In this week’s episode, we speak with Lisa Gill from Consumer Reports about the ever increasing trend of unpaid medical debt in America. Lisa discusses real-life scenarios, what to look for on your bills, what to ask for when getting treatment, and who you can go to if you get overburdened with costs.
Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host Jeffrey Freedman.
Jeffrey: With coronavirus cases reaching all-time highs in the United States. Several hospitals around the country have already exceeded capacity and overall we are at our highest level of Hospital admissions we have ever seen. That being said our Frontline workers, our scientists, our physicians our nurses, the have done a miraculous job in learning how to treat this disease and without trying to downplay any of the pain and suffering the patients are currently going through. A vast, vast majority are going to go home and they are going to make a full recovery.
Jeffrey: And in this week podcast, we are going to take the next step. We are going to take a look at what happens after the patient comes home a week, maybe two weeks, maybe even a month later. These patients are going to receive a bill for the medical services they just received. In fact, they may receive several bills from an ambulance, from a clinic, Physicians practice, lab or hospital.
Jeffrey: And yes. Well, approximately 90% of us have some form of insurance. A very large percentage of people are underinsured or have high deductible plans or not even sure what their insurance covers. These people that just escaped a life changing medical scare are now going to receive life-changing medical bills that they never thought imaginable. And frankly, a lot of people just cannot cover.
Jeffrey: Thousands and thousands of people in our country are going to have to think about making trade-offs in their daily lives just to begin paying off their medical bills. So, to discuss this issue with us today. We have Lisa Gill, Lisa has been a health and Medicine investigative reporter at consumer reports for the past 12 years.
Jeffrey: Lisa thank you so much for joining us today.
Lisa Gill. Oh, it is such a pleasure to be here. Thanks you so much for having me.
Jeffrey: Great. Now, you have written quite a bit about the burden of medical bills and how they are affecting society. Now, during the pandemic our hospital system has been overwhelmed and with more and more people seeking medical help every day. We are now at record levels, but every single one of these people going to their doctors right now or hospitals or clinics. They are all going to get a bill of some kind or another. And with the volume of the people now in the system coupled with the slowdown of administrative work at the hospitals. It is going to be an awful lot of people getting horrible surprises around holiday time. Now, can you talk about this from high level about what you have been hearing and talking to people about over the past eight months of this pandemic?
Lisa: Sure. So, the concept of surprise medical bills or just even medical debt. This has been a very serious ongoing problem even as we were rolling into the pandemic. I mean, we have been planning this kind of coverage for actually quite some time and because medical debt poses such a unique problem to the American household. In that, you do not really save for it. You do not really plan for it. A lot of people do not really understand what type of insurance coverage they have until they really are hit with an acute problem.
Lisa: Again, it is easy to accumulate medical debt. It is difficult to track it down. It is difficult to understand what you actually owe and when. And so, this issue has sort of been an on-going sort of like slow motion, a different type of medical crises. And as we as we get into this pandemic, starting right in March and we start to see people losing their jobs. That was lot of people that we had interviewed. Losing their jobs, losing the health insurance that that is connected to their jobs and then being saddled sometimes with medical debt from pre-pandemic or even medical debt accrued during the pandemic. We are headed into like a type of medical debt financial crisis. Unlike I would say anything that we have ever seen in the United States and we are not quite there. But we are just about there and I think as we get closer to the end of the year. Lockdowns continue, covid continues, it is a problem that I am afraid does not quite have an end to it at the moment. It is a little [crosstalk] frightening.
Jeffrey: It really is and it is exponential with the way things are going right now. And all rights, get into this. I mean even before somebody gets sick and I was under the impression that if you wanted to get a covid test even at a clinic or hospital. That the tests were free or their paid for by the government or your insurance but then I read a bunch of articles recently that people were getting these outrages bills for testing. Right?
Jeffrey: So, unbeknownst to them. They were getting not only a covid test but a full viral panel which includes flu testing and all these other things. And this was done so these clinics could charge even more money. And I saw in some instances they were even being charged for phone calls telling them if there were positive or negative and these bills that were running like a thousand dollars. Now, is there anything people can do to protect themselves from this?
Lisa: This is those stories are examples of doctor offices and medical providers and even just sort of like pop-up testing centers that are taking advantage of a crisis, right? A severe medical crisis in the US and what I can say is from the reporting that we– there lots of reports out there about this problem. From the reporting we did. Yes, there are a few things to just kind of like keep in mind and I will kind of just generally walk through them. But the federal government passed two bills earlier this year that guaranteed people, well most people I should say, who have most types of health insurance that they would– including Medicare and Medicaid that they would be provided a free covid test if they had symptoms of covid or if they believe they have been exposed to somebody who had covid. It also guaranteed that the copay for your doctor visit, for that test specific test would be covered. But there is a whole host of things that does not cover and one.
good thing about those two Federal bills is it also promised people that they could still go get the test and go to the doctor even if they had met a deductible.
Lisa: So, half of employer plans in the United States or even half of really most health insurance plans in the US have a high deductible but usually about $1,200 or higher that a person has to meet before their insurance actually kicks in. So the bills were trying to protect that scenario, so they did not have to actually meet 1,200 dollar deductible. But for everything else. So just exactly what you described. Flu shots or I am sorry flu tests and other viral test, any test that a doctor thought might be related to covid is not actually the covid test that stuff is not covered. If you go to a provider who who does those tests who are out of network for your insurance that is not covered. If you get sick with covid that is not covered. And you actually have to be hospitalized and treated for it that is not covered. Your insurance would cover that.
Lisa: We ran into some people who went to go get a covid test and the other went to the doctor’s office. But they did not actually get a test. They got everything else. They got basically, got to work up but no covid test. They wind up with bills that are not related to the test. It also can be the case that your insurance just is not comprehensive and the one type of insurance that did not– was not really mandated that they cover covid testing our short term insurance plans. And a lot of people do not realize if they have one of these but you would buy it on the open market. You would not get it through an employer. And it is usually for coverage, it is about six months or less but it can be maybe even 12 months or less. So, if you have that kind of insurance your covid test will not be covered. There was also the situation that some people that did not have insurance thought that their covid test would be free and it is but you have to apply once you actually get the test something called the Provider Relief Fund which you can look up online. It is not hard. It is just like another multiple administrative steps that somebody has to do.
Lisa: There is one other thing too. If your employer is requiring a test just as a just as a course of business just you know, if you have to show up to work and pass covid test that kind of cut it and you try to turn into your insurance and that might not be covered. Hopefully, your employer will just directly pay for it but if you try to run it through your regular insurance that is likely not to be covered. The main tips are things like really understand what your insurance coverage is. Go to an in-network provider, when you are at the doctor’s office make sure that– you can ask it every single point. What is this test? And is it covered by, is it free, is a free covid testers at something else. And if it is something else how much it is going to cost?
Lisa: We have been writing about this for a long time whether it is drugs, screening test, diagnostic test, any anything. Before you could do it, ask. How much will this cost me? And if they tell you I do not know ask them to call the insurance company and find out. The only thing you can do is look up in the blue book what the cost of something would be ahead of time. But that is– I like putting it on the healthcare provider and really getting them involved in your financial situation before they send you down, long alleyways of different tests and treatments and do not know what they were cost.
Jeffrey: That is a great advice and especially with the prices these days and you really have to be your own self advocate and really ask these questions.
Lisa: It stinks. It really stinks and unfortunately when you ask, are the things that people can do to protect themselves the answer is yes and there is a lot of them. It should not have to be that way. You should not have to especially if you are old enough, you were sick. The last thing you want to do is pick up the phone and start calling insurance company, start calling a hospital or testing center to find out how much is this going to cost? Is it covered? And we have interviewed people who even after being assured something was covered they still wind up with surprise medical bills and it is sometimes just really unfortunately, an unavoidable sort of symptom of a bigger problem.
Jeffrey: Yeah. Now, going back to those interviews you were talking about you recently wrote an article that was published in November’s Consumer Reports entitled “Could your medical bills make you sick that debt does not just hurt your bank account. It could harm your health too, what you must know?” So a lot of what you are talking about is coming out of this article and it was terrific. So, you also discussed several stories of real people and the effects their medical bills are having on their lives and on their health. Can you share a story…
Jeffrey: …from the article?
Lisa: There are people made all kinds of trade-offs in all different kinds of ways and that was really what the article is looking at is. What are the things that people do or do not do as a result of having medical debt or just when their faced with high medical costs. I spoke to Devin Barrington Ward a really terrific guy out of Atlanta, Georgia. He was about 30 years old. He went to an emergency room earlier this in January 2020. He had a really acute stomach problem.
Lisa: He did not have insurance and because of that he did not take an ambulance even though his family was urging him to take an ambulance. Instead, he got his one of his relatives to drive him to the emergency room. He had a battery of tests. He saw multiple doctors and health care providers and at the end had a medical bill really right at $10,000. It is only the hospital does not provide any kind of charity care. There was no way to apply for like a free health care because there may be a non-profit hospital and he was on the hook for 10,000 bucks. He was not paid it. So here we are many, many months later. It was an unpaid medical bill. He says he is not going to be able to afford it. And he told us that he started his own business. He was also trying to save for a house. He wants to get married and he wants to start a family. He wants to get down, he wants to take those different Milestones those financial Milestones really like take advantage of, whether it is housing market or starting up a small business and cannot because he got this medical that hanging over his head.
Lisa: So what we want– one issues, there was a cascade of events with unpaid medical bills and one really bad thing is that these things can wind up going against somebody’s credit, a credit score. And so, not only do you may have even have ten thousand dollars in medical debt but your credit takes a hit. So when you try to go maybe get a loan or mortgage, for example, you might have a very very ugly surprise when they start looking deeper into credit reports. And that was something we found with another woman who wanted to move into an apartment, a larger apartment. She was taking care of her mother who face dementia in a one-bedroom apartment. She worked full-time and she applied to get a two-bedroom apartment but because of– listen this for like a really low amount, I think this medical bill was under Two Thousand dollars might have been about 1,500 bucks. She had paid all kinds of medical attention, she paid on time but one bill slipped through the cracks went into collections and wound up on her credit report. And when she went to go try to get a two-bedroom apartment. She was stopped and could not do it because of this this silly bill. Eventually, it got taken care of. She got really just some angels rip medical debt is a firm that purchases old medical debt at a deeply, deeply discounted price. They purchase it in the aggregate and then they pay it off for people. So they had actually paid off her medical debt and kind of offer credit report eventually but it took a long time.
Lisa: Those are financial consequences. Then we did a nationally representative survey asking people about their number one, their highest medical bill in the last 12 months and we learned that in order– once they got that bill and they were faced with other decisions in there lives. It affected that and people told us that they put off, 40% told us that they put off a doctor visit because they owed money on a medical bill. A lot of people, third of the people told us they treated themselves at home 20 percent said that they declined a test or a procedure, 15 percent said that they did not fill a prescription and 14 percent said they wanted to be using Telehealth instead of going into a doctor’s office which is actually a good thing at least they saw a doctor. But people made not know they have financial trade off. Some of these are pretty serious. I mean, when you do not fill a prescription for something that– in the reason that you are not doing it is because you cannot afford it or you are trying to cut back costs.
Lisa: It is hard for any of us to really understand what the physical consequence of that is. But it is probably not very good if your doctor has gone to the trouble to write a prescription for you. We saw in a Kaiser Family Foundation a similar survey from about a year and a half ago showing that people who did that very thing by not– they did not seek treatment because of cost about one in eight people saw the condition for which they had sought treatment worsen. So we know there is a health consequence with some percentage of those people. And it is a dangerous situation and looking at, I mean think about other areas of your life where you cut back because you cannot afford something and maybe it is one thing if you like cut the cable, you are like “Okay. We are not gonna have cable anymore because we cannot afford it.” That is maybe a lifestyle decision, but it does not affect your health necessarily or maybe you do not get your car fixed, you delay maintenance. But there is countless examples of these but when you start messing with not going to the doctor, not filling prescriptions, not getting tests that are really needed. There can be pretty serious consequence and I think that is the overall health of the nation is quite a risk as a result of high medical bills and the fear of medical debt.
Jeffrey: Yeah. It sounds like a vicious…
Lisa: It is a cycle. I mean really and [inaudible]
Jeffrey: Yeah. Now, to follow along with that you also recently penned another article that for me was extremely eye-opening. It was entitled “Veterans saddled with debt”. In your whole article, I personally was under the impression that veterans had insurance and the insurance was through the office of Veteran Affairs with the VA and our veterans were taken care of and this regard. But your article mentioned that veterans, a combined– I think it was a billion dollars in medical debt. That is crazy to me. Can you tell us a little bit more about this?
Lisa: I discovered this accidentally and once you discover it you realize there has been a lot out there in the world about this problem but it is not very well communicated. And I came across it as a result of interviewing the co-founders a Rip medical debt who is I mentioned earlier purchase large, they purchased aggregate amounts of medical debt heavily, heavily discounted so that they can pay it off. They are nonprofit, they are do-gooders. Right? And the the co-founders come from the collect debt collection world. I mean, they were like the quote bad guys for a long time and they switch sides. So Rip Medical Debt has a very special line into veterans debt and they start talking to me about this problem. And I did not quite grasp it at first until I started to look a little deeper and I learned that like you, I assume that all veterans had medical coverage through the VA.
Lisa: But what I found was in fact that if they had a disability that would that was, the VA classifies disabilities by percentage amount. And I do not have enough articulation about how they arrived at those percentages. But what I do know is that if your disability is 50% or less you can wind up being on the hook for all kinds of copays and other health care costs. If you have insurance like commercial insurance through an employer and that is where things get very much into a gray zone for a veteran. If they for example, whether if you do not have any disability or you have disability of less than 50% and you maybe go to the emergency room and that emergency room either is not covered by your employer’s Insurance, you have insurance through a job or there is bills or there is anesthesiologist or somebody not covered or you have not met the deductible. You have to pay that, the federal government does not pay that, that is one problem The second problem I learned too is that if the VA sends you, the VA does not provide Health Care of all types and when they cannot provide it they contract with doctors in the community or healthcare providers in the community.
Lisa: And not all of those costs might be covered and veterans can be on the hook for those costs. So there was sort of multiple strange avenues where a veteran can arrive at having medical debt they did not expect. And then the most curious thing is that if you were a veteran and you have, whether you were disabled or not and you do not have any insurance and you launch yourself into the Healthcare System even outside of the VA. You would not have to pay for any of it. It is really only when you have Commercial Insurance that it gets into this place where you can be on the hook.
Lisa: So, here you are trying to do something, you are trying to do the right thing by using your insurance if you are getting through your employer. And you can wind up paying, I mean thousands and thousands are being on the hook for thousands and thousands of dollars. It is strangely, there is actually multiple lawsuits about this and there is one ongoing that we that we wrote about and it is just sad situation, it really– it should not happen. I mean, it is just simply should not be the case.
Lisa: I hope it gets resolved in the courts and I know it is going around the major one is going around again, and hopefully it would clarify what the VA will and will not cover. I think that would go a long way toward helping veterans.
Jeffrey: Yeah. That would be great and what an incredible story and you know people should be more aware of this. So you write it as communication issue and I hope we can figure this out. All right. So, finally if someone finds themselves overburdened with medical debt or finds themselves in a hole and they are struggling. With all your research, what is some advice that you can provide? What can they do with this?
Lisa: There was a couple– there is actually quite a bit and it depends on where you are in the in the arc or the lifespan of your medical debt. I will say this and I will jump to like one of the most important things. If you are overwhelmed with medical debt and the bills are coming in and whether it is coming directly from a hospital or it is coming from say it was gone into collections. You were getting hounded by collection agencies. I woud say at this point, your best resource is the Patient Advocacy Foundation. They are a non-profit group that specifically exists. They have got counselors on hand. You call a phone number, we interviewed a couple of people that work with them and who got medical debt down from you know tens of thousands of dollars down to just something very manageable. Those counselors are are both financial counselors but they are really, they are Health Care experts in dealing with medical billing and dealing with hospitals and doctors offices.
Lisa: If I were being overwhelmed medical debt that is who I would turn to. It is PatientAdvocacyFoundation.org. They are absolutely wonderful. They are there to help you. I am looking for their phone number but you can look up online patientadvocacyfoundation.org. That would be the first thing. If you face simply one medical bill where you are like, “Whoa, that is really expensive” and it is not what you expected. That is earlier in the life cycle and my tips about, we wrote quite a bit about that and the weirdest thing is do not automatically pay a bill when you get it if you have insurance. And I know it is counterintuitive and it is a little frightening because you are like, “Whoa, here is a medical bill from a hospital. But wait, I have insurance.”
Lisa: We tell people not to do that because they are the providers sending you the full bill but they have also have your insurance information. They are sending that bill to your insurance company insurance. Your insurance company needs to decide how much it is going to cover. So, what you are waiting for is an explanation of benefits from the insurance provider that shows you at that point what you are actually on the hook for. So that is and then at that point you start to take action.
Lisa: So let us say that now you have gotten medical bill, but it is really your insurance company says, “Hey, Jeffrey, you are on the hook here for $5,000” and you are like, “Wait a minute. I thought it was I thought it was going to be a lot less than that.” The next thing to do is to go to the provider, the hospital or doctor’s office and ask for an itemized bill. You want to see line-by-line everything that you were charged. We have interviewed people who were charged for nights and hospitals that did not exist. Test that they never got or they were, they did get a test but they got charged twice for it and we learn from the Patient Advocacy Foundation that half of all medic[?], listen this half 50% of all medical bills contain errors. People are being overcharged or they are being double charged or charge for things that just they never got.
Lisa: So you have got and then you got to go through that. Once you get that itemized list, you go through it with a fine-tooth comb and make sure everything is legit. Once you settle on that, start trying to compare prices especially for something that looks really high like a CT scans or MRI any kind of test but just looks you are just like, “Whoa, that is way more than I thought it would be” we suggest people go to the healthcare bluebook.org and go take a look at the average prices. And your going to do that because you are going to go back and try to negotiate with the hospital or doctor’s office. And they say look you guys are overcharging me for these different procedures. You also double charge me here and you charge me for stuff. I did not get over here.
Lisa: So you are going to try to basically adjudicate that bill. And this is so annoying especially if you are sick and we talked about this earlier. I mean, it is really terrible that the patient is on the hook for they are all of her own administrative billing. But there was really no other way. Otherwise, you are going to end up paying potentially awful lot of money. I mean, could be into the thousands of dollars for stuff that you do not even know. From that point, when you are negotiating with the hospital or doctor’s office. Ask them if they will reduce the amount that you are on the hook for if you pay it all up front. Sometimes they will do that and it is worth asking if you cannot do that. You want to do a payment plan ask for a payment plan and ask for a reasonable term whether it is 12 months and whatever the amount you can pay per month.
Lisa: Do not go overboard, do not prioritize as medical bill before you prioritize things like rent or mortgage, groceries, utilities, your car when you need all the basics in your life in the medical bills actually should be one of your last priorities. The other thing that you can do, there is actually a couple more things. If you have a problem, I talked to some folks not necessary for this particular article. But whose family members face like almost $100,000 in debt and or they were really struggling with all the tips I gust described because there were too many bills and it was just too much administrative work.
Lisa: You can get ahold of somebody a group called The Alliance of Professional Health Advocates. And we also, you can also hire an attorney. We learned that about a quarter of people who face this problem hire attorneys to help. To help serve deal with those bills and negotiate down in the case that you do not have any insurance and you are stuck with gigantic medical bills from a hospital. Ask them if they provide any level of charitable care. Most nonprofit hospitals in order to retain their Federal nonprofit status must offer by law some percentage of their care free to the community. It sounds really good. The only problem is that there is a lot of administrative burden on the consumer to do this but we interview people who are successful at it. And able to fill out all the paperwork and get ten, twenty, thirty thousand dollars in medical bills covered.
Lisa: One thing to know about that, that is extremely important. They may eat charitable hospitals with these kinds of programs are often will not let you know. They will not offer it to you. You will actually have to ask and this is where being an advocate comes into play. So when you face any kind of medical bill whether you are insured or not. Ask the hospital, what are the different payment options including charitable care, do I qualify for ending financial assistance of any kind and or any additional discounts for upfront payment. The Health Advocates can also help with this situation. It is advoconnection.com and you can look up advocates in your area based on the ZIP code.
Jeffrey: Lisa, these stories are eye-opening and in your advice is fantastic and is going to help a lot of people. So, I want to thank you so much for your time today.
Lisa: It was such a pleasure to be here. Thanks so much for having me.
Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions comments or a future story suggestions. Please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.