Guide to Managing Medical Bills
Source: Triage Cancer
Cancer is expensive. But knowing some key tips on how to manage your medical bills can help you avoid unnecessary expenses. This Guide will cover some ways to reduce your costs before you get medical care and after. The most effective way to avoid high medical bills is to make sure that you have adequate health insurance coverage that covers your healthcare providers and your prescription drugs.
To better understand health insurance terms and how to pick a health insurance plan, read our Quick Guide to Health Insurance Basics (https://triagecancer.org/quickguide-healthinsurancebasics) or watch these animated videos:
Health Insurance Basics https://triagecancer.org/video-HealthInsuranceBasics and
How to Pick a Plan https://triagecancer.org/video-pickingaplan.
Ways to Avoid Higher Medical Bills Before Care
While it is impossible to completely avoid out-of-pocket medical costs related to a cancer diagnosis, you can take steps to avoid higher-than-necessary medical bills.
- Have the Right Insurance. People tend to only look at a plan’s monthly cost when choosing a health insurance policy. You should also look at the out-of-pockets costs that you have to pay when you get medical care, such as co-payments, deductibles, and out-of-pocket maximums. You also need to make sure the plan covers your providers, hospitals, and prescription drugs. Reviewing your health insurance coverage is something that you should do each year to make sure that you have the coverage that is best for you. For tips on how to do this, visit https://TriageCancer.org/HealthInsurance.
- Discuss Costs With Your Health Care Team Before Treatment. Your health care team may have suggestions for reducing costs … for example, arranging healthcare appointments grouped together, helping you avoid extra co-payments for office visits.
- Get Necessary Pre-authorizations. Many health insurance companies require you to obtain prior approval (also called pre-authorization, prior-authorization, or pre-certification) before you get medical care. If you don’t get the pre-authorization, your health insurance company might deny your claim. Make sure your healthcare team contacts your health insurance company before treatments, testing, surgery, or hospitalization to check if you need a pre-authorization. If your healthcare team does not request pre-authorizations for you, you are responsible for getting approval from your insurance company. Also, even if you receive approval, it does not guarantee that your insurance will cover your care.
- Go to In-Network Providers When Possible. To be a part of a plan’s network, doctors and facilities contract with the plan and agree to accept a specific rate for their services under the plan. These doctors and facilities are considered “in-network.” Doctors and facilities that do not have a contracted relationship with an insurer are considered “out-of-network.” Some Preferred Provider Organization (PPO) plans have limited coverage for out-of-network providers (eg, 50%). Most Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans pay 0% for out-of-network providers.
- Make Sure Health Care Providers Have Up-to-Date Information. Make sure that all of your healthcare providers have your current contact and insurance. Take your insurance cards with you to each medical appointment and to the pharmacy.
- Be a Good Consumer. Consider your healthcare options like you would any other item or service you purchase: shop around and compare prices. For example, you usually don’t have to use a specific lab for a blood test. Not all labs charge the same amount, and there can be a significant difference in your cost if the lab is not in your health insurance plan’s network. For more information on ways to shop for medical care, visit the Managing Finances module at https://TriageCancer.org/Cancer-Finances.
- Negotiate With Health Care Providers. If shopping around for lower cost providers is not an option, you might be able to negotiate your medical bill, before you get care. Ask for up-front pricing for all non-emergency tests and procedures and ask if there are any discounts available. For instance, providers may offer a discount for paying in cash rather than by credit card. You might qualify for an “ability to pay” program or “charity care” at a healthcare facility. Many hospitals have a billing department and even patient navigators who can help you negotiate a bill.
- Keep Track of Your Out-of-Pocket Maximum. While your insurance company usually keeps track of what you have paid for medical care out-of-pocket, and may even list that on each Explanation of Benefits (EOB) that you receive, it can be helpful to keep track on your own to make sure those amounts match. Mistakes happen and you don’t want to pay more than you are required to under your plan.
- When you visit a provider, you may be asked to pay a co-payment when you check in. If you have an insurance plan that includes your co-payments in your out-of-pocket maximum, your provider may not know that you have already reached your out-of-pocket maximum and, are not responsible for paying any more co-payments for the rest of your plan year.
- Leverage Out-of-Pocket Maximums. If you reached your maximum for the year, consider addressing any other healthcare needs you have, rather than waiting until the new plan year, where you will have to meet your out-of-pocket maximum again.
Understanding Balance Billing and Surprise Billing
Be Aware of Balance Billing. Balance billing occurs when out-of-network doctors and hospitals bill patients for the difference between a billed charge and a health insurance plan’s allowed amount. For example, if you choose to see an out-of-network provider and that provider charges you $100 for a service, and your health plan pays only 50% for out-of-network care, then that provider can bill you for the $50 balance.However, this type of balance billing is typically not allowed if:
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- You have Medicare and use a health care provider who accepts Medicare
- You have Medicaid and use a health care provider who has an agreement with Medicaid
- Your doctors or facilities have a contract with your health plan (in-network) and are billing you more than the plan’s contract allow.
Be Aware of Surprise Billing. You might face a surprise medical bill when you receive care from a provider you did not know was out-of-network. For example, you schedule a surgery with a surgeon and hospital that are in-network, but after your surgery, you find out that the anesthesiologist was not in-network when you get a large surprise bill from the anesthesiologist. Some states have tried to protect patients from balance billing: http://triagecancer.org/statelaws.
Communications Around Medical Bills
The amount of paperwork generated each time you receive medical care can be overwhelming. Each time you get medical care, you can expect to receive some, or all, of the following items in the mail, by e-mail, or posted in your online insurance account, or online electronic medical record offered by your provider.
From the health insurance company, you may get:
A letter indicating it has received a claim from the health care provider
A letter saying it is processing the claim
An explanation of benefits (EOB), which details the claim received, how much the provider charged for the particular service (eg, an X-ray), what the health insurance company is going to pay the provider, and what the patient may owe the provider (often called the “patient responsibility”). Generally, EOBs are identified by the statement “THIS IS NOT A BILL” somewhere on the page
From the health care provider:
The bill with an amount that the patient is responsible for paying
Wait to send in a payment to your provider until you receive your insurance EOB to ensure that the bill and the EOB match and that they are correct. If you are concerned about missing the due date on the bill while waiting for your EOB, contact your provider and let them know that you are waiting for your EOB.
Reviewing Your Medical Bills
Once you’ve gotten a medical bill, it’s important to review it to make sure it is accurate. Don’t be afraid to ask your providers to explain codes or descriptions of services you received. You should look for:
- Small errors, like a wrong number or code, can make a big difference in your bill. Ask for an itemized list of charges, request a copy of your medical records and pharmacy ledgers, and check that everything matches up.
- You might be able to challenge certain charges, such as:
- Procedures that were ordered and then cancelled
- Medication ordered for you but never given to you
- Hospital errors (e.g, lab results were lost so the test had to be redone)
- Hospital delays (e.g, an extra night’s stay in the hospital because of an unavailable surgical suite)
If you need help managing your medical bills, consider:
Asking for family and friends for help. They can open mail, match EOBs to bills, and put payment due dates on your calendar.
Reaching out to a case manager: Some insurance companies provide their customers with case managers to help them navigate medical care, health insurance policies, and bills. But it is important to remember that they work for the insurance company. You still need to keep track of every conversation, write down who you talked to, the date you talked to them, and what you discussed.
Hiring a professional bill reviewer: A professional bill reviewer or medical claims organization can help you with things like doing a comprehensive review of our medical bills to make sure they are accurate and checking diagnosis codes for upcharges. The Alliance of Claims Assistance Professionals has referrals: www.claims.org.
When your Insurance Plan Says No …
At some point during your cancer treatment, you may experience a denial of coverage from an insurer, whether for an imaging scan, prescription drug, treatment, procedure, or genetic test. Most people take “no” for an answer. But those who don’t accept the denial, and file an appeal, may actually win and get coverage for the care prescribed by their health care team!
For more information about appealing a claim denial, read the Quick Guide to Appeals for Employer- Sponsored & Individual Insurance at https://TriageCancer.org/QuickGuide-Appeals or watch this webinar, “When an Insurance Company Says No:” https://vimeo.com/triagecancer/understandingappeals.
Getting Organized
There are lots of tools available to keep track of your medical bills, EOBs, medical records, and other paperwork related to your medical care. But the key is to use whichever tool is going to make it easier for you to stay organized, whether that is a box with file folders or a 3-ring binder. You should also keep track of any communications that you have with your provider and health insurance company.
If you need to appeal any denials of coverage, you can use this Appeals Tracking Form: https://triagecancer.org/AppealTrackingForm.
You can also watch this webinar on staying organized:
https://triagecancer.org/webinarreg-organize.
One reason it is important to stay organized is that tracking all of your expenses related to your medical and dental care could actually save you money.
- If you need to get a pre-authorization, keeping that in a safe place is useful, in case your insurance company says they never gave approval.
- You should also keep track of all medical and dental costs, including meals, lodging, and travel expenses related to medical care, because these expenses might be tax-deductible, or possibly paid for through a flexible spending account (FSA).
Paying Your Medical Bills
If you get a medical bill that you are unable to pay, it is important not to ignore it. Consider contacting your provider to ask for more time, or see if your provider would be willing to negotiate a payment plan or accept a lower lump-sum payment.
It is also important not to wait too long to contact your provider about an unpaid medical bill. Contacting your provider before unpaid bills get sent to collection agencies can help protect your credit score.
Be careful when you’re considering paying medical bills with credit cards. They usually have high interest rates and you could end up spending more than necessary. You should also be careful when considering taking out a home loan to pay off medical debt. Using your home as collateral transfers the debt from being unsecured to secured, which means that the lender could take your home if you are unable to make payments.
You can apply for financial assistance programs to help offset the cost of your medical bills.
Visit https://TriageCancer.org/Cancer-Finances for financial assistance resources.
Thank you! Triage Cancer .. you are amazing!
The Allyson Whitney Foundation
Provides grants from $500-$1500 for various needs (medical bills, rent, utilities, car/health insurance premiums, IVF treatments, integrative therapies, travel expenses, and medical hair pieces) for young adults with cancer.
Assistance Fund
855 845 3663
Provides assistance with co-payments, premiums, and other financial assistance.
Cancer Care Co-Pay Assistance Foundation
866 55 COPAY
A nonprofit organization dedicated to removing insurance barriers by helping qualified patients afford the co-payments, co-insurance, and deductibles for their prescribed treatments. Patients must meet certain financial, medical, and insurance criteria. The funds are disease-specific. The patient’s primary cancer diagnosis must match the program’s fund definition and the medication prescribed must be to treat the primary diagnosis.
If the Foundation does not have funding for the patient’s type of cancer, the co-payment specialists can provide information about other patient assistance programs, support services, and additional resources that may be helpful.
In order to be eligible for assistance:
• Patient’s primary cancer diagnosis must be the same as one of the funds that the foundation covers.
• Patient must have a valid Social Security number to apply for assistance and receive treatment in the United States.
• Patient must be in active treatment or have a treatment plan in place prior to applying for assistance.
• Patient is required to have valid insurance coverage. Some funds are restricted to assist only those insured through a federal health insurance program, such as Medicare or TriCare.
• Patient income level must be at or below 500% of the Federal Poverty Level.
Patients can apply for this foundation through its online process (cancercare.org/copay-apply) or speak with a co-payment specialist at 866.55.COPAY (866.552.6729). Patients will be enrolled for up to one year from the time they are approved.
Cancer Financial Assistance Coalition
A coalition of financial assistance organizations joining forces to help patients with cancer experience better health and well-being by limiting financial challenges. It educates patients and providers about existing resources and links to other organizations that can disseminate information about the collective resources of its member organizations.
CFAC is a coalition of organizations and cannot respond to individual requests for financial assistance. To find out if financial help is available, use the CFAC database at cancerfac.org. Search by cancer diagnosis or by specific type of assistance or need (i.e., co-pays, general living expenses, transportation, genetic testing). Patients and providers may also contact each CFAC member organi- zation individually for guidance and possible financial assistance.
Offers health insurance co-payment assistance up to $10,000 per year to eligible patients for chemotherapy and targeted therapy drugs. They currently offer this program to people affected by breast cancer, colon or colorectal cancer, glioblastoma, head and neck cancer, non-small cell lung cancer, pancreatic cancer, and renal cell cancer.
Good Days
Good Days is a non-profit advocacy organization that provides resources for lifesaving and life-extending treatments to people in need of access to care.
Good Days covers what insurance does not — the co-pays for treatments that can extend life and alleviate suffering. Good Days also has a premium assistance program for patients who need help paying their monthly medical insurance premiums. Its travel assistance program helps pay for travel costs to ensure patients have access to the care they need.
Good Days has streamlined the enrollment process so patients can receive immediate determination of eligibility for financial assistance.
Eligibility criteria:
Patient must be diagnosed with a covered disease and program must be accepting enrollments
Patient must have a valid Social Security number to apply for assistance and receive treatment in the United States.
Patient must be seeking assistance for a prescribed medication that is FDA approved to treat the covered diagnosis.
Patient is required to have valid insurance coverage.
Patient income level must meet program guidelines.
To enroll, go to mygooddays.org/ apply to apply online, or you can download the English or Spanish enrollment form and fax completed forms to 214.570.3621. Contact GoodDays by phone (877.968.7233), Monday through Friday, from 8:00 AM to 5:00 PM CST.
Formerly known as Chronic Disease Fund.
HealthWell Foundation
A nationally recognized, independent non-profit organization founded in 2003, the HealthWell Foundation has served as a safety net for more than 320,000 underinsured patients by providing access to life-changing medical treatments they otherwise would not be able to afford. HealthWell provides financial assistance to adults and children facing medical hardship resulting from gaps in their insurance that cause out-of-pocket medical expenses to escalate rapidly. HealthWell assists with the treatment-related cost-sharing obligations of these patients.
When health insurance is not enough, HealthWell Foundation fills the gap provides financial assistance to help with:
• Prescription co-pays
• Health insurance premiums, deductibles, and coinsurance
• Pediatric treatment costs
• Travel costs.
Healthwell Foundation offers financial assistance through a number of disease funds, with new funds opening every year, so patients can get the care they need.
To be eligible, patients must meet certain criteria:
HealthWell must have a disease fund that covers the patient’s illness, and their medications must be an eligible treatment for that illness.
Patients must have some form of health insurance, such as private insurance, Medicare, Medicaid, or TriCare.
Patients have incomes up to 400 to 500% of the federal poverty level (HealthWell considers household income, the number in the household, and the cost of living in patient’s city or state).
Patients must be receiving treatment in the United States.
Anyone with the patient’s express permission may apply on behalf of a patient in two ways:
1. Apply online using the HealthWell provider portal at https://healthwellfoundation.secure.force.com/
2. Apply by phone at 800.675.8416, Monday through Friday, 9:00 AM to 5:00 PM EST.
Once patients are approved for a grant from one of the disease funds, they will receive assistance for a rolling 12 months, after which they can reapply if needed and if funding is available. Upon approval, patients will receive both a HealthWell Pharmacy Card and a Reimbursement Request Form.
Funding varies, so check website for up-to-date list of covered diagnoses and medications.
Leukemia & Lymphoma Society’s Co-Pay Assistance Program
877 557 2672
Offers financial help toward:
Blood cancer treatment-related co-payments
Private health insurance premiums
Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, Medicare Advantage premium, Medicaid Spend-down or co-pay obligations
You have complete freedom to choose doctors, providers, suppliers, insurance companies and treatment-related medications. You can make changes to these at any time without affecting your continued eligibility.
Live Like Bella
786 505 3914
Assists pediatric cancer families with medical co-pays, gas, food, and utilities.
National Organization for Rare Disorders
800 999 6673
Since 1983, NORD has been the primary source of support and information for patients and families affected by rare diseases. This Resource Center provides patients and caregivers with free webinars, fact sheets, infographics and other helpful materials to guide you on your journey with a rare disease.
Since 1987, NORD has provided assistance programs to help patients obtain life-saving or life-sustaining medication they could not otherwise afford. These programs provide medication, financial assistance with insurance premiums and co-pays, diagnostic testing assistance, and travel assistance for clinical trials or consultation with disease specialists.
Patient Access Network (PAN) Foundation
[email protected]
866 316 7263
Helps underinsured people with life-threatening, chronic, and rare diseases by assisting their out-of-pocket costs.
Patient Advocate Foundation (PAF) Co-Pay Relief Program
We put patient and family peace of mind above all else. We provide direct payment for co-pays, co-insurance, and deductibles for patients who need financial assistance. In some instances, assistance with insurance premiums and/or ancillary services associated with the disease also may be available. Patients approved for assistance are required to have their verified diagnosis and treatment plan along with supporting documentation completed and returned within
30 days of approval to ensure continuation of the award. Eligibility requirements:
- Patients must be currently insured and have coverage for medication(s) seeking financial assistance.
- Patients must have a confirmed diagnosis and treatment plan.
- Patients must reside and receive treatment in the United States.
- Patients’ income must fall at or below 300 percent or 400 percent of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household.
Once approved, the award can be used immediately. Claims should be submitted via the Virtual Pharmacy Card, uploading them to the online portal, or faxed to PAF using the unique bar-coded fax cover sheet.
Patients and providers can apply online (https://copays.org/portal/#/ login) or by calling 866.512.3861. If applying via phone, applications and supporting documents must be faxed to the unique bar-code on the application.
Patient Services, Inc.
Provides peace of mind to patients living with specific chronic illnesses by providing financial assistance to eligible persons by:
- Subsidizing the cost of health insurance premiums
- Providing pharmacy and treatment copayment assistance
- Providing travel assistance
Rofeh Cholim Cancer Society
Provides a number of different services to patients dealing with a cancer diagnosis, primarily assisting with insurance premiums.
Anita Bagnall says
Thank you for your website. God bless you.
Anita