Medical issues can land anyone, at any age, in any state of health, into the American medical system. The system consists of private and public insurance providers, hospitals and often affiliated medical groups, physicians and surgeons, and other healthcare practitioners.
Among all of these entities are arcane billing practices, in and out of network providers, out-of-pocket expenses, deductibles, who is ill or injured, frequently sidelined from work or school and usually overwhelmed by trying to figure out what they owe and to whom.
Sometimes simply viewing a bill from a hospital or practice is highly confusing, except for that little line at the bottom which may contain a five or even six-figure number.
“But I Have Insurance!”
Let’s lay it out straight.
Balance billing is not allowed if you are being billed over and above Medicare or Medicaid or the insurance agreement that the provider has with the provider, facility, or hospital. However, balance billing is allowed when you are using a provider who does not have agreements with Medicare, Medicaid, or your insurance provider.
billing is also allowed when you are having treatments, procedures, or services outside the scope of your agreement with Medicare, Medicaid, or your insurance plan. You may also be billed for an ambulance and other transportation charges.
The Affordable Care Act requires all health plans without that have not been grandfathered in to provide coverage for out-of-network emergency care even when the plan does not provide out-of-network coverage. Moreover, in Florida, had previously banned balance billing HMO patients, and the law currently covers all HMO, PPO, Medicare, and Medicaid plans. If you are on any of these plans and are being billed for out-of-network care, you need to see an attorney to make sure that the matter is brought to the biller’s attention and remediated.
“But I Don’t Have Insurance!”
This is a problem. Even young and healthy people have accidents and illnesses. However, saving a small amount per month by not having insurance is blown out of the water by not being able to pay the hospital bill, or follow up care.
If you are uninsured and facing medical expenses, then your best bet is to work with the hospital to see if you qualify for financial aid or to negotiate your bill. If your expenses are ongoing, such as with treatment for chronic diseases, and you don’t make enough to afford the insurance that you need, then applying for Medicare (if you are 65 or older) or Medicaid can help to get you the care that you need.
Florida, Transparency, and Rolling Over and Playing Dead
There’s not much in the world that is less transparent than healthcare pricing – and that includes prescription drugs. It costs money to run a hospital or a practice, but at the same time, people need to know what costs actually look like before they have a procedure. In the case of emergency medicine, nobody’s seriously going to stop the gurney and give the patient a price sheet. Hospitals are required by federal and Florida state law to post their prices – called a chargemaster sheet – but don’t say how they arrive on the prices presented. Also, the price on the chargemaster sheet may not reflect the patient’s final cost.
Unfortunately, there are some bad apples in the transparency barrel who have technically complied with the law – such as posting a chargemaster list that is machine-readable only.
They say that the final bill is always discounted, but without a baseline to work from how are we supposed to tell? Let’s face it, if full-time investigative journalists at the Orlando Sentinel are having a tough time of it, the patient will, too.
“But, Chad, what if I Can’t Pay My Hospital Bill?”
And we circle around back to this because sometimes there’s just no way for you to pay, or the bill has gone into collections. You’re trying to keep a roof overhead, food on the table, and the power on.
There are several approaches to consider aside from not picking up the phone when the collections agency calls.
- Hire a medical billing advocate. Medical billing advocates gather your insurance company EOBs, medical records, and medical bills, then look for errors, overcharges, improper denials, and billing discrepancies that can raise the costs of your bill.
- They also work with the provider billing advocate to reduce costs and work out a payment plan. These professionals are best for large bills, multiple bills from multiple providers, and ongoing medical bills. The downside is that they charge hundreds of dollars.
- It’s unfortunate, but around 66 percent of bankruptcies are due to medical issues. The high bills are just one part of the picture as time off work and lost jobs contribute to a financial crisis. Bankruptcy is not the big, bad b-word, but a way to deal with insurmountable debts either through liquidation (Chapter 7) or through restructuring (Chapter 13). It is, admittedly, the last resort, but one that needs to be on the table before the finances spiral out of control.
- Wait it out. Florida has a statute of limitations on medical debt. Even if the medical bill goes to collection, medical debt is time-barred – meaning that if the debt is older than five years, the collector does not have the standing to sue. You will still owe the debt and it will be on your credit report, but you can’t be pursued for it in court.
- Medicaid will pay retroactively pay for three months of bills for approved applicants.
- There are also many ways to defray the costs of a baby’s stay in the NICU. Parents of NICU babies may be eligible for supplemental income for the length of the little one’s hospital stay.
- Medicaid can also become a secondary provider along with your insurance, or sole provider if the little one is not on your insurance for as long as their first year of life.
We Can Help!
Since 2009 Van Horn Law Group has been here to help South Floridians through the tough times. Our experienced attorneys and staff handle all kinds of debt, not just bankruptcies. We are the largest bankruptcy practice in Broward County, and even if you don’t opt for bankruptcy we can help you deal with your debt and rebuild your life. Our offices in West Palm Beach and Fort Lauderdale are open six days a week and by appointment on Sunday. Even better, your first consultation is absolutely free. We pride ourselves on treating people with compassion and respect and getting the best possible result to put in and to financial worries on everything from foreclosures to student loans to medical bills to credit card debt. All you have to lose is the sleepless nights and anxiety – call us today.