Escape from Medical Bill Mountain….


It’s getting close… so close I can almost see it.  The month when I send my last payment to for the last hospital bill I am paying off.  For the last eleven and a half years, since Caitlin’s original diagnosis, I have been consistently sending money to somebody for some type of medical service – paying off infusions, physical and occupational therapy, orthotics, x-rays, MRI’s, psychologists, medications – whatever.

Let me just say first off – I Am Lucky.  We have great insurance through my job.  So despite the fact that I pay 20% of doctors and hospital bills (including infusions) – I feel extremely lucky that no medication, no treatment has ever been denied to us.  AND we have never had to wait for a hierarchy of approvals before access.  Whether or not we would be allowed by our insurance to follow our doctors prescription of treatment has never been an issue for us.  And I know that is a huge privilege and luxury… one that so many do not have.  More and more, people are having to take extreme measures to deal with medical expenses, as this recent article details.  We have never had to forgo a medicine because we could not afford to pay for it (though sometimes it takes us awhile!)

That being said – this is all some pretty expensive stuff.

I remember getting the first bill, after Caitlin’s five days in the hospital to get her disease somewhat controlled and get diagnosed.  I believe my share of that first stay was about $2400. Honestly – at that point, we were so shell-shocked with everything that had happened, the financial aspect had never even occurred to me.  I called the hospital in a total panic the day after I got the bill to beg for some type of assistance because I did not happen to have that much lying around waiting to be spent.  And I got my first lesson… the hospital was willing to negotiate.

“If you could send $500 now and $700 next month, we would accept that as payment in full.”  Hmmmm… let me do the math.  500 plus 700 is 1200, which is HALF of 2400.  Yes Please!  Afterwards, talking about it with my family – I wondered if maybe the lady I worked with was brand new and had made a mistake.  My family guessed that so many people are unable to pay their bills in full, that once a hospital has already received a hefty payment from insurance, they might be willing to take what they can get on the rest.  Well, it hasn’t always worked – but it did teach me that at least I should ask.

The next time, the hospital did not reduce my bill… but they did put me on a no-interest payment plan.  I was allowed to spread the total over six months (12 months for really large bills) and make no-interest payments until everything was paid off.  This has been the only way I could keep up….because there are some very ugly and frustrating truths I have learned:

  • sometimes, the hospital doesn’t bill the insurance for months after a service
  • sometimes, even after they bill, a typo in the service code can clog things for many more months
  • often, if there is a problem with billing, the hospital just keeps sending the same bill to the insurance, who keeps sending the same denial over and over until I happen to notice and step in to see what the heck is wrong
  • sometimes, the insurance needs information from my doctor regarding a treatment (such as the last TB test results), but nobody ever got word to the doctor or his office

All the while, you are getting more services and more medications – and it seems like the bills and paperwork and insurance forms pile up like Mt. Everest.  And frankly, it’s easy not to focus on it when you are just trying to get your kid out of pain…. it’s doesn’t always rise to the top of the priorities list.

So, I have just a few bits of info that might help you with your own bill mountain:

Go Paperless-  With my insurance, I get an EOB (Explanation of Benefits) for every medical service from any member of my family.  Some of these are pretty standard, and I can’t think of any reason why I need to refer back to them (ie: a standard co-pay for an office visit).  But some of them are more complicated and I can tell I will need it for future reference (ie: a $4700 infusion bill that my insurance has denied).  Either way, just getting and filing all the copies of these papers is overwhelming.  Most insurance companies have an option to go paperless – and still allow you to go online and view these statements for 12-24 months past the service date.  If you do want to have your own copy, then I would recommend scanning your paper, keeping an electronic copy (with a backup) and shredding the hard copy.  It will help keep you from drowning in paper.

Ask.  So if you do get a large medical bill, it never hurts to ask the billing department what your options are.  Do they have a discount if you are able to pay now?  Do they have a payment plan? Do they have a patient advocate who might be able to help you find means of assistance with the bills? The worst they can say is No, right?

Check out Drug Assistance programs.  This is something I never did, and I’m not exactly sure why.  I guess that maybe because we always seemed to be on the biologics really early, often before they were FDA approved for children, I was sort of behind in my knowledge of these options. Or, I thought that maybe we would have been above the threshold for qualification. But a lot of pharmaceutical companies have a drug assistance program, which will allow for reduced copays, take care of copays, gives rebates and many other options to help you afford treatment. Many of these websites also have links to third-party prescription assistance programs – great resources!  Again – it never hurts to ask!

Enbrel (Entanercept) Payment Assistance, ENcourage Foundation

Kineret (Anakinra) Patient Assistance

Actemra (Tocilizumab) Patient Assistance

Remicade (Infliximab) Patient Asisstance

Humira (Adalimumab) Patient Assistance

Orencia (Abatacept) Patient Assistance

Simponi (Golimumab) Patient Assistance

Rituxan (Rituximab) Patient Assistance

United Healthcare Foundation Grant – which may be able to help pay for medical services or devices not otherwise covered by your insurance

There are also lots of online articles, with advice for consumers on dealing with medical debt.  Because there are a lot of professionals out there, and I’m just a mom trying to get off of Medical Bill Mountain!

What tricks or tips do you have to share about dealing with this issue?

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2 Responses to Escape from Medical Bill Mountain….

  1. Jenny Nelson says:

    Thank you for sharing this information. It is truly helpful.
    a JIA Mom, Jenny

  2. Steve Bertram says:

    God Bless You and Dave for all that you have doen in the effort to heal Caitlin.

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