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curiouslillady21's avatar

Financial aid for medical bills insurance won't cover or only cover part of?

Asked by curiouslillady21 (33points) January 23rd, 2009

I finally found a medical practice to address my complex health problems but my insurance (Anthem BlueCross Basic Hospital PPO) won’t cover any of my bills. And because it’s a private practice it’s quite expensive and they don’t have financial aid like some hospitals do. I also found out that I need surgery for endometriosis but the surgical center where my surgery will take place does not offer financial aid & my insurance will only cover part, leaving me to pay upwards of $10–15,000. That may not seem like a lot of money to some but it’s huge to me. I have a steady full-time job but I work for a nonprofit so my income is pretty minimal. I’ve applied but don’t meet the criteria for MediCal.

I’m hoping that someone knows other ways, organizations, etc. to get financial aid so that I can have the surgery. Trust me, if the surgery was at all “optional” I most deff wouldn’t have it.

Thanks very much!!

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19 Answers

Snoopy's avatar

I don’t know of any financial aid, per se, but would suggest that you try to see if you can work w/ the billing offices of the facilities you mention to set up payment plans.

Often unadvertised, institutions and even private doctors’ offices will work on a case by case basis w/ people.

pekenoe's avatar

Figure out how to sign up as an illegal immigrant and it’ll all be free.

Sorry, just had to say that.

What irritates me is the fact that if your insurance doesn’t cover a procedure and you have to pay cash, you pay more than the insurance co would have and a lot more than someone pulled off the street that has nothing, including no job.

Welcome to the “Stick it to me” bracket on the income scale.

There is no help for you in your present situation, sorry. Been there, done that.

You might shed you identification papers, go to the ER and pass out in the lobby from extreme abdominal pain. When you regain consciousness, feign amnesia but do not forget the pain. They have no choice but to admit you, repair you and set you free at absolutely no cost to you.

There are people in this bracket that actually commit a crime so they are jailed and then get the medical help they need, how sorry is that?

I wish I had more than a tongue in cheek answer but I don’t.

Good luck, have you tried appealing to the Ins co. On occasion they will actually listen to complaints and give in, but it’s not easy nor fast. See if your insurance has an appeals process and begin that.

Snoopy's avatar

@pekenoe Should you find yourself in this unfortunate situation again please talk to your doctor and/or the hospital. Explain that you would like to pay the average rate that they receive from the insurance companies….they may very well be willing to work w/ you….

The worst they can do is say no…

Just to give you some more info…as an example assume a surgery took place. Insurance Co A pays $100, Insurance Co B pays $125 and Insurance Co C pays $175. To capture the max amount from everyone, the hospital will charge all of them $250…..and “write off” $150 for Co A, $125 for Co B and $75 for Co C.

The person who is uninsured/self pay gets the short end of the stick and gets charged $250, as you can only have one fee schedule.

Understanding the above might be helpful in negotiating down your bill. It is possible and it does happen.

AlfredaPrufrock's avatar

Actually, there are several ways to address this issue. The first is to ask the doctor to join the Blue Cross/Blue Shield network prior to seeking treatment. With a PPO plan, the charges for in-network (participating) providers is much lower than out-of-network (non-participating) providers. When a doctor agrees to join a network, he agrees to accept payment at a contracted rate, in exchange for the volume of business that accepting the insurance generates.

The second thing that you can do is to call or write Blue Cross/Blue Shield and ask for a claims review. If this is truly the only doctor in your area capable of treating your medical condition, and there is not a doctor in your network that is comparably credentialed and can provide comparable care, then often the claim will be paid at the contracted rate.

The most important thing that you can do, especially if you have complex medical issues, is to read your certificate of coverage. This is your contract with the carrier, and details what is covered and how charges are paid. Most carriers have your certificate on their website, in their secured member communications area. There should also be a provider directory on the site as well. When money is an issue, be sure to ask if a provider accepts your insurance before making the appointment.

Have your surgery at a covered center. These will be listed in the directory. Be aware that when you have these types of procedures, you may be billed for more services than initially quoted, like a surgical assistant. Your carrier should be able to help you determine how to receive the care you need.

pekenoe's avatar

@Snoopy Thank you, armed with that information I possibly could have saved a lot of money. Not useful now but hopefully it helps curious.

It’s a bad situation to be in.

Snoopy's avatar

@AlfredaPrufrock I think your second and third points are great info…

As to the first…it would be highly unusual for a doctor to not already be a part of every panel/insurance plan that he/she can be in….insurance plans will occasionally be “closed panel” meaning that they only have a limited number of doctors in any given geographical region that are allowed on a particular plan.

AlfredaPrufrock's avatar

@snoopy, but if that’s the case, then the g & a process would kick in, and coverage would most likely be granted based upon limited access to care.

jessturtle23's avatar

I would spring for better insurance and wait until it kicks in. I pay a little over a hundred bucks a month for mine and after my $1500 deductible was met, my surgery I just had to remove my endometriosis was paid for in full. There is no point in paying for insurance if it won’t cover anything. I learned this lesson when I was in a boating accident.

Snoopy's avatar

@AlfredaPrufrock g & a = ?

@jessturtle One caution there would be the concept that if you had the problem prior to obtaining the insurance, the new insurance company might be unwilling to pay for anything directly related to that particular problem….

AlfredaPrufrock's avatar

Grievance and appeal

Snoopy's avatar

@AlfredaPrufrock Ahhhhhhhh. Well good luck to whoever wants to give that a go…..more power to them.

Not to sound cynical, but I would believe that process to be a shot in the dark at best. But, anything is worth a try! :)

cooksalot's avatar

I found out that my credit union does HSA, and FSA’s. That’s Health Spending Account, and Flexable Spending Accounts. The way it works is it is set up to work in conjunction with your current health insurance. What ever the insurance doesn’t cover you can use the savings account for. Now you set it up and then they withdraw a specific amount that you decide on from your paycheck each check prior to taxes. That way it doesn’t effect your check as drastically. Then you use this account with a debit card for what ever medical expenses you have. Not all banks or credit unions have this but it is something you could look into.

jessturtle23's avatar

@cooksalot That is a really good idea.

swfpdx's avatar

It is not impossible to find physicians who will discount for high deductibles, co-insurance or self pay patients. I would not be shy about asking. You don’t know unless you ask. I have worked with physicians for many years as an administrator. I have seen docs who will not budge and docs who will cut everything in half because the patient asked. It is more difficult if you let it get to the collections stage. The doctor will be less likely to write anything off at that point. You may think that the docs are out of the loop, but many want to review every chart for discounts or write-offs so that they can make decisions on a case-by-case basis. Good luck to you. Endometriosis is a very painful condition. I hope you find a way to get the help you need.

AlfredaPrufrock's avatar

You can have a flexible spending account with any type of plan. The money that you put into the account must be used up during your plan year, or you lose any money left over. A HSA, health savings account, carries the money forward, and any unspent money is yours, like a retirement account. You must have an HDHP plan in order to make contributions to an HSA account.

I work for a health insurance company, and this is my first year on a HDHP plan. My contribution to the HSA is equal to the amount of the annual deductible. In other words, I’m saving enough money to pay all of my deductible out of that account, if I need to. The way a HDHP works is when I seek medical coverage, I am responsible for paying all of the doctor’s charges (there is no copay amount). For example, I had to have an ingrown toenail removed. The doctor’s bill included $270 for the surgery, $65 for the first office visit, $65 for the second office visit, and $90 for the lab biopsy fee. I paid the network discount rate for these services. Instead of $490, my out-of-pocket was approximately $300. I paid the bill with a debit card, drawing money out of my HSA to do so. My HDHP has a $2000 deductible, so I paid $300 of the $2000 I’m responsible for. If I use $1700 more in medical services, then anything after that is covered at 100%. If I don’t use the money, the balance carries forward. I can use the money for prescriptions, vision, dental, even over-the-counter medications that are FSA eligible. My HSA account has roughly $1,900 in it.

Flo_Nightengale's avatar

I guess I remember a better time in healthcare. There was a time when we paid the doctor for the visit and hopsital care was paid 80% by the insurance compnay and the patient was left paying 20%. The idea of healthcare was to provide help and nothing more. It was never intended to pay complete costs. I remember paying for dentist appointments and the doc allowed to pay on a weekly or monthly basis. I have seen so much progress in heathcare over the years and where did it get us. I am headed toward the Hospice Shute ! I hope things work out for you. Some of the flutherites gave very good suggestions.

Strauss's avatar

@Flo_Nightengale Those were also the times when the idea of insurance was to spread out medical costs over the pool of policyholders, not make profit for the shareholders.

Dr_Dredd's avatar

@AlfredaPrufrock I didn’t think they allowed you to carry anything over from year to year. I thought there was some tax laws against it.

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