Any bills from a hospital must be paid. Even people with health insurance are required to pay the balance of bills which health insurance doesn’t cover. Uninsured individuals are on their own and fully responsible for the debt to the hospital.
However, if your bills are the result of an accident where you were not at fault, you may not be liable for bills. This doesn’t mean the hospital will not chase you down for payment but you may have other options outside of health insurance. You will need to contact your insurance company to see what is covered, what you are responsible for and many times they will work the at fault parties’ insurance. In some cases, you may need to contact a personal injury lawyer.
When medical bills cause financial hardship, there are steps you can take to alleviate the burden. Many hospitals have programs to help people who are uninsured, have low incomes or simply do not have the means to pay a bill.
What things may not be covered by my health insurance?
The worse time to find out what your health insurance will not cover is when you already in the hospital. You should always read your policy carefully for exclusions well ahead of getting sick.
Some policies will not cover things like elective surgeries, self-inflicted injuries, and pre-existing conditions. If your bills are a result of a non-covered service, you will be responsible for paying the entire cost.
Many policies also have deductibles for services and tests that will have to be met before they start paying. They can be as high as $5000 or more in some cases. The hospital will require you pay this before they can bill any remaining balances to your insurance.
In addition to your deductible, you may have an annual or lifetime cap on your policy. This means that after your insurance pays out that amount, they will no longer pay any more claims on the policy. This usually happens when people have multiple hospitalizations for chronic illnesses.
One final thing you need to check is whether your policy requires preauthorization for hospital services. Some policies may even require them for emergency services. Some allow you a certain timeframe after services to get the referral or authorization but if you fail to do it, they can refuse to pay any claims related to the service.
What is balance billing?
Balance billing is the practice of collecting the difference between the amount your health insurance authorizes a doctor or hospital to bill and the actual amount they bill. It can be confusing, but most health insurance companies negotiate a fee contract with providers. This is the maximum amount they will pay for services provided.
Sometimes healthcare providers will then bill for the difference of what their contract pays them and what they actually charge. This practice is illegal in 47 states. If your insurance pays for contracted services, they cannot bill you for the rest, unless it is part of your co-pay or cost share.
If you receive a bill for services that your insurance has already paid a claim for, you need to contact your insurance provider. They can help you understand if this is something you are required to pay or if you are being balance billed.
You will need to contact your doctor’s office next. Sometimes balance billing is the result of clerical error. If this is the case, they will discharge the bill. If this does not work, you may need to file a dispute with your state’s attorney.
What can I do if I cannot pay my hospital bills?
Ignoring hospital bills is the worst thing you can do even if they are causing financial hardship. If you do not pay them, the bills will be turned over to a collection agency who will report it on your credit report and collection agencies can file a lawsuit against you to collect the debt.
You should contact the hospital immediately and try to work negotiate the amount billed. Many times if you can show proof that the bills cause financial hardship on you or your family, they will reduce the debt. Some hospitals even have a sliding scale based on income for people that do not have insurance.
The hospital will try to work out a repayment plan in most cases. They will help determine what you feel you could pay every month and as long as you make your payments, they will not turn your account over to collections. Hospitals do not want to turn your account over to collections because they have to write off the debt.
Another place to look for assistance is non-profit organizations. These organizations may be able to help if you qualify for one of their programs. Your hospital may have a list of places in which you can seek assistance.
If your hospital bills are still too overwhelming, you may need to consider bankruptcy. Medical bills account for over 60% of all bankruptcy cases filed. You will need to contact a qualified lawyer to see if you qualify though.
Can a hospital refuse treatment if I do not pay my hospital bills?
Yes, hospitals can refuse to treat you if you have unpaid balances. The law only requires they treat emergency patients. If you are being treated for non-emergency care or need tests authorized by your primary care provider, the hospital is not obligated to accept you as a patient.
At the end of the day there are thousands of friendly doctors and nurses willing to provide treatment but healthcare in America is a business and (like any business) someone has to pay the debt. There is no magical genie that pays for hospital bills in this country yet.
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