By Martine G. Brousse (not AI!)
"The Medical Bill Whisperer"™
Patient Advocate, Certified Mediator
AdvimedPro
December 27, 2024
With the new year comes a new deductible, and the question, can it ever be waived?
Let's go over the not-so-good news and the better ones, and, of course, look into helpful tips.
Watch the video here: https://youtu.be/dlf99cb4gVI
A. The not-so-good news
1. Your deductible is kinda set in stone. It is one of the terms of coverage that can't be changed during the course of your policy
2. It is the first amount you must pay before your insurance begins issuing payments. It usually starts on January 1st, or resets once a year when the policy renews.
3. Once you have met your deductible, your co-insurance kicks in, meaning your insurance starts paying a % of the allowance on your behalf while you pay the rest.
4. Each member under the policy must meet his/her deductible in order to release insurance payments. However, a "family" deductible also applies. Once 2 (or sometime 3) members have met their individual liability, the rest of the family is considered "met" and their deductibles will not need to be reached in order for insurance payments to be issued.
B. Better news
Even if a deductible amount cannot be changed, there are ways to potentially reduce it or avoid paying it.
1. Preventive care services: if you have read any of my several blogs on the topic, you know preventive care is free.
· There is NO deductible when you consult a physician for a good number of screenings, tests, health evaluations, vaccinations, educational advice or health maintenance.
· Preventive care is not subject to a deductible or any share of cost, as the goal is for your insurance - and you by extension! - to save $.
· Helping patients maintain the best physical and mental health levels, preventing disease, stopping chronic conditions from developing, detecting health problems early saves $ and can ensure the best outcomes at no cost to them.
2. The Federal No Surprise Act helps patients in case of emergency services.
· It mandates that emergency services must be paid at the In Network rate, even when the provider or facility/hospital is Out of Network.
· How can that help you reduce your deductible? If you have already met your In
Network deductible, or part of it, you do not have to meet a separate Out Of Network ("OON") liability for OON providers.
· However, you may have an emergency room co pay or a co-insurance liability per the In Network terms of your policy.
3. OON providers at In Network facility (non-ER)
· The same Federal No Surprise Act mandates that Out Of Network non-emergency professional services (i.e Drs, therapists, specialists, consultants, labs etc) rendered at an In Network hospital of facility MUST be paid at the higher In Network rate
· If you have already met your In Network deductible, or part of it, you do not have to meet a separate Out Of Network ("OON") liability for OON providers.
4. Financial Assistance
· These programs put in place by all hospitals and some other medical groups as well as labs or other medical facilities help patients avoid financial crisis or bankruptcy due to large medical bills
· Qualifying patients who cannot afford to pay for hospital or medical care can be given a charity discount or some form of fee reduction if they have no insurance, are underinsured, have a very large share of cost or a too significant a balance.
· The criteria for eligibility vary from hospital to hospital or for every provider, but is usually based on the size of the patient’s household, their income, monthly expenses, some assets (savings), the ratio of total medical debt to income, and internal policies.
· I have found that trying to negotiate a deductible down or off is really difficult, but “Self Pay” discounts or “Prompt Pay” discounts (when you pay most of a balance all at once now) are much better ways to reduce it or even have it written off.
C. Tips
· When scheduling preventive care services, make sure communicate this exact reason and also at the time of the visit. Remind the nurse, PA or physician, as a special insurance code must be used to avoid you getting a bill.
· Checking your “explanation of benefit”, that shows how your insurance process that claim is essential. If you see “Office visit” instead of “preventive care” or have a copay or liability, it is a red flag. Contact the office to have them resubmit a corrected claim, or call your insurance to have them reprocess the claim with no deductible or liability to you.
· When filing an application for financial assistance, make sure all the required documentation is attached. If your circumstances have changed since the date of service, do include a letter explaining you have lost your job or work less hours, that you are now on disability, that a new baby has joined your household, or that more medical bills have accumulated.
· If the facility grants you any kind of a reduction or discount, send a copy of that grant letter to any of the physicians or billing services involved in the care at that time and ask for the same courtesy discount to be applied to their bills. They usually do, whether a deductible or not.
While Deductibles are fixed, there are ways to avoid paying them, or reducing them. Patients should be aware of medical services free to them, or legal mandates imposing payments on insurances and of programs helping them reduce their financial burden
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2024 @ the medical bill whisperer 2024™
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