I ain’t sayin’ I’m a gold digger…

Hello from the land of Ramen and energy-saving light bulbs. Being sick is a lot of things, and being a total bank-account buzzkill is at the top of the list. As if it’s not bad enough to be schlepping around in a body that has a broken on/off switch, the healthcare industry (industry, business, corporate crapfest…) seems to have everything in mind BUT the actual well-being of the patient. Don’t get me wrong, I am the most fortunate and grateful person to be living and working in the world’s medical mecca (NY to the C!), but trying to navigate through the financial woes of chronic illness can be sickening all on its own.

I’ll start off by saying that I am writing this post due to the overwhelming feedback I got from people saying they could relate to the craziness that happens to me regarding my medical bills. I wish I was over-exaggerating when I say I have some sort of an administrative issue every 2 weeks on average, but it’s the truth. I’ve said it before and I’ll say it again – I am one of the “lucky” ones. I am educated. I have 31 years worth of experience as a sick person. And finally, healthcare: it’s what I do. And even with that armory of weapons in my corner, I still get hosed, screwed, and lost in the mix.

For the purposes of delivering what ya’ll are asking for, I’ll keep this post specific to the money stuff, even though it shares space with scheduling horrors, idiot office staff, clinical error and state prescription laws. I could (and will) write a book one day, but until that glorious light shines, we are here, and the bills are rolling in.

The first place I think we should go here is to talk about how many different avenues there are when it comes to the general payment of ones health. It’s funny, because reading that last statement back, it seems so inhumane for “payment” and “health” to even be in the same sentence. I wonder at what point in our history people changed from being good and kind to deciding that their life was only important if it was worth everything they own. It seems extreme, but I assure you that working with cancer patients for the last 10 years has made it very clear that when someone’s life is on the line, anything is on the table to be sold if there is a dollar sign attached to it.

So there are a few different things that can happen when you’re sick. You can ignore it (it’s free!) or you can seek medical attention. Whether it’s a walk-in clinic, the ER, or your family doctor, it’s gonna cost you some shells, and unfortunately, not literally. If you’re lucky enough to have health insurance, a good portion of the services might be covered, but even that has levels of security. And if you don’t have health insurance, you are still among a very large population, which in America, is around 15% or 30 million people.

Whether you have health insurance or not, it’s still insanely important to do your absolute best in trying to understand the billing process and the charges that will be coming your way.

For those who have health insurance:

  1. Know WHAT’s covered. Do you have a deductible? Do you have to hit a certain maximum out-of-pocket payment before your insurance decides to join the party? Do you have co-insurance? Are you responsible for a certain percentage of certain services, even after the deductible is met, again, before the insurance company steps up to the plate? Do you have a co-pay? Do you know what it is for each type of service? Typically, your insurance card will usually tell you what the different amounts are (ie: $30 specialist, $20 PCP, $50 urgent care, $100 ER, etc.).
  2. Know WHO’s covered. The worst thing a person with insurance can do is not pay attention to the doctors that are or aren’t within their network. So for example, let’s say you have to see a Rheumatologist. Your PCP says that Dr. Smith is a great guy, gives you the number, and so of course, you get the next available appointment because you trust your PCP. I don’t care how great this Dr. Smith is – if he does not participate with your insurance plan, do not go see Dr. Smith (unless you can afford it. And I mean REALLY afford it. Because it’s never just a fee for the MD. You’ll get zapped for the visit, the Medical Assistant taking vital signs, bloodwork, and god forbid you have to go to the bathroom, there’s another $100 for toilet paper. Some places also charge a “facility fee” but I’ll talk about that later.) The bottom line is that your PCP is not going to pay your medical bills, and Dr. Smith isn’t doling it out for free (or this post wouldn’t exist), so make smart decisions about the providers you choose. Typically, insurance companies have some sort of resource for letting their subscribers know who is/isn’t in-network, but the best way to confirm this information is to call a specific doctor’s office and ask them  if they accept your insurance before you make the appointment.
  3. Know how to read your bills. You ever get a bill in the mail from a doctor pretty soon after the appointment, and it says you owe something crazy like $500 dollars for the office visit? “But wait, I paid my copay to the idiot who didn’t make eye-contact in the office, and I confirmed that the doctor accepts my insurance. What gives?” Well first of all, trust your gut. ALWAYS trust your gut. If you’ve done your due diligence and you know WHAT and WHO is covered, you absolutely, 100 percent, without-a-doubt should question why you have a monster bill. One tip that I can give you is that since so many medical facilities have become automated with their billing processes, sometimes the computer does a better job than it should, which ends up causing some problems. Basically, medical centers pay millions (sometimes more) to install computer programs into their process which automatically send out notices to patients when bills are outstanding on their account. But since the computer doesn’t have an actual brain, all it’s conditioned to “know” is that there is money unpaid, and a bill is printed and sent out to the patient. The real issue, however, is that insurance companies sometimes take a month or two (or more) to respond to a medical claim when it is submitted by the doctor’s office. So let’s say you saw a doctor on June 1st, and the claim was submitted to the insurance company on June 5th. On June 20th, there might not be a response from the insurance company yet, so rather than your balance being covered, the balance gets sent to you (which is no mistake, since you typically sign a waiver at the beginning of your visit, swearing to give limbs and children and vital organs if the insurance denies to cough up the dough.) BUT,  since you now know this information after reading this post, what you can do is call the number on the bill, and what you will usually find out is what I just mentioned. You will typically be able to discard the bill, or at least do nothing with it immediately, because until the insurance company has paid its portion, the balance is not yours. As I said earlier, the portion varies from coverage plan to coverage plan, but if you have insurance, SOMETHING should be covered. Once the insurance responds, you’ll usually get an updated balance from the doctor’s office, and at that point, it’s reasonable to panic. But not a second before.
  4. If something doesn’t seem right, ASK QUESTIONS. Since I have had the unfortunate experience of taking many ambulance rides in my adult life, I am familiar with the fact that it is common for the EMS workers to not gather insurance information, because let’s face it – what patient is riding in the back of an ambulance just to give it a whirl? Most people in that situation are very sick, debilitated, traumatized and in some cases, unconscious. I don’t know about you, but I’m not usually very valuable when I’m not conscious. As a result, the ambulance company gets the basic demographics from the patient’s ID and sends them a “get well, soon” present, and in my case last week, it was in the form of a bill for $978. Since it took so long for them to find me, a collections agency was asked to step in and help, and when I spoke to the woman managing my case, she stated, and I quote, that “this was the bill after the insurance paid it’s portion.” Because I’m not an idiot, I asked her why the insurance denied my claim. She said she didn’t have access to that information. “Well, that’s interesting,” I thought, because how could she know that this was really the amount I owed if she had no access to the explanation of benefits? When I asked her the same questions, she said that I could call the insurance company myself and figure it out. Which I did. And do you know what I found out? I didn’t owe $978 or anything close to it, because my insurance company confirmed that they had no claim on file for the date of service in question, which means I was being billed for the entire, insurance-untouched amount. I avoided paying almost $1000 just because I knew enough to ask questions and trust my gut. How many people out there know enough to do the same?
  5. Don’t be afraid to follow-up with your doctor’s office about charges. Regular office visits, for the most part, can be relatively straight-forward when billing is concerned. The problem sort of arises when you are having something out of the norm added to the mix, like an in-office procedure (ie: a scope at an ENT’s office) or a surgery you have to go to the OR for. One thing that I’ve seen happen many times (and have had happen to me, unfortunately) is when patients are scheduled for surgery and require an insurance prior-authorization (which is sort of a soft promise from the insurance company that they might, just might, pay for some or all of your surgical procedure)  and you either find out last minute that the office didn’t obtain the authorization so your surgery is cancelled (better case) or they didn’t obtain the authorization and you had your surgery and just like that, you owe a billion dollars to the hospital (worse case). The second scenario very rarely happens because most operating rooms will cancel a procedure if they have no evidence of ever getting paid, but you better believe that when it does happen, the only fingers that are pointing will be pointing in the direction of the patient. Because in general, the expectation is that the patient knows the process and knows when to speak up when it’s not adhered to. It’s unfortunate, but it’s the truth, and it’s why I always say you have to be your own patient advocate. So if you have anything coming up and you aren’t sure of what your financial responsibility is, ask questions, talk to your insurance company, and don’t be afraid to be the squeaky wheel, because it sure beats being in the car when the tires fall off.

For those who DON’T have insurance (and other tips):

  1. Read the forms you are signing. This is a tip that I have as a result of working at my current job. As some of you might know, I have had a career in healthcare operations management for about 10 years. This means that while I have had the priceless opportunity of weighing-in on patient care matters and implementing ways to make things better, I have also had access to the ugly insides of this industry, and at times, have been expected to carry-out policies that I don’t necessarily agree with. I think I have done a good job fighting to keep my immediate situation honest and ethical, but there’s a bigger picture, and no matter which way you spin it, that picture is green. In my current role, I have worked closely with the patient relations department, and have learned a lot about how to handle patient complaints and grievances. One of the most common pieces of feedback that I’ve received in the last 3 years has been about getting billed for charges that patients didn’t know existed. Among these mystical bills is called a “facility fee,” where a specific type of facility (specifically, an Article 28 site) can charge extra, because the patient has certain conveniences in that type of site that a regular outpatient private practice medical office wouldn’t be able to provide, like everything being in one place (infusion floors, radiology, and social work all being in the same building as your doctor, for example). It’s sort of like the patient is going to a mini hospital, and this type of site has very specific guidelines that they need to follow according to the department of health, like being within a certain radius of a full-fledged hospital, or always having an ambulance parked out front in case of an emergency. Since this fee was relatively new in the beginning, leadership provided some leniency when patients would complain, and maybe a percentage of what they owed would have been reduced. But over time, as the complaints became more frequent, it caused the institution to be more creative in communicating this policy to patients, and one of the ways in which that happened was to create a form that patients sign when they arrive for their appointments. As time moved on, when patients would complain about the fee, if they had a signed form on file in their medical record, they had no leg to stand on. It didn’t matter if that patient didn’t speak English or if the importance of the form wasn’t communicated well-enough by the staff, let alone the patient being distracted by whatever illness they are battling. If the signature was on the page, the bill was theirs. So just keep in mind that you are asked to sign things for a reason, and usually that reason is so you have no defense.
  2. Know who you’re speaking with. Whether it’s the person in the office  who answered the phone or the representative at the insurance company – get names. Get names, get names, get names. This has always been important, but I was on the phone with a collections agency the other day (with the same winner I mentioned above), and she used that age-old saying of, “it’ll be your word against theirs.” Think about this for a second. This is a person who makes her living harassing sick people for money they probably don’t have, and if that wasn’t bad enough, she had to throw in some aggressive zinger to make me feel shorter than I already am. My word against theirs? Last time I checked, I was the one who called them about the money I owed, and I was also the one who figured out that the information she was providing me was way off. I know I’m flaky and have a lot going on, but neither of those sentiments implies I’m some half-wit that doesn’t do my due diligence. Yet, because I didn’t have the name of someone (I should have just made it up, honestly…), none of my efforts would matter because when you owe money, your doctor might as well be in the mob.
  3. Get health insurance. I’m not even trying to be funny with this one. There are so many options out there now for people who are unemployed or whose shitty employer doesn’t give a flying pig about their health. It doesn’t matter how healthy you are; everyone gets sick, and when it’s something bad, you never see it coming. Depending on your financial situation, you could be a candidate for Medicaid, or if not, the Affordable Care Act options have grown tremendously. Many big-name private insurance companies partner with the ACA and offer several options for those who need help. There are different levels of coverage based off of what you can afford, so at the very least, become educated on what’s out there before you just submit to a lifetime of debt or living in a bubble.


So that’s sort of a snapshot into the ins and outs of how to stay on top of your medical bills. There is so much more to deal with than these few paragraphs could even begin to cover, but hopefully this will be a good jumpstart into the basic knowledge you need to start feeling confident about speaking up when things aren’t right.

Our world is filled with human error, don’t let it cost you your health.


(And as always, if you have any questions or need some help, feel free to email me at BeckyMotivated@gmail.com)




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