Strategies to Help You Plan for and Manage Large Medical Bills

Whether they’re the result of an unexpected illness or injury, out-of-network care, a high cost medical procedure like joint replacement or organ transplant, or a common but costly medical expense such as labor and delivery, large medical bills not only affect your financial wellbeing, they can also impact your health. The stress caused by high bills and medical debt can increase your risk of a range of physical and mental health problems, including:

• heart disease
• diabetes
• migraine headaches
• gastrointestinal problems, including GERD and IBS
• insomnia
• a weakened immune system
• anxiety
• depression

But there are some strategies that can help you plan for and better manage large medical bills:

• Learn about all the ins and outs of your insurance plan. In some cases, especially those that involve large medical bills for care received out of your health plan’s network, having a full understanding of what your insurance plan does and does not cover before you receive care can help you avoid some of these costs. If you get your insurance through your employer and have questions about your coverage, talk to your HR or Benefits team. Your insurer’s member services team is another good resource for questions about coverage, how to find healthcare providers in your plan’s network, and special circumstances like whether you need referrals or pre-authorization for certain types of care.
• Sign up for and use health savings accounts and reimbursement arrangements. A health savings account (HSA) can help you pay for deductibles, copays, and other healthcare services, as well as prescriptions, eyeglasses, and hearing aids. Find out if your employer offers these accounts and whether the company contributes to the account. If you have a high deductible health plan, you can open a health reimbursement arrangement account (HRA) to help pay your deductible and other costs. Unlike an HSA, the money you put in an HRA does not have to be used up each plan year, so you can save for future health expenses as well.
• Consider using specialty pharmacy services. If you’re taking expensive medication like cancer biologics and immunotherapies or hepatitis C treatments, find out if your health plan includes a specialty pharmacy benefit. Specialty pharmacies can help ensure that you receive medications like infusions in the most appropriate, cost-effective, and safe setting (doctor’s office versus hospital, for example). They also help make sure that the prescribed medications are the most appropriate choice not simply the newest available, and frequently a lot more costly, drug.
• Work with a medical billing advocate. If you get your health insurance and other benefits through your employer, find out if the company offers the services of a medical billing advocate. If not, you can also hire an advocate directly. An advocate can do several things for you if you’re faced with large or unexpected medical bills. First, the advocate will carefully review all bills to check that there are no errors or upcoding (listing a medical service under a billing code for a more expensive service on a bill or insurance claim) and that all services that should have been covered by your insurance were covered at the correct reimbursement rate. The advocate also checks to make sure that there was no inappropriate balance billing (billing you for more than the cost your health insurance has negotiated with an in-network healthcare provider). Once that comprehensive review is complete, the advocate will negotiate with the healthcare providers on your behalf, working to lower the overall amount due, and if needed, set up a payment plan.

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