Drowning in medical bills - any advice appreciated

[jandel]

I apologize in advance - this could get lengthy.

We are in deep trouble with medical bills piling up. We have BCBS thru hubby's work but it seems that fighting with the insurance company is becaoming a full-time job for me. We have a $1250.00 per person copay and then they will pay 80% up to a maximum out of pocket expense of $5000.00, and then they will pay 100%.

Last month, Dh was taken to the ER with a suspected heart attack. After two days in the cardiac care unit and numerous tests it was determined not to be a heart attack but a pulmonary embolism (blood clot in the lung) instead. He was transferred to a regular room for a couple more days then released with very expensive medications. One co-pay was over $200.00 and that script was refilled twice.

Fast forward 7 weeks later and he is still on medical leave from work (paid thank goodness) because even though his primary doc is willing to let him go back with restrictions his employer says he can't come back til fully released. I guess they'd rather pay his full salary for him to sit and home???

His hospital visit alone was over 20K. Charges for lab tests, intern visits and other misc charges are still coming in. It would take a brain like Stephen Hawking to decipher all these bills. I've been trying to match up the insurance explanation of benefits sheets with the bills but half of them do not match at all. HUGE RANT - why can't the billing be simplified to make any sense at all? Would it be so difficult to get streamlined billing in plain english?

So then, in an attempt to find out the cause of the PE, DH has had to see a cardiologist and a pulmonologist. The cardiologist had him do a nuclear/chemical stress test because he didn't think an ordinary stress test was a good idea with the clot (which I just received a letter today from BCBS that that claim of $1700.00 was going to be denied - wth? How can you deny a test if a specialist deems it necessary?).

Went to the pulmonologist yesterday and he says his lung function is fine, the clot has probably desolved by now and by the way, does hubby snore and could he possibly have sleep apnea? Turns out that this pulmonologist is affiliated with a sleep center and according to him everything that hubby has wrong with him - type 2 diabetes, chest pain, slight weight gain over the years, borderline high blood pressure, etc INCLUDING the blood clot, is a direct result of sleep apnea. So now he wants to schedule a sleep study. Call me paranoid, but something just doesn't seem right here. (As a side note and a shout out to the wonderful DIS'ers here -when filling out info at this dr.'s office they asked for info on me as a spouse, name addy, phone, birthdate and SS #. I just about flipped out! I wasn't even the patient, DH was the primary insured and they wanted MY ss#??? Thanks to you guys we left it blank and when the receptionist questioned it I gave her an earful about HIPPA, identity theft, etc. She probably thought I was nuts but she just smiled and said never mind...go figure!)

I'm so grateful that we have insurance but I must admit I get a teensy bit jealous when I hear of people who don't have it getting their medications for free or ir medical bills wiped out.

Anyway, to sum this up: We currently have over $7000.00 ( and climbing every day) in outstanding medical bills. We can pay some of the smaller ones outright, like the ones for a couple of hundred or less. My question is - what to do about the high-dollar ones? Can we just send in what we can afford every month and will that keep us out of collections? We have one credit card for emergencies that we keep zero balance but is is only a 5k limit and we would like very much to keep it that way. Our budget is pretty much set in stone with only two to three hundred discretional money left over each month and that is usually put into savings.

Between the stress of hubby's illness and all the other crap going on in our lives right now I am at my wit's end and just need a break. Any suggestions you guys have wuold be great.

thanks - Lisa

 

[wdwmaw]

I don't have any advice but send you our thoughts and prayers.

 

[Disney_Freak56]

I know this is very overwhelming. Take a deep breath.

You state that the most you have to pay out of pocket is $5,000. The rest should be picked up by Blue Cross, except maybe the one charge they are disputing. I believe you can ask them to reconsider that. It may be that someone did not get a pre-approval from Blue Cross -- not sure if there's anything you can do about that at this point though.

As far as the bills you will have to pay, once you receive your first billing statement from a particular provider/hospital/lab, etc., decide what you can afford to pay towards the medical bills. Contact each one and speak to someone in either accounting or their billing department. Tell that person you would like to make payments on your account. Do not just send in whatever you feel like as it definitely looks better to them if you call and set up a payment plan with them. Once you set up the plan, stick to it. If someone tells you that they can't accept payments for past due accounts for more than 90 days, then tell them that you can't possibly afford to pay it off in 90 days that you can pay it off in 6 months, 9 months, or whatever it will take (according to your budget). Most billing dept. are very nice and very flexible, but someone will try to shorten your paying time. Stand your groound, if at all possible, and they will usually cave as a partial payment with an eventual zero balance is better than no balance at all.

I've heard that once an account is turned over to a collection agency, the doctor or hospital will only receive half of what they collection agency can get out of you. this may nor may not be true. some collection agencies will buy the debt at a fraction of a cost and then harass someone into paying the full amount.

I'm so sorry this happened to you. I, too, have Blue Cross and have the high deductible plan which means I have basically the same out of pocket expenses that you have, but don't have to pay the higher premium for the low deductible plan which I believe is what you must have.

Good luck!

 

[amez]

We've had a horrible year with medical bills as well. Contact the hospital about setting up a payment plan-we've been in ER in three different hospitals and each of them have worked with us. If it is over $300 they will let you pay it off over 12 months. They also have credit counselling and if you fall within their guidelines they may help you out of some of the bills as well.

 

[disneyfan007]

My husband has had issues over the year. I agree with the previous poster about the payment plans. But first check with the hospital and see about getting paperwork for financial assistance from the hospital. You might be able to get some of that written off. We thought we would never qualify because we made semi-decent money, but got a huge portion written off. Then payment plans were set up on the balance that was owed.

 

[Mrs. Bradbury]

Oh boy, do I feel for you. We had a situation with my daughter that resulted in tons of medical bills. And although I had heard that doctors and hospitals were always willing to work with you, in my experience they wanted their money NOW. Complicating the fact was that my daughter was in numerous hospitals with multiple doctors and treatments and no one seemed to connect that taken together, we couldn't give everybody what they wanted $ wise.

My first advice for you is to get ready to fight with the insurance companies. We have BCBS as well and I'm fairly certain the deny almost everything the first time just to see if they can get by with it. You'll need to call them and find out why it was denied and then work with the provider to get it paid. And you have to really stick with it. I made a spreadsheet to keep track of all the bills (scrips toos) and what the status was, because it was way too much to keep in my head. Then I would send letters to the providers and enclose a copy of the spreadsheet - that explained things in technicolor.

My second piece of advice is to get ready to consider this a second job. It takes a lot of time, and if I had lots of money I wouldn't have pursued it so doggedly, I would have just paid the bills.

Get ready to learn your medical benefits booklet backwards & forwards, because you are going to have to make sure your insurance company covers what they say they will. It's a shame to have to do that; I mean, you pay premiums and expect customer service. It's like going to a restaurant and paying for your entree and having to go back in the kitchen & cook it, too.

And lastly, put down your burden every once in a while. Before I realized it, the medical debt situation was consuming me - and all the while I still had a sick child, a full time job, other kids and a husband, too, who needed and deserved my attention. It's tough to find a balance, but try. And take care of yourself, too.

Good luck and I hope your husband's condition is easy to treat.

 

[leebee]

OP, our health insurance is through Harvard Pilgrim, but deductibles, oop, partial payments, etc. are similar to yours. Last year was a terrible year: DH had a lump in his scrotum, DD had her tonsils out, I had extensive tests for what turned out to be nothing, and we were awash in medical bills. I simply called the hospital (where the majority of the charges were) and asked them to put everything into one account and said I could pay them $150 a month. They were more than happy to do this, and I had picked an amount I was sure I could keep up with, so they were paid regularly. I am still paying, but there was no way we could do it all at once, and there's no interest charged by setting up a monthly payment with the hospital (unlike putting the balance on a credit card). This never effected our credit rating, we never ended up in collections, etc. Keep after BCBS, they will do what they can to get the most $$ out of you, like any insurance company. Talk with the guys who you owe a LOT to, explain the situation, and know ahead of time how much you can reliably pay every month. It'll work out... it's a long haul, but it'll work out.

 

[Helene]

Talk with the billing department at the hospital. You could try going in person and have someone in the billing department review the EOB's and explain any questions you have. Your max OOP should be the $5000...is the other 2k related to his meds??

Our community hospital now deducts 25% off of what they are owed as long as you enter into a payment plan. I've taken advantage of this twice last year due to having a high deductable plan as well.

Good luck and

 

[lastminutemom]

We have BCBS as well and my husband had that fancy stress test this week. Our out of pocket for it was nearly $1000. That was our deductible for it, not real sure why it was so high, but it is a pricey test.

I would appeal that. Your doctor's office can help you with that.

Make sure the problem isn't that the insurance company is slow to pay. Are you certain that you need to pay some of those bills.

I would have each biller resubmit again each bill. Since your out of pocket is to be capped at $5,000 I would push BCBS hard.

 

[apnep]

Hi,
First off, I'm so sorry about the pulminary embolism your DH had. My DH ended up with one a couple of years ago after having knee surgery. I feel your pain.

Second, I agree with another poster, take a deep breath and calm down. After you have done that, go over your medical benefits again.

It sounds like what you have is a medical plan that has a $1250 deductible per person. That means you are responsible for everything up to $1250 before BCBS will pay anything. After you have paid your deductible of $1250, they will pay 80% of the bill and you have to pay the other 20%. You will pay 20% until you have reached $5000 and then they will pay 100%.

Now, I don't know all the benefits BCBS offers but that is usually how benefits and deductibles work.

YOU have to keep track of how much you have already paid out. If you have already paid $1250, you have to be vigilant about making sure BCBS pays their 80% AND making sure the hospital and doctors understand that you've already paid your deductible. The portion you should pay would now be 20%.

Go over your bills that come in, and before you pay a cent out, make sure BCBS has paid their portion. Make sure you understand what is covered and what is not even if you have to call a bajillion times. Sometimes it takes a while for records to get updated. I know it is alot, especially when you are trying to get DH better, but if you are not vigilant, you will get screwed. Good luck, hope DH heals fast.

Angela

 

[Kay1]

It sounds like you have a lot in savings. I would use that before picking up the credit card.

Good luck to you and your husband.

 

[apnep]

You'll need to call them and find out why it was denied and then work with the provider to get it paid. And you have to really stick with it...

Yes, sometimes providers don't use the right billing code. I would definitley call BCBS and ask why it got denied--maybe it's a billing code issue and you can get the doctor to bill it differently.

Get ready to learn your medical benefits booklet backwards & forwards, because you are going to have to make sure your insurance company covers what they say they will.

Yup, know it backwards and forwards and truly understand how to use them!

By the way, sometimes hospitals will offer you a percentage off the total bill if you can pay it all at once. I was able to get a 20% discount on our bill by paying it all at once and saved quite a bit. Maybe you can find yourself a 0% interest credit card that will give you a year to pay it off at no interest? Just make sure the insurance has already paid their part and don' t let them get away with denying your claims!

 

[mhsjax]

Hospitals are wonderful about setting up arrangements. I know, I have several. Hubby also had a heart attack and then knee surg, and a whole list of other medical problems with other family members. Anyway, just call them, you may have the bill around for a while but they don't charge interest and they just take out our predetermined amount each month out of our checking acct. No problems what so ever.

I also worked for Drs for years, and as long as the patient made arrangements and made their payments, we had no issues what so ever.

I think someone said something about you putting it on a credit card. Please don't, like I said the hospital wont charge interest, the CC will.

 

[DisneyAndRedSox]

First...

Second- if there are any bills that you can pay immediately, ask if they have a prompt pay discount. UMass Memorial in Central Mass has a tiny litte line at the bottom of the bills that says "call this number for a discount if you pay in 30 days" (note- you have to call, they don't automatically discount if you pay in 30.) You get 20% off the charges you are responsible for! I saved a ton off my ear surgery!

 

[SunnieRN]

Please forgive the rant. I work in a hospital, have BCBS through my employer, the hospital. I have several health problems. I have to go to another hospital system for my care. Why? Because the specialists, associated with the hospital in which I am employed, refuse to take our hospital insurance.

I care for these Doctors patients every night when I work, but can not be seen by them as a patient. I told my supervisor about this, she didn't believe me, asked the doctor, who confirmed that it is true.

I have several thousand dollars of medical debt that I am paying. I know this sounds crazy, but at this point, I feel I would be better off on disability/medicare. That is a sorry state of affairs and a glaring shortcoming in our medical system.

Before you start blaming hospitals, you have to understand insurance companies and look at the situation in the same light as farmers, consumers and the middle men. This is how the insurance companies work. For the most part they are who drive the medical prices. I was an OR manager and was responsible for billing. What it says on a bill (ie:: the $20 tylenol), is for the cost of the product, pharmacist, nurse administration etc. An insurance company reimburses a hospital about $.25-$1.00. The hospital overcharges, due to insurance company payments.

The argument can be made, that there should be truth in billing, but there should also be truth in reimbursement amounts vs what the hospitals costs truly are. For example, a pharmacist is responsible for checking allergies the patient has, possible drug interactions of ALL the medications the patient takes, dosing/safety requirements, side effects, etc.

A nurse doesn't just get the pill and hand it to you, but has to check the doctor order, time of last administration, record the medication, observe for side effects, effectiveness (pain medications) and monitor the patients condition. It does take time and that is what the hospital is billing.

You may notice that MANY independent and small hospitals have been closed, acquired by conglomerates or scaled back services severely. I have not seen medical insurance companies suffer the same fate.

Sorry for the long rant. OP, call the hospital billing department and ask if they can cut the $$ amount you owe for your copay. Some hospitals will do so. If not, talk out a payment arrangement. (((Hugs)))), I hope and pray your husbands medical issues are resolved with treatment.

 

[kwnancy]

We've had numerous hospital bills as well throughout the years. The best advice I ever received was to NEVER pay a medical bill with a credit card.

It sounds like your DH's hospitalizations were fairly recent. Don't be in a hurry to pay the hospitals or doctors. Many times it takes a few months for the insurance payments to be posted. Keep excellent records of your phone conversations/emails. Question every charge on the billing. You may need to request an itemized billing from the hospital. Most of the hospital bills are a summary billings only.

If a claim is denied, contact the provider (hospital or doctor) and ask for a review and re-submission of the claim. Many claims are denied due to billing coding errors.

Good luck to you.

 

[disney1990]

I apologize in advance - this could get lengthy.

We are in deep trouble with medical bills piling up. We have BCBS thru hubby's work but it seems that fighting with the insurance company is becaoming a full-time job for me. We have a $1250.00 per person copay and then they will pay 80% up to a maximum out of pocket expense of $5000.00, and then they will pay 100%.

Last month, Dh was taken to the ER with a suspected heart attack. After two days in the cardiac care unit and numerous tests it was determined not to be a heart attack but a pulmonary embolism (blood clot in the lung) instead. He was transferred to a regular room for a couple more days then released with very expensive medications. One co-pay was over $200.00 and that script was refilled twice.

Fast forward 7 weeks later and he is still on medical leave from work (paid thank goodness) because even though his primary doc is willing to let him go back with restrictions his employer says he can't come back til fully released. I guess they'd rather pay his full salary for him to sit and home???

His hospital visit alone was over 20K. Charges for lab tests, intern visits and other misc charges are still coming in. It would take a brain like Stephen Hawking to decipher all these bills. I've been trying to match up the insurance explanation of benefits sheets with the bills but half of them do not match at all. HUGE RANT - why can't the billing be simplified to make any sense at all? Would it be so difficult to get streamlined billing in plain english?

So then, in an attempt to find out the cause of the PE, DH has had to see a cardiologist and a pulmonologist. The cardiologist had him do a nuclear/chemical stress test because he didn't think an ordinary stress test was a good idea with the clot (which I just received a letter today from BCBS that that claim of $1700.00 was going to be denied - wth? How can you deny a test if a specialist deems it necessary?).

Went to the pulmonologist yesterday and he says his lung function is fine, the clot has probably desolved by now and by the way, does hubby snore and could he possibly have sleep apnea? Turns out that this pulmonologist is affiliated with a sleep center and according to him everything that hubby has wrong with him - type 2 diabetes, chest pain, slight weight gain over the years, borderline high blood pressure, etc INCLUDING the blood clot, is a direct result of sleep apnea. So now he wants to schedule a sleep study. Call me paranoid, but something just doesn't seem right here. (As a side note and a shout out to the wonderful DIS'ers here -when filling out info at this dr.'s office they asked for info on me as a spouse, name addy, phone, birthdate and SS #. I just about flipped out! I wasn't even the patient, DH was the primary insured and they wanted MY ss#??? Thanks to you guys we left it blank and when the receptionist questioned it I gave her an earful about HIPPA, identity theft, etc. She probably thought I was nuts but she just smiled and said never mind...go figure!)

I'm so grateful that we have insurance but I must admit I get a teensy bit jealous when I hear of people who don't have it getting their medications for free or ir medical bills wiped out.

Anyway, to sum this up: We currently have over $7000.00 ( and climbing every day) in outstanding medical bills. We can pay some of the smaller ones outright, like the ones for a couple of hundred or less. My question is - what to do about the high-dollar ones? Can we just send in what we can afford every month and will that keep us out of collections? We have one credit card for emergencies that we keep zero balance but is is only a 5k limit and we would like very much to keep it that way. Our budget is pretty much set in stone with only two to three hundred discretional money left over each month and that is usually put into savings.

Between the stress of hubby's illness and all the other crap going on in our lives right now I am at my wit's end and just need a break. Any suggestions you guys have wuold be great.

thanks - Lisa

Every time something is denied; don't pay it; appeal it. Sometimes it take one appeal, sometimes it take 2, 3 or 4 appeals. But 99% of the time, I have had the insurance company cover whatever charges I have appealed. Don't give up -- keep trying. Remember, you have nothing to lose by continuing to appeal.

 

[ldo]

appeal all denials--esp. the $1700 nuclear stress test. Get the Dr. to write a letter that it was medically necessary--also talk to billing office. Also, do a search on the web--I believe that BCBS in some other states covers this. For, example, if you do a search for Anthem BC in VA, you would probably find that it is covered--let billing office know this, so they can call BC and discuss with them. If you can arm yourself with some states in which BC covers this, you have a better chance. Also, call your state insurance commissioner and complain politely, esp. if you have evidence that in other states it's being covered, then follow up with THAT person with a letter--they might make a call for you and get the test covered.
Lastly--you can die from pulmonary embolism--be thankful he recognized that he was in distress and went to hospital and had a good outcome! Elaine

 

[Chelley00]

From Jan 1st - March 8th, I racked up $129,000 in medical bills. We also have BCBS and I had to fight them on a mistake on an EOB where they charged an amount as a copay and it shouldn't have been, and even then, it should have been paid since we have reached our out of pocket maximum.

This was in addition to a large bill we are paying on for some testing for DS last year. I called the hospital we used, and they were great about setting up payment plans. Our hospital actually is automated, you don't even have to talk to someone...just push the correct buttons.

One time I did talk with someone there, and when she looked at our the amount we owed them, she asked some questions, said she could write off some of one bill, and then said she could offer me a deduction if I could pay a smaller bill in full.

Thankfully, even the majority of the doctors, specialists and labs were more than willing to take a payment plan too. They want their money, so they are willing to work things out with you.

Just make sure to set up a plan and stick with the due dates. If you can't make one, call and let them know. Good luck!

 

[tinkmom2]

I agree with appealing it. We recently took a hardship loan from my DH's 401K. With the stock market the way it is he was loosing a lot of money. Taking the witdrawal puts a freeze on his funds for a year. We were able to take out enough to pay the medical bills down. Good luck to you!
Some hospitals will work with you on a payment plan that won't affect your credit adversely. If you have bills in collection, sometimes they will take a fraction of what you owe and forgive your debt.
It's pretty sad when people are forced into bankruptcy over medical bills.