call 1-800 Medicare.  You can and should also file complaints against providers and collection agencies online.

    Medicare rarely punishes providers for violating billing rules and sending bills to collection, when they have no right to do so.  Both the providers and the collection agencies should know the rules and should be penalized for violating them.

    Here’s more from Just Care:

  • Poll: More than forty percent of adults have medical debt

    Poll: More than forty percent of adults have medical debt

    The Kaiser Family Foundation reports that more than 40 percent of adults have some medical debt, and fifty percent of adults are at risk of medical debt. Whether you are insured or uninsured, you are likely to be faced with medical debt, which could force you to forgo or delay medical care and jeopardize your health. [This Just Care post offers some ways to avoid medical debt.]

    On top of the 41 percent of adults with medical debt–including unpaid bills from doctors, dentists, hospitals and other health care providers–another 16 percent had medical debt that they were able to pay off in the past five years. About 20 percent of people with medical debt today say that they will never be able to pay that debt back. Only 33 percent of people with medical debt expect to be able to pay it back within a year.

    Because of the way the US health care system works, it is nearly impossible to budget for your health care costs. Copays tend not to be fixed and, even when they are, there is virtually no controlling the number and types of services providers deliver in most instances. Of course, each comes with its own copay.

    Health care debt can take a huge toll on people’s savings. More than forty percent of adults with debt say that they have used all or most of their savings to pay off their debt. Others say that in order to pay off their debt, they had to stop paying other bills, skip going to college, or move out of their home.

    Debt can take a toll on people’s credit rating, for example, keeping them from being able to buy a car or a home. As of July 2022, if you have fully paid off your medical debt, it will be removed from your credit report. Of course, that’s no help if you haven’t been able to fully pay off this debt.

    Moreover, the poll finds that people with medical debt can struggle to get medical care. Fourteen percent of them can’t get a doctor to treat them. People postpone care or skip it altogether at twice the rate of people without medical debt.

    People with low incomes and Black Americans are more likely to have to deal with collection agencies regarding their debt. They are also more likely to struggle to find a doctor to provide them needed care. And, they are also more often forced to switch residences to afford their housing costs and unburden themselves from medical debt.

    That said, more than one in four people with annual incomes over $90,000 (26 percent) have medical debt. Another 19 percent of them had medical debt in the last five years.

    Here’s more from Just Care:

  • How to pay less for your hospital care

    How to pay less for your hospital care

    If your income is low, you might be able to pay less for your hospital care. Among the many elements of the Affordable Care Act is a requirement that nonprofit hospitals provide financial assistance to patients with limited means. Kaiser Health News reports that most people do not know about this law that can keep them from medical debt.

    Most hospitals in the US are nonprofit. Under federal law, these hospitals must forgive your hospital bills if you make less than a certain income. But, there are a lot of people who qualify for “charity care,”–full or partial help paying for their treatment–who do not know they are eligible.

    Jared Walker founded an organization, Dollar For, that helps people get the charity care to which they are entitled and avoid medical debt.

    What should you do to apply for charity care? Find out what your hospital’s policy is. It likely won’t be on the hospital website’s home page or easily searchable on its website. To find the hospital’s policy online, try googling the name of the hospital and “charity care” or “financial assistance.”

    Once you find the policy, you should also have an application. If you can’t find the policy through a simple google search, call the hospital and ask for a copy of it, along with an application.

    Are you eligible for charity care? Hospitals all have different policies. For example, one hospital might charge you nothing if your income is below 200 percent of the federal poverty level. It might lower your out-of-pocket costs if your income is between 200 and 300 percent of the federal poverty level.  You probably will need to show proof of income.

    What if you’re not eligible? You should still apply if your income is low and you can’t afford the cost of care. For example, if the hospital’s policy only covers uninsured people but your costs with insurance are super high, it’s still worth applying. It’s also worth applying if your income is higher than the cut-off, but you can’t afford your hospital costs. In these and all cases, write a letter to accompany the application that explains your financial situation.

    How long do you have to apply? Under federal law, you have about eight months (240 days) from the date of your hospital bill to apply for financial assistance, and your hospital might give you much longer.  Unfortunately, that could be after the hospital has sent your bill to collection. (A hospital can hire a collection agency to try to collect the money you owe as soon as six months after it first bills you.)

    What if a collection agency is going after money from you for your hospital care? Let the agency know that you have applied to the hospital for charity care. And, ask the hospital to call off activity by the collection agency.

    What’s the best way to send my application and letter? Hand-deliver or fax them in order to be sure the hospital receives your letter and application and that they do not get lost in the mail. If you opt to fax them, see if your public library will fax them for you.  You can also fax them through an online app.

    To be sure, getting charity care is not the easiest undertaking. But, it’s worth the effort. You could save yourself thousands of dollars and avoid medical debt.

    Here’s more from Just Care:

  • Hospital prices out of control, competition not working

    Hospital prices out of control, competition not working

    If there ever were evidence that competition does not work to drive down prices in the health care marketplace, look at the hospitals. A new report in Health Affairs by Gerard Anderson and Ge Bai reveals the failure of market forces to drive hospital prices down. There are 4,050 hospitals in America, and some prices are inexplicably high. What makes matters worse, try comparing hospitals based on their prices; they’re often not transparent.

    Hospital prices are rising way faster than inflation, particularly among the for-profit hospitals. The 50 hospitals with the highest markups have list prices for their services that are easily 10 times more than what Medicare pays. According to Bai, “For-profit hospitals appear to be better players in this price-gouging game.” “They represent only 30 percent of hospitals in the U.S., but account for 98 percent of the 50 hospitals with highest markups.”

    What’s the reason for these high markups? It’s hard to make the case that they reflect actual costs given that the other 4,000 or so hospitals mark up their charges some 3.4 times Medicare’s approved rate, which is already an enormous amount. It’s more likely that Community Health Systems, which owns 25 of these hospitals and Hospital Corporation of America, which owns 14 of them, take advantage of the lack of price transparency or price regulation in the hospital marketplace to drive greater profits.

    Until Congress regulates hospital prices, it’s likely they’ll keep rising. As with the drug companies, which often can charge what they will for their patented drugs–(check out this post on the cost of cancer drugs)–hospitals generally have the power to set prices however they see fit. In most states, no one is regulating their charges. Only Maryland and West Virginia have laws regulating hospital prices.

    Unreasonably high hospital prices drive up health care costs for everyone, if not directly, then indirectly. The 30 million Americans without insurance get stuck with the biggest bills and likely are least able to afford the charges. But, anyone with insurance who’s getting out-of-network care can get hit with huge bills. All of these people often end up dunned by collection agencies and saddled with tremendous debt and bad credit ratings. Workers compensation and auto insurance rates are higher as well in states with unregulated prices.

    Insurers are able to negotiate hospital rates down from the list price for their members. But, in many markets, insurers tend to lack the leverage to bring down hospital rates to a reasonable level.  As a result, insured people getting in-network care end up paying higher premiums and out-of- pocket costs than they otherwise would if hospital prices were regulated.

    Keep in mind that if you are uninsured or need to use an out-of-network hospital, you could be better off using a non-profit hospital, since you might qualify for financial assistance.  And, if a collection agency is going after you for a debt you don’t owe, report it to the Consumer Financial Protection Agency and click here for help. Finally, if you have Medicare, click here for six tips for keeping your drug costs down and five programs to lower your costs.

    N.B. Massachusetts has a law that requires hospitals to reveal their charges, both their list price and the insurer price, within two days of the request.  But, according to the Pioneer Institute, compliance remains an issue. 

    If you or someone you know has received a crazy hospital bill, post a comment below or email us at [email protected].