Women’s health articles

Managing the finances of your illness

by Marcelle Pick, OB/GYN NP & Dixie Mills, MD

Many women report that the financial pressures of being ill can be almost as bad, or sometimes even worse, than the stress of the illness itself. Yet there are a number of steps you can take to help keep costs in check when you’re sick, even if you have a serious or chronic illness. We know how overwhelming it can seem, so we’ve compiled some tips to help you navigate the system. These are simple, commonsense suggestions, but you’ll still need patience and persistence to make them work for you in reducing the total financial impact of your illness. And most experts agree that you can make a profound improvement in the bottom line if you invest the time and effort.

Don’t be embarrassed. The most significant obstacle for many people when it comes to reducing their medical costs is that they’re simply embarrassed to admit they can’t afford care. So they just quietly pay bills they can’t afford, or they ignore the bills and find themselves faced with collection agencies — or even worse, they avoid getting the care they need until their health becomes a crisis. When you stop to consider how out-of-control healthcare costs are in this country, it just doesn’t make sense to feel as if this is your fault — none of us can truly afford such inflated costs! An inability to pay medical bills is not a personal failing — it’s a systemic social and political problem that we all must deal with. Embarrassment and shame are only going to prevent you from effective management of your health and your finances. If you need to talk about these feelings with a friend, a pastor, a therapist, or a financial advisor, by all means do so — it will help reduce the stress you feel — but don’t allow your feelings to rule your financial health.

Partner with your provider to reduce overall costs. It’s important that your provider know that cost is a concern, so that he or she can help you. In some cases, your provider can scale back testing for less likely or less common concerns, or substitute less costly generic drugs for trademarked medications when there’s only a slight difference in the efficacy or side-effect profiles. With some medications, your practitioner can prescribe double the needed dosage of the medication so that you can then split each pill in half — which can save you substantial costs in terms of refilling prescriptions. This cannot be done, obviously, with medications that have an enteric coating, timed-release formulations, or those that come in a gelcap. Depending on insurance restrictions, some medications can be filled every three months instead of every month, which can also save you money. And it’s okay to ask whether tests or procedures can be deferred, or postponed until you can ascertain whether they’re covered.

Understand your insurance benefits. Many people think that their healthcare provider knows what is covered by insurance, or even that the provider is able to find out if a certain medication or treatment is covered. This just isn’t the case — the only source of information about your policy is your insurance company, and your provider won’t know the ins and outs of specific companies or insurance products. The booklet the company provides when you enroll gives details about the coverage for your policy, but many people find it hard to keep tabs on updates and changes. The bottom line is, you are going to be held responsible for whatever the policy doesn’t cover, so it’s in your best interest to know what you’re getting from your policy — ideally, before you need it.

This may seem easier said than done — insurance policies can be pretty complicated sometimes. If you have an insurance agent handling your policies, you can ask him or her to help you determine what is covered, what isn’t covered, and the potential costs that will be your responsibility — it may be a lot easier for an agent to decipher the details, since that’s what they do for a living. If you don’t have an agent, your best bet is to go directly to the insurance company and ask their customer service reps to give you the coverage details. And many insurance companies offer on-line help for their customers, which can sometimes be a better option than trying to make contact by phone.

Dealing with insurance companies may be an aggravating process, as it’s often hard to get an actual person on the other end of the phone — more often than not, you are forced to hold the line and wait, or navigate through a seemingly endless phone tree. If possible, use a phone with a headset or a speaker phone, so you can carry on with the rest of your life while you’re waiting for the answers. But don’t give up just because they take their time getting to you — in the end, your patience and perseverance will pay off. And if your insurance company refuses to tell you what you want to know, call your state’s insurance commissioner — insurance companies are legally obligated to provide information about costs and coverage to their policyholders.

Stand your ground if a claim is denied. If your insurance denies coverage for a claim you think they should pay, you don’t have to just accept the decision. You have the right to appeal the decision, and it often helps to ask your practitioner, hospital business office, or employee benefits manager to assist you with the appeal. Sometimes a simple change in the language of the claim can reverse a “not medically necessary” denial for a procedure that straddles the line between cosmetic and therapeutic (such as breast reduction surgery performed to relieve back strain, for example). Understand that your practitioner cannot change a diagnosis code in order to get a claim accepted, unless an incorrect code was used on the claim in the first place. Collecting all the facts about your case from your practitioner and your insurance company will help you sort through the many factors that can affect medical billing and make you better prepared to press your case. It may take a letter from your practitioner, or even several appeals, to get a favorable resolution, but this kind of persistence can often pay off.

Get creative about finding health coverage. If you don’t have insurance, organizations like the Foundation for Health Coverage Education may be able to help you obtain low-cost insurance as well as assist you in negotiating with insurance companies. The US Uninsured Help Line (1-800-234-1317) also offers advice regarding public or private options for which you may be eligible, and can help identify resources to assist you with special situations that affect your insurance eligibility, such as preexisting conditions. You can also find low-cost insurance in the most unlikely places if you have a membership in a professional organization. For instance, joining your state’s Farm Bureau may make you eligible for health insurance at the Bureau’s discounted rates, and membership is open to just about anyone — even if you live in an apartment complex miles from the countryside!

Look for opportunities to reduce fees not covered by insurance. Fees for tests, supplies, and procedures aren’t written in stone, and many medical facilities will provide discounted services if you can demonstrate financial hardship. Laboratories and imaging centers likewise will work out payment plans or even waive fees for tests and procedures if you let them know that you’re unable to pay the full fee. If your provider orders a specific test, you can ask him or her to recommend two or three sites for the test, then call each center and ask the office manager to give you an estimate of costs. Let them know that you’re concerned about keeping costs down and ask what can be done to reduce the expenses. This obviously isn’t an option if you’re taken ill suddenly, or involved in an accident and wind up wherever the ambulance takes you, but after your recovery it’s not too late to negotiate. You can offer to match your payment to the level of Medicare payments if you’re not covered by insurance. But it’s important you get the payment plan agreement from the hospital’s administrator in writing for your own protection, as many hospital or clinic business offices are quick to send unpaid fees out for collection.

Shop around before undergoing elective or prescheduled surgery or other procedures. Surgery or other treatments done at specialist centers often have lower overhead than hospitals, so if you know that surgery or other specialist treatment is in your future, shop around for the best deal near you. It might be worth the cost of driving a little further in order to get treatment in a specialist facility. And do be sure to research your options — ask yourself these seven questions before surgery — you may be able to defer surgery until your finances are more secure; or undergo a less expensive, less invasive procedure; or avoid it altogether.

And if you live near a medical, nursing, or dental school, find out whether they offer low-cost services for patients who agree to allow students to participate in their care. Although you probably don’t want a student to give you urgent or acute care, allowing a (supervised) student to perform routine follow-up services after you’ve gotten past the acute phase might help save you money.

Double check that the bills are accurate. Even the most careful medical billing department makes mistakes, and unfortunately, not all of them are careful. It’s not at all unknown for patients to be charged thousands of dollars for something as simple as disposable gloves, or even to be charged for procedures that weren’t performed! You have the right to ask for an itemized bill so that you can look it over very carefully for errors, and doing so as a matter of course could save you a great deal of money.

Get help from patient advocacy organizations. If you’re faced with a whopping, unexpected medical bill, you absolutely do not have to face it alone! There are many organizations and advocates devoted to helping patients find financial resources to help them resolve healthcare costs. We’ve listed a few such organizations in the box at right, but these are only general resources — there are many other disease-specific advocacy groups, too many to list, that you can find by searching the internet. In addition to this list, one of the best resources we’ve seen for addressing a huge variety of patient issues is the Patient Advocacy page compiled by the University of Connecticut Health Center’s library.

Look for government resources that can help. Both federal, state, and even some municipal health and human services departments offer programs to assist with healthcare costs, particularly for individuals or families with little or no insurance, and those with chronic diseases. Check your state’s website, or go to the US Government’s Department of Health and Human Services website for more information.

Patience, persistence, and creativity

The tips we’ve included here are really just general advice — there is so much more out there, we can’t include it all. We urge you not to go it alone — talk to patient advocates, and get a friend or relative to help you, especially if your recovery is particularly long and difficult. A good support system can make all the difference. Managing the costs of illness is a challenge to your financial creativity — but with a little research and time, you can often rein in what may have seemed an overwhelming problem.

Related to this article:

References & further reading on money saving tips

Original Publication Date: 10/27/2008
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP and Dixie Mills, MD, FACS