The Hospital Already Knows You Can't Pay

Hi friends,

Four things happened in the news this week that could change what you end up owing. I'll take them one at a time.

Hospital companies tell their investors things they don't tell patients

Three of the biggest hospital companies in the country talked to their investors this week. Somebody asked one of them about patients who show up with no insurance, and he said that on those patients they only collect a few pennies on the dollar. That is a company executive telling stock owners, out loud and on the record, that his hospital does not expect to be paid.

That should change how the phone call feels. When you call the billing office and say you cannot pay the $14,000, you are not asking for a favor and you are not telling them anything they haven't already worked out. Their own finance people said it first, to a room full of investors.

So make the call, and get three things out of it. Ask for the uninsured discount. Ask for the financial assistance application even if nobody offers you one. Ask them to put a hold on your account while you fill it out. Write down who you spoke to and what day it was, every single time, because the only thing that reliably makes a hospital bill worse is silence. Silence is what turns a bill into a collections letter.

A judge said no to 25 states, and there's a date you should write down

Twenty five states asked a federal judge to block the new Medicaid work rules, and on July 29 he told them no. He did not rule that the requirements are legal; he said it isn't an emergency yet and the case will keep going. Either way, the rules are still on track to start January 1, 2027.

If you or someone in your house has Medicaid, that means showing you're working, in school, caring for a family member, or that you qualify for an exception.

What I want you to know is that people almost never lose Medicaid because they didn't qualify. They lose it because the renewal letter went to an apartment they moved out of two years ago, or because nobody told them which pay stub to send, or because it arrived during a week when everything else was already going wrong.

So do the boring thing now, while it's calm. Log in to your state Medicaid account and check your address, phone number, and email. Then start a folder, paper or on your phone, and put something in it once a month: a pay stub, a class schedule, a doctor's note, proof that you take care of a parent or a child. When a letter shows up, open it that day.

Because if you lose coverage and then you get sick, you become the uninsured patient from the story above, and you already know how that one goes.

There's one kind of bill you probably shouldn't pay

New government numbers came out this week showing a huge fight over surprise bills; almost 1.4 million cases in six months, and billions of dollars moving back and forth between insurance companies and doctors. Almost none of that fight belongs to you.

The rule is simpler than most people think it is. If you go to the emergency room, or you go to a hospital that takes your insurance and one of the doctors treating you doesn't take it, you only owe what you would have owed if that doctor had been in your plan. That's the ceiling on the whole thing. It covers the anesthesiologist, the radiologist, the emergency room doctor, the assistant surgeon, all the people you never picked because you were lying on a table when they walked in.

So when a bill arrives from a doctor you don't remember choosing and the number is frightening, don't pay it just because it looks official. Call your insurance company and say the words "No Surprises Act." Ask them to put in writing what you actually owe. Then call the doctor's billing office holding that number.

If you're on Medicare, your drug plan is about to get more expensive

For the last two years a federal program has been quietly holding down the price of Medicare drug plans, and it ends in December. The drug plans you buy on their own, instead of getting drug coverage bundled into a Medicare Advantage plan, are likely to cost more next year.

Medicare open enrollment runs October 15 through December 7, so put it on the calendar now and don't let your plan roll over on its own. Prices change every year and so do the lists of which medicines each plan covers, which means the plan that fit you this year might not cover your prescription next year. Twenty minutes on the Medicare website in October is worth real money by March.

What didn't change

Same as last week, because all of it is still true. Nonprofit hospitals still have to have a financial assistance program and still have to tell you about it. They still have to send four notices over 120 days before they can come after you, and you still have up to 240 days from your first bill to apply for help. Appealing a denied claim still works more often than people expect. Asking for a face to face meeting still gets you further than a phone call.

None of this is good news exactly. But every one of these four things is easier to handle in August than it will be in December, which is why I'd rather you hear about it now.

More next week,

April

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