Every week, The Pink Fund receives inquiries from breast cancer patients asking for help in paying the co-pays for their medical bills.
Being in treatment is stressful enough without the daunting deluge of bills arriving in your mailbox, reminding you of every aspect and cost related to saving your life. And while The Pink Fund does not provide financial aid for medical co-pays of any kind (our funding is limited to basic cost of living expenses), we do advise patients on ways they can negotiate, lower and pay off co-pays over time.
Here are some tips to help you navigate this minefield:
By Laura Riley, Esq
When dealing with a serious medical condition like cancer, it might seem like medical bills will never stop pouring in. And unfortunately, once you receive treatment, you (along with the help of any insurance coverage that you might have) are typically responsible for paying for any costs associated with that treatment. However, there are a few things that you can do to ensure that your provider charged the correct amount, that your insurance company has covered the correct amount, and that the amount you are being told you are responsible for is correct. Figuring these amounts out can be confusing because you may receive a bill from the provider before you receive the Explanation of Benefits (EOB) from the insurance company. It is a good idea to wait for the EOB before paying the bill so you know what you were charged and what the insurance company paid. If you do not receive an EOB, contact your insurance company for a copy.
Here are some strategies for reading and negotiating your medical bills:
- Review, Review, Review Your Medical Bills: Many medical bills contain errors or items that are overpriced. Also, sometimes insurance companies will incorrectly deny coverage and the provider will send you the bill. You can appeal that decision through your insurance company’s internal appeals process or your state’s external medical review process.
- Request a Copy of the Medical Record and Pharmacy Ledger: The pharmacy ledger shows all the drugs you were given. The pharmacy ledger, along with their medical records, can give you a complete picture of your hospital stay so you can compare the medical records and the pharmacy ledger to the itemized hospital bill. Additionally, check for procedures or medications that were ordered, but then cancelled.
- Compare the Bill to the Hospital’s Standard Charges: Some states require that hospitals make their standard charges, regardless of payer type (e.g., private insurance, Medicare, Medicaid, etc.), available to the public for all products and services. This document is typically called the “charge master.” Patients can compare their bills to the hospital’s standard charges to make sure they are not being over charged.
- Look for Items Billed Due to the Hospital’s Negligence: Generally, when a hospital makes an error, the patient usually pays for it. For example, if an x-ray is lost or the results of a blood test are misplaced, those procedures will be redone and the patient will be billed a second time. You can challenge these charges.
- Hire a Professional Bill Reviewer: If you try the techniques above, but still think the bill is too high, it might be time to call a professional bill reviewer, also known as a claims assistant professional.
- Negotiate a Payment Plan: Setting up a payment plan with providers can be a good option when (1) the charges are legitimate, (2) you can make the payments, and (3) the debt will eventually be paid.
- Dispute Items that You Believe Your Health Insurance Company Should Have Paid: Call the plan to determine the reason for nonpayment. The health insurance plan may have refused to pay the bill because of a mistake on the bill. If you are able to resolve the error, follow up with the health care provider and health insurance company to make sure the bill is paid and that your account is cleared. If you are unable to resolve the issue, and you disagree with a decision that their health insurance company has made regarding their coverage, you have the right to appeal that decision. For more information about appealing decisions in your state, contact the Cancer Legal Resource Center at 1-800-THE-CLRC (866-843-2572) or CLRC@LLS.edu.
There are also financial assistance resources available to help pay medical bills. These include:
- Private Financial Assistance Programs: There are many private financial assistance programs that help patients with expenses, such as Salvation Army, Lutheran Social Services, Jewish Social Services, and Catholic Charities. Look for programs that serve your local community.
- Nonprofit Programs: Nonprofit organizations such as the American Cancer Society, LIVESTRONG, and the Patient Advocate Foundation also provide financial assistance for various types of treatment-related expenses.
- Cancer Specific Programs: Some programs focus on assisting patients with a certain type of cancer, such as the Leukemia & Lymphoma Society, American Kidney Fund, and Lung Cancer Information Line.
- Government Benefits Programs: Government benefits programs include state disability insurance benefits (depending on the state), SSI and SSDI. These programs provide people with income while they have a qualifying disability and are unable to work. Please note that the eligibility requirements for these programs vary, and not all programs have income and asset restrictions.
- Local Service Organizations: Local service organizations such as Kiwanis, Rotary Club, or Lions Club may also provide patients with financial assistance.
For credit counseling information:
Consumer Credit Counseling Service (CCCS) (800) 873-CCCS or http://www.cccsintl.org
For assistance with tax preparation:
Volunteer Income Tax Assistance (VITA) (800) 285-2221 or http://www.abanet.org/lsd/vita
For more information about these topics, visit www.CancerLegalResourceCenter.org or call the CLRC’s National Telephone Assistance Line at 866-THE-CLRC (866-43-257
(Laura Riley is a Staff Attorney at the Cancer Legal Resource Center, a joint program of the Disability Rights Legal Center and Loyola Law School.
Ms. Riley graduated from Barnard College, Columbia University with a B.A. in English, where she completed a Guggenheim Fellowship and was a Mellon Minority Undergraduate Fellow. Upon graduation, Ms. Riley worked in public relations at Time Inc. for three years before heading to the west coast.
Ms. Riley attended USC Gould School of Law, where she was President of the Public Interest Law Foundation and Co-Editor-in-Chief of the Los Angeles Public Interest Law Journal. She comes to CLRC after working for Judge Patrick Robinson, President of the International Criminal Tribunal for the Former Yugoslavia.
Ms. Riley currently serves on the pro bono committee of the Los Angeles County Bar Association and continues to volunteer in the community.)