OfTheCross
Veteran
Healthcare is too complicated. When something goes wrong it's too hard to navigate the system.
If they're going to put it on the consumers to do our own research, it should be made as easy as possible to get information
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 public insurance like Medicaid or Medicare. Ask the provider or hospital if they can help you check your eligibility before you commit to a care plan — and then stay with providers who participate in those programs.
Check whether the specifics of your care are covered. After your doctors map out your treatment plan, check whether all the providers you need to see are in-network and whether any part of the treatment needs to be preauthorized. Ask lots of questions of your insurance provider, doctor’s office, or hospital, especially for planned procedures, said Joy Dockter, a lawyer at Central California Legal Services, a public interest law firm. “‘Are my authorizations in place? What are my copays going to be?’ Find all that out beforehand, if you can,” she said.
Additionally, said Mark Rukavina, a program director at health equity advocacy group Community Catalyst, if the drug you want isn’t covered by your insurance, ask whether the drugmaker has a patient assistance program; many do, though eligibility requirements vary.
Get a cost estimate. If you’re uninsured, ask for a cost estimate in advance. Rukavina noted that the federal No Surprises Act, which took effect in January, requires providers to give uninsured patients “good faith” estimates of what planned care will cost.
Find out whether you’re eligible for financial assistance — and come prepared to make your case. Almost every hospital offers some form of financial assistance, or “charity care.” Each hospital sets its own eligibility requirements but typically will waive or discount bills for patients earning less than two to threetimes the federal poverty level. (Three times the federal poverty level for a household of four in 2022 would be $83,250.)
People who are employed often still qualify for a discount, if not for free care, said Jared Walker, founder of Dollar For, a nonprofit group that helps patients secure charity care. His group developed a database of hospital charity care policies and has an online tool that allows patients to check their eligibilit
Even if you’re not sure whether you qualify, it’s worth trying. Gather up documents such as pay stubs or income tax returns. Do not expect this to be an easy process. For example, Walker said, health care providers often require documentation to be faxed. “One of the most common refrains I heard from experts: Persistence pays,” Walker sai
If you’ve already qualified for government benefits like the Supplemental Nutrition Assistance Program, or SNAP, that may streamline applying for a hospital’s financial ai
If you’re not a U.S. citizen or legal resident, check whether your state bars the hospital from considering immigration status, as is the case in New Mexico and Maryland.d.d.y.
If they're going to put it on the consumers to do our own research, it should be made as easy as possible to get information
How to Get Rid of Medical Debt — Or Avoid It in the First Place
Medical bills can add stress to the already stressful experience of dealing with a medical crisis. And if you can’t pay those bills, they can linger, wreaking havoc on your financial goals and cred…
khn.org
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 public insurance like Medicaid or Medicare. Ask the provider or hospital if they can help you check your eligibility before you commit to a care plan — and then stay with providers who participate in those programs.
Check whether the specifics of your care are covered. After your doctors map out your treatment plan, check whether all the providers you need to see are in-network and whether any part of the treatment needs to be preauthorized. Ask lots of questions of your insurance provider, doctor’s office, or hospital, especially for planned procedures, said Joy Dockter, a lawyer at Central California Legal Services, a public interest law firm. “‘Are my authorizations in place? What are my copays going to be?’ Find all that out beforehand, if you can,” she said.
Additionally, said Mark Rukavina, a program director at health equity advocacy group Community Catalyst, if the drug you want isn’t covered by your insurance, ask whether the drugmaker has a patient assistance program; many do, though eligibility requirements vary.
Get a cost estimate. If you’re uninsured, ask for a cost estimate in advance. Rukavina noted that the federal No Surprises Act, which took effect in January, requires providers to give uninsured patients “good faith” estimates of what planned care will cost.
Find out whether you’re eligible for financial assistance — and come prepared to make your case. Almost every hospital offers some form of financial assistance, or “charity care.” Each hospital sets its own eligibility requirements but typically will waive or discount bills for patients earning less than two to threetimes the federal poverty level. (Three times the federal poverty level for a household of four in 2022 would be $83,250.)
People who are employed often still qualify for a discount, if not for free care, said Jared Walker, founder of Dollar For, a nonprofit group that helps patients secure charity care. His group developed a database of hospital charity care policies and has an online tool that allows patients to check their eligibilit
Even if you’re not sure whether you qualify, it’s worth trying. Gather up documents such as pay stubs or income tax returns. Do not expect this to be an easy process. For example, Walker said, health care providers often require documentation to be faxed. “One of the most common refrains I heard from experts: Persistence pays,” Walker sai
If you’ve already qualified for government benefits like the Supplemental Nutrition Assistance Program, or SNAP, that may streamline applying for a hospital’s financial ai
If you’re not a U.S. citizen or legal resident, check whether your state bars the hospital from considering immigration status, as is the case in New Mexico and Maryland.d.d.y.