How to avoid costly medical bills and get out of medical debt : Shots

How to get rid of medical debt — or avoid it in the first place

Patients and the consumer advocates say there are things people should do to try to avoid, or navigate, the medical debt trap. Financial assistance is available, but it all requires self-advocacy.

Lori Mangum was 32 when apple-sized tumors sprouted on her head. Now — six years and 10 surgeries later — the skin cancer is gone. But her pain lives on, in the form of medical debt.

Even with insurance, Mangum paid $36,000 out-of-pocket, charges that stemmed from the hospital, the surgeon, the anesthesiologist, the pharmacy, and follow-up care. And she still has about $7,000 more to pay.

While she was trying to manage her treatment and medical costs, Mangum remembers thinking, “I should be able to figure this out. I should be able to do this for myself.”

But medical billing and health insurance systems in the U.S. are complex, and many patients have difficulty navigating them.

“It’s incredibly humbling — and sometimes even to the point of humiliating — to feel like you have no idea what to do,” Mangum said.

If you’re worried about incurring debt during a health crisis or are struggling to deal with bills you already have, you’re not alone. Some 100 million people — including 41% of U.S. adults — have health care debt, according to a recent survey by KFF (Kaiser Family Foundation).

But you can inform and protect yourself. NPR and KHN spoke with patients, consumer advocates, and researchers to glean their hard-won insights on how to avoid or manage medical debt.

“It shouldn’t be on the patients who are experiencing the medical issues to navigate this complicated system,” said Nicolas Cordova, a health care lawyer with the New Mexico Center on Law and Poverty. But consumers who inform themselves have a better chance of avoiding debt traps.

That means knowing the ins and outs of various policies — whether it’s your insurance coverage, or a hospital’s financial assistance program, or a state’s consumer protection laws. Ask a lot of questions and persist. “Don’t take ‘no’ for an answer,” said Cordova, “because sometimes you might get a ‘yes’.”

Even people with health insurance can land in debt; indeed, one of the biggest problems, consumer advocates said, is that so many people are underinsured, which means they can get hit with huge out-of-pocket costs from coinsurance and high deductibles.

Here is some practical advice about facing down medical debt, at every stage of care and after.

Before You Get Care

Get familiar with your insurance coverage and out-of-pocket costs

Get the best insurance coverage you can afford — even when you’re healthy. Make sure you know what the copays, coinsurance, and deductibles will be. Don’t hesitate to call the insurer and ask someone to walk you through all the potential out-of-pocket costs. Keep in mind that you cannot make changes to your policy except during certain windows of time, such as open enrollment (typically in the fall or early winter) or after a major life event.

Sign up for public insurance if you qualify

If you’re uninsured but need health care, you might qualify for

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Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots

Jason Dean received six stitches and a tetanus shot after he cut his knee in May. In August, his wife, DeeAnn, feared going to the same emergency room where he was treated, delaying her diagnosis of Rocky Mountain spotted fever.

Blake Farmer/WPLN News


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Blake Farmer/WPLN News


Jason Dean received six stitches and a tetanus shot after he cut his knee in May. In August, his wife, DeeAnn, feared going to the same emergency room where he was treated, delaying her diagnosis of Rocky Mountain spotted fever.

Blake Farmer/WPLN News

Jason and DeeAnn Dean recently relocated to her hometown of Dellrose, Tenn., where she grew up on a farm. Both in their late 40s, they’re trying to start a green dream business that combines organic farming with a health and wellness consulting company. They want to inspire people to grow their own food in this fertile rolling farmland just north of the border with Alabama.

Until the business fully launches, Jason is working in construction. In May, he was injured on the job site when a piece of sheet metal slipped and caught him on the kneecap. He bled quite a bit. After closing the wound with a butterfly bandage, he thought that might be enough. But on his drive home, he figured it would be best to have a professional stitch it up.

It was late in the day, and the emergency room seemed the best option since his doctor’s office was closed. He and DeeAnn had opted for a health plan with lower monthly payments and a high deductible. So he knew the cost of care wouldn’t be cheap — and he was right. When the bills for thousands of dollars came, they were shocked. They were in the midst of fighting them in August when DeeAnn started feeling as bad as she has ever felt.

“I haven’t eaten. I’m not drinking. I have a horrible fever. I can’t get out of bed. I’m shaking,” she said.

She was pretty sure she had contracted COVID-19 — the delta variant was surging across the South. She was kicking herself for putting off vaccination. She got tested and the result was negative. The next day, she visited a doctor who said her condition was bad enough to go to the ER — but she regarded that option as financially perilous.

“That is fear,” said DeeAnn. “If they charged Jason this much, what would they charge me?”

She was terrified of a potential bill from the same ER in Pulaski, Tenn., that had treated her husband. So even though she was deliriously ill, she hit the road in search of cheaper treatment, asking her parents to drive her. They headed south. The first stop was an ER in Huntsville, Ala., but it was so full of COVID-19 patients that she would have had to wait all day. Then they drove north nearly an hour to Maury Regional Medical Center, a public hospital in Columbia, Tenn., where she was

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