YiKeS!

don’t just pay it. do not automatically pay the hospital bill when you receive it. call your health insurance provider and POLITELY say, “excuse me, i just received a bill for $1200 for my hospital visit/ER visit/etc., is that the correct amount i’m supposed to pay?” because hospitals bill you before your health insurance and they will take your money no matter how the amount due may change based on your health insurance looking at it. 90% of the time, if your health insurance is in any way involved in the payment of that bill, you do not have to pay as much as the hospital is billing you for. call your health insurance provider first, and POLITELY request clarification, always remember that the person you are talking to is human and this is just their job, and then you will very likely find out you actually only owe $500.

Also, it is important [for people receiving medical care in the USA] to carefully read all of the items on the medical bill and look for errors and overcharges. I know that the normal feelings of avoidance and dread can make it hard to look at scary hospital bills, and that’s okay! But as the OP mentions, private orgs like hospitals don’t monitor overpayment of bills - they are motivated to charge you extra - and it is basically impossible to get your money back. Read the bill carefully and make sure that the charges are correct, using the links below for help if you need. If they haven’t sent you an itemized list, you can ask for one. Sometimes you will be charged extra for items or treatment you didn’t receive. Most people don’t know that you can dispute medical bills! But in 2009, Consumer Reports stated that 8 out of 10 medical bills scrutinized by a watchdog had errors, and generally you are not obligated to pay for someone else’s error.

You may be charged for using medication that you actually brought into the hospital with you - that’s easy to dispute! You may be charged for the consumables used during your stay such as sheets, gloves, gowns, etc - the hospital should actually cover that under its running budget. You may be charged for a brand name drug if the generic was available for cheaper - the links below explain how and when you can dispute this. You may be charged a surprisingly expensive “oral administration fee” (where a nurse puts pills for you to take in a little clean paper cup and then hands it to you) but that’s worth disputing if you were actually able to take the pill out of a bottle and put it in your own mouth. And so on.

8 Things You Should Know About Challenging a Medical Bill (FORBES) (includes links to sites that help you calculate how much a procedure/treatment usually costs in your area, if the costs seem super high)

7 Tips for Fighting and Paying A Huge Medical Bill (FORBES) This explains briefly how to negotiate costs, and payment plans.

10 Common Medical Billing Overcharges You Can Prevent (Bill Advocates) A breakdown of errors and overcharges to double check.

“Thank you for this incredibly stressful 30 minutes that I have had to re-structure my entire day around and which will give me anxiety poos for the next 24 hours.”

It occurs to me that quite a few of the younger tumblr posters and readers might not yet have had to choose their own health insurance, (and older folks often struggle as well) so I thought I’d talk about a few of the basic terms you need to know.

Disclaimer:  While I work in a health insurance-related field, I am not an expert–please talk to a professional before making your health insurance decisions.  Also, the U.S. health insurance system is snafu so parts of this won’t apply to saner countries.

Premium:  This is the periodic payment you make up front just to have health insurance in the first place.  In the olden days, some plans had this as an annual fee, but now most plans go with monthly plans or withholding per paycheck.  Premiums are the main income for insurance companies, and to stay viable, income must always be higher than outgo.  If it’s a for-profit operation, the income needs to be higher than outgo by a considerable margin.

Deductible:  The out of pocket cost that must be met before your health insurance starts really kicking in.  Many healthy people will not spend enough in a given year to meet the deductible, and that’s by design.  However, you do get some of the benefits of being in a health insurance plan even before meeting the deductible–see “allowed amount” and “preventive care.”  Plans with low deductibles tend to have high premiums and vice versa.  Not all plans have deductibles.

Coinsurance:  After you’ve met your deductible, the insurance company will now pay a percentage of further medical costs.  The industry standard is 80% but you may see lower.  The remaining amount you must pay out of pocket, and is called “coinsurance.”

Co-pay:  Some plans, instead of or in addition to having a deductible, have a flat fee that you are required to pay out of pocket for services, and this is called a “co-pay.”  For example, a quick office visit so the doctor can check on your skin rash might have a $50 co-pay per visit.  These tend to have higher premiums or be government plans.

Out of Pocket Maximum: The point in a calendar year where you’ve spent enough of your own money that you no longer have to pay coinsurance or co-pays; your insurer takes over all remaining costs.  This number is usually very high, but if you are very sick or unlucky you may reach it.

Lifetime Maximum:  The stinger in most health insurance contracts.  Some benefits, such as infertility treatments, are often capped with an amount that the insurance company will pay up to, but no more–ever.  Some plans may also have a lifetime maximum apply to the plan itself.  You’re now costing the company more than you’re worth and they used to be able to just kick you to the curb. (Now they’ll help you sign up for Medicaid.)  This usually looks like a very high number until you get one of the nastier cancers, or a chronic condition with expensive treatments.

Preventive Care:  Medical care and tests designed to prevent future illness.  Things like annual checkups, flu shots, mammograms, etc.  Most medical insurance plans fully cover this even before the deductible is met as it is way cheaper for them to have your problems taken care of early than when they become noticeable to the naked eye.

Allowed Amount:  Providers can charge anything they feel like up to legal amounts, but if you have a sufficiently large risk pool for your insurance plan, the insurance company can negotiate the maximum amount allowed to be charged for various procedures, services and medications.  These prices are generally a bit less than those charged to the uninsured, and apply even before you meet the deductible.

Prior Authorization:  Some procedures or treatments require proof of medical necessity before the insurance company will pay out, and they won’t pay if it hasn’t been cleared with them beforehand.   This is usually spelled out in the medical policy that comes with the plan.  There may be considerable preconditions attached to a prior authorization, so read carefully and ask questions.

Formulary:  May be called “Preferred Drug List” or something similar.  This is the list of medications your health insurance plan will cover.  Some drugs that are not on the formulary may be covered if your provider submits a “formulary exception” (like a prior authorization, but for drugs.)  Others may require you to try other drugs first, or never be covered.  Formularies are subject to frequent review and changes based on new information.  The most important time to check is if you’re switching insurance plans and need to keep your medications stable.

If you’re in good health and have low risk factors, you might come out ahead if you pay for a less expensive plan. Your deductible will be higher, but your preventative care benefits *should* apply even if you haven’t met that deductible. Stay as healthy as you can, but remember that if catastrophe strikes, you DO still have coverage. 

Also, if you’re injured on the job, workers comp pays first. Likewise, if you’re injured as a result of an auto accident, YOUR auto insurance has the first payout for your injuries. (And if you’re not at fault, they’re the ones who go after the other driver’s insurance to get reimbursed.) 

you open the card

Libra sun with Gemini Moon confession- I can’t really get angry at people and I genuinely like everybody I know, even if sometimes I try to manipulate them or charm them to get something I want, orto provoke a certain chain of events. I can’t stand for myself and I hate to admit I prefer being insulted than respond back.