Frederick McNulty, Finestra: Hey everyone. Welcome to the channel. I'm Frederick McNulty, Director of Content at Finestra. In this series, we're asking the most common questions about health care in the United States and hearing answers from certified experts.
Amethyst Storey: Hi, I'm Amethyst Storey. I'm a certified professional biller and I in the field for 17 years,
FM: Medical bills can be seriously expensive. It's many people's worst fear that they will receive a medical bill that they're unable to pay. Here's what you need to know. If that happens. When people go in for medical care, one of their worst fears is that they're gonna be hit with a bill that's too expensive that they can't pay. What happens if someone gets a bill that they can't pay?
AS: If someone gets a bill that they can't pay, the first thing that I would do is check your explanation of benefits that you receive from your insurer to make sure that the bill is correct. I, at that point, if it is correct, you should talk to your provider about setting up a payment plan. It's very provider specific as to what they'll accept for a payment plan, but they generally do have some kind of financial hardship paperwork in order to be able to set that up. If you really can't afford to pay the bill.
FM: If someone receives a bill that is too much for them to pay, is it possible to negotiate with a provider?
AS: It is possible to negotiate with a provider. If you get a bill that's too high to pay and you haven't used your insurance, if you have used your insurance and your deductible, your co-insurance or your co-pay is too high, your provider is not allowed to waive that per their contract with the insurance company. However, they can set up a payment plan with you so that it makes it a little bit more affordable. And then you can pay at each visit.
FM: So just to be clear, if you did not use insurance, then it is possible to negotiate. But if you did use insurance, then it's not even worth trying.
AS: That's correct. Due to federal and state laws, a provider is not allowed to waive deductibles, copays, or co-insurances. They can actually lose their contract for that. And you as a patient could actually lose your contract with the insurance company if they were to do that, but it is worth it. If you're not, not using your insurance or in some cases, if it's out of network, it's worth negotiating with a provider, because if you can't pay a bill, you can't really get blood out of a stone.
FM: What would you say the best way to go about negotiating a bill is?
AS: The best way to go about negotiating. A bill would be, if you're using insurance, I would call the insurance company and find out how much out of pocket you're going to be responsible for, to begin with. And then I would negotiate with the doctor prior to your first visit that way, you know exactly what you're gonna be expected to pay. And you have a payment plan in place. If you're using insurance, I would recommend the same thing. Find out what your benefits are. See if you're gonna be able to afford the patient cost, whether it be deductible co-insurance or co-pay. And then if you need to set up a payment plan with the doctor, I would suggest setting that up prior to your first visit.
FM: When someone receives a medical bill, ideally, they would be able to pay it as soon as possible. But sometimes that isn't possible. Sometimes they need to wait till their next paycheck drops. Sometimes they need to arrange the money. When are medical bills due?
AS: In most practices, they're usually due by the first of the month. However, if you're in a situation where that is just not possible, if you call your provider's office and you ask them to make a note of when you will be able to pay the bill, most providers are completely fine with that. As long as you're calling in to let them know what the situation is.
FM: In general, when are medical bills going to be considered overdue?
AS: Medical bills are generally considered overdue after a provider has sent you three statements with no response. In some cases, they will send you to collections after that, if you don't respond to their bills at all. So the best case scenario would be if you get the, to call the provider's office and to make arrangements so that they can put a note on your account and you don't end up going to collections, collections can affect your credit score and could cause you trouble in the long run. So you always want to let your provider's office know what your situation is and make the best arrangements that work for both the provider and yourself.
FM: If you work with a provider to set up a payment plan, does this affect your credit score in any way?
AS: No, setting up a payment plan with a provider's office will not affect your credit score in any way, unless you failed to pay a bill and they send you three more statements with no response medical bills, don't usually go towards your credit score unless you get sent to collections for nonpayment.
FM: In addition to people being unable to pay medical bills, a lot of times people are hit with surprise medical bills, and it's been in the news recently that Congress has taken steps to crack down on those broadly speaking. What does that mean for patients?
AS: So the act is called the no surprise act. It was put into effect on January 1st of this year, 2022 in general, it means that a patient that has insurance, but isn't using it or whose provider is out of network, a patient who's uninsured or a patient who goes to a house or a group that's in network, but is seen by an out of network provider needs to receive a statement that states what the maximum allowed they might have to pay might be three days prior to their first visit that eliminates them getting all these extra bills that they were not planning on. Having it also allows them a chance to budget for that.
FM: You mentioned that people are typically sent three statements before a medical bill is considered overdue. Could you elaborate on that a little bit?
AS: Generally a practice will send the first statement after they receive the explanation of benefits and or the payment from an insurance company. And then usually you'll get a statement most of the time on the first of the month, each month, following that. So for example, if a doctor received a statement from the insurance company today, you would receive your next bill on the first of the following month, and that would be considered the second statement. And then on the first of the following month after that, it would be your third statement.
Be sure to check with your doctor's office to make sure that they have an updated address and a phone number for you. Because if a provider sends statements out to an incorrect address, three times, they may send you to collections and they very well be that you never got the statement. So at each visit, you should check to make sure that all of your demographic information is updated with the provider's office.