Recovering from the financial impact of a serious illness can be as difficult as curing the disease. But there are ways to manage the bills.
By BRYAN GILMER
Published June 29, 2003
Leighsah Jones was 30 when a welt appeared on her chest and quickly swelled into a large mass under her left arm.
She was between jobs with no health insurance. Jones, who had served in the Army, qualified for veteran's benefits, but VA doctors were unable to diagnose her without consulting a specialist at Moffitt Cancer Center in Tampa.
She had inflammatory breast cancer, a rare, usually deadly form, she finally learned. Doctors advised her to reconcile herself to her fate and seek hospice care.
Instead, Jones sought out experts in inflammatory breast cancer outside the VA. They gave her repeated chemotherapy, radiation therapy and surgery.
Now the resident of Longwood, near Orlando, has been symptom-free for three years. But she's still battling the pile of medical bills from her treatments. Taking advantage of her training in accounting, she uses a computerized spreadsheet to keep them straight.
"My spreadsheet now is almost 700 pages," she said. "Each page is something that was billed. It may be chemo, it may be supplies. Keeping up with it became a full-time job."
At its peak, Jones' debt reached $1.2-million. Though not every patient's medical expenses are as high, hundreds of thousands of Americans face overwhelming medical bills each year.
"Some of them mount up to thousands of dollars, and some are very small," said Cindy Streur, coordinator of operations and counseling for Consumer Credit Counseling Service of the Florida Gulf Coast. "Several bills in the hundred-dollar range get overwhelming for some people."
Harvard University law professor Elizabeth Warren and colleagues surveyed bankruptcy filers last year and found that half filed at least in part because they couldn't handle the financial consequences of an injury or illness.
"A family with a serious medical problem is a family with a serious financial problem," Warren said. "Middle-class families are so close to the edge financially that most can't withstand any financial blow. Unlike the family of 30 years ago, which had 10 percent of its income in savings and owed almost nothing in credit card debt, today's family has no savings and owes on average $7,000 in credit card debt."
But with the right techniques and lots of persistence and patience, most people can work through seemingly unaffordable medical bills, personal finance experts and medical billing officials say. Here are steps they recommend:
# Face the bills head-on right away.
"Doing nothing is the worst thing," said Streur, the credit counselor. Ignored bills quickly end up with collection agencies, which are far less understanding than doctors and hospitals that originally sent the bills. Bills that are "in collection" harm your credit rating, which can worsen your financial problems.
Even if you can't pay, call the hospital billing department or physician practice administrator of each place that billed you and explain that you intend to deal with the problem. Ask for an extension of the due date while you rearrange your finances. Jones says being nice on the phone persuaded many medical providers to work with her.
"More often than not, you are one of 85 people they have talked to that day," she said of billing specialists. "If you can be absolutely the most pleasant and charming and funny, you'll get people not to be ticked with you."
# Pay for your essential living expenses before paying toward any medical bills.
"Unfortunately they're down the list," Steve Rhode, president and co-founder of Myvesta.org, said about medical bills. The nonprofit financial management organization, in Maryland, offers clients both free and fee-based services to help them avoid bankruptcy.
"What people do is make the mistake of making promises to the creditor who is screaming loudest at the moment," said Rhode, who previously worked as a medical practice administrator. "The first bills you should always pay are rent or mortgage, transportation, food and utilities. After that, (minimum payments to) unsecured creditors like credit card companies who will sue you quickly. After that comes medical bills. You want to pay the things you need to keep living and keep working."
Jones found that grantors of credit were understanding about large medical debts on her credit record. They may not have been as forgiving of a default on a loan, for instance. "Frankly, medical debt is kind of blown off" more readily than other debt is, she discovered.
# Investigate whether someone besides you is responsible for all or part of the charges, and stay after that person or company until its share is paid.
In some cases, this is a health insurer. Just because a bill comes to you doesn't mean that your insurance company isn't responsible for it. Call and find out why you were billed or why a claim wasn't paid.
"That would mean working through billing offices for physicians to get the right amount from the insurance," said Colin Ball, a St. Petersburg health care billing consultant with Gregory, Sharer & Stuart, PA. "Work with the physician practice or the hospital to make sure all the bills got paid properly."
Even if you have no health insurance, an insurance policy may cover part of the bills.
If you were injured on company time, your employer should cover your medical expenses under worker's compensation. Talk to your human resources department about this as soon as you are injured, if possible.
"If you fall off the roof of your house or somebody else's house, there's a possibility that homeowner's insurance will pay," Ball said. "If it's an auto accident, maybe it's auto insurance."
You may need to consult an attorney in some cases to recover money from an insurer or from the person or company that caused your injury.
Jones was between jobs and without insurance when she became ill. She was able to get state Medicaid to cover most of the charges. Still, it took hundreds of phone calls and cooperation with her doctors to get all of the claims paid.
"Procedures that should have been covered were rejected" initially, she said. Her doctors were grateful for her help at getting the bills paid.
"I needed doctors who believed in me," she said. "Once I found doctors who would treat me, I needed them to treat me and treat me as aggressively as possible. I wanted them to feel like they had a vested interest in keeping me alive, and getting them paid was my only way of doing that."
# See if you qualify to have the doctor or hospital write off some of your bill as charity care.
"People above the federal poverty level who don't qualify for Medicaid - up to 175 percent of federal poverty level - there's possibly some sort of assistance," Ball said. "They might put you on a sliding fee scale because you don't have an ability to pay, or they could take part of the bill off. They will know of any programs that exist that could help you."
# Analyze your budget to figure out how much income you can pay toward your medical bills, then agree on a payment plan with everyone you owe.
If you have savings or get a lump-sum settlement payment of some sort, you may be able to negotiate to pay off each bill for less than the full amount.
If not, you need to add up your monthly expenses, figure out what luxuries you can cut and determine how much you can realistically pay on your medical debts.
"Develop a comprehensive plan to solve the whole problem," Rhode said. "One of the basic mistakes people make is to call and say they are going to pay X amount and then not be able to pay it. Then the doctor's office can't trust their promises any more."
Still, health care providers usually are willing to set up affordable payments.
"Something is better than nothing; that logic is not lost on doctors," Rhode said.
Jones began tackling her share of her medical debt by agreeing to pay about 30 health care providers just $1 per month each. That was enough to show her intent to pay. As her income increased, she increased the payment for just one bill at a time until it was paid off. Then she focused on another bill, then another.
"I don't miss a payment," said Jones, who now works as an accounting manager for a telephone company. "I send them a spreadsheet every month of every bill I have paid."
# Seek financial care just as actively as you sought medical care.
If any of this seems beyond your ability, get help. Jones let her mother manage the medical bills while she was in the early stages of fighting cancer.
You may have a friend or relative who is good with money and willing to help you, or your church or a community organization may be able to offer you advice. Or you can seek credit counseling.
Finally, know you're not alone, said Warren, the Harvard professor.
"Protecting themselves from a serious medical problem," she said, "is one of the hardest issues facing families."
