When you’re ill or recovering from a procedure, out-of-pocket medical costs can weigh you down—especially if you’re already paying a high annual deductible. And while paying off the debt requires some planning, this article can help you understand why your insurance may not cover certain costs, along with different ways to use medical loans, savings and your community’s support to tackle bills.
When insurance may not cover the bill
Medical insurance claim denials may happen for reasons that aren’t always obvious when you first get the bill. Common reasons can include:
· Out-of-network care
Sometimes, in an emergency or when in-network care isn’t available, an out-of-network provider may need to treat you, and your insurer may not cover that care in part or in full. Finding care through your insurance company’s directory or app may help you avoid an accidental out-of-network visit.
· No prior authorization
Some procedures, tests or specialist appointments require authorization from your insurance company before they take place, or the care may not be eligible for coverage.
· Incorrect billing or coding
When doctors, specialists, hospitals or other medical centers mistakenly code a procedure or bill you incorrectly, your insurance may deny the claim until it’s accurately processed.
· Unmet deductible
For many health plans, you have to pay a certain amount out of pocket before insurance kicks in. Sometimes that amount can be $2,000 or more for high-deductible plans.
Depending on your situation, calling your insurance provider could help clarify the reason for the denial or start an appeal, but even then, your appeal may still be rejected.
Tips for managing medical bills
Several approaches might help you make progress with medical debt, so your fears over damaging your credit don’t get the best of you.
Call your doctor’s office
Speaking directly with your health care provider’s billing team may help you understand how they calculated the charge and whether they can adjust or reduce it. You could also ask if financial assistance applies to your situation or whether a no-interest payment plan is available. Making these calls can be uncomfortable, but billing staff have these conversations every day and may be more understanding than you expect.
Tap into health care savings
An HSA is a popular medical savings account for people with high-deductible health care plans that lets you set aside pre-tax money for eligible health care expenses. Using HSA funds might help cover out-of-pocket costs without adding new debt or noticeably shrinking your budget. You can opt to use part of your HSA balance for bills as they come or set funds aside for future care.
If your health care plan doesn’t have a high deductible, you may be eligible to open a Flexible Spending Account (FSA) for health care costs instead. FSA dollars aren’t taxed, and you can use them for deductibles, copayments and certain medications. However, FSAs have a use-it-or-lose-it structure, so planning ahead for what you expect to spend over the year can help you make the most of the funds.
Consider crowdfunding
Crowdfunding involves raising contributions from friends, family or online communities. Sharing personal medical information may feel vulnerable, but many people might find emotional support and financial relief through these platforms. If you feel comfortable being open about what you’re going through, crowdfunding could be an option worth exploring.
Explore a medical loan
A medical loan is a type of personal loan used to help you afford medical care. Personal loans let you borrow a lump sum of money up front that you repay in predictable monthly installments over a set period. Rates, prepayment penalties and the overall cost of borrowing can vary based on your credit profile and lender’s terms. If you’re managing several medical bills from different providers, a medical loan could help streamline those payments. And if you make your payments on time, every time, you could potentially improve your credit, too.
Tackle medical bills with confidence
Managing uncovered medical bills can be stressful, but you have options. Regardless of the path you take, self-advocacy can often be a crucial part of paying down medical debt, so it’s a good idea to get comfortable with asking questions and making calls. And while gaps in health care coverage continue to exist, there are ways to bridge those gaps, move forward and stay healthy.
Information provided in this article is for information purposes only and does not necessarily reflect the views of mirrorreview.com or its employees. Please be sure to consult your financial advisor about your financial circumstances and options. This site may receive compensation from advertisers for links to third-party websites.
