Parkinson’s disease manifests differently in each person. For some, life goes on with modest disruption. For others, essential tasks that may include working, are not possible. The financial impact of Parkinson’s may include loss of income, difficulty paying for medical expenses like medications and therapies, or worry about paying for long term care.
If a Parkinson’s disease diagnosis has made employment impossible, or if medical expenses have gotten out of control making it impossible to keep up, there are options that can help reduce debt, or in extreme cases, eliminate it all together.
As you consider the possibility of seeking financial help, it’s vital that you not blame yourself for circumstances that are out of your control. Illness, is after all, not your fault. If you are finding this difficult to accept, consider the following information from CNN:
"Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine".
A life time of being financially prudent, with health insurance, does not prevent the possibility that health care bills resulting from treatment for Parkinson’s can be ruinous. Many people find in the later stages of the disease that they need more physical or occupational therapy than what their insurance covers; some medications may not be covered by every insurance company’s formulary, which can quickly add up.
"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."
Hopefully, you are not at the point of declaring bankruptcy, but if you are, remember that bankruptcy laws were enacted to give those with impossible financial obligations a chance to start over. There is no shame in doing what millions of Americans, and countless businesses, have done to relieve financial pressure and begin again with a clean slate.
There are different types of bankruptcies and conditions that apply to all of them. In every case, certain income, and savings, and property types are exempted, or have some exemptions. Be certain to consult an attorney with experience in bankruptcy law. Most bankruptcy lawyers offer a free initial consultation, and many offer payment terms.
If medical obligations resulting from Parkinson’s disease treatments have not pushed you to the point of declaring a bankruptcy, there are ways to reduce existing, and planned medical expenses.
Negotiation
Negotiating service fees from your primary care physician, neurologist, hospital, or other health care provider, may seem unseemly – and something you would prefer to avoid. It’s natural to feel this way, but understand that your doctor is also in business – and that means dealing with payment issues with his or her customers.
Health care providers are also consumers, and they know the financial drain medical expenses can have. They are used to negotiating with patients as well as health insurance companies. Giving discounts for unusual circumstances is common practice, and significant discounts are not unusual. Providers will also likely be able to provide resources that can help with the cost of medications.
When you begin a negotiation – whether before a service has been received or after - the key to being successful is knowing the range of possible outcomes. For example, you may discover you have been charged $10,000 for a certain procedure or group of procedures. Unable to pay the bill, you ask the doctor or hospital for a reduction down to $3000. The business/billing office refuses your offer. Had you done the necessary research, you would have known that bottom end of the range of expected payment for that procedure in your geographic are is $4000, an offer that likely would have met their criteria and been accepted.
Information is key for medical negotiations. Fox Business tells us that “… patients need to know the fair market price for a procedure or treatment before making any decisions so they can plan accordingly. Information about the cost for different treatments based on the region or even city is readily available online. Consumers can also find the rate the government pays for medical procedures online…” That rate can often be 25% less than even what insurance companies pay.
Know the real costs of hospital and doctor visits and procedures
Knowing the costs of a procedure or series of treatments is a major component of a successful negotiating strategy. You can find information on medical services and procedures by looking at your insurance company’s website; in most cases, they publish their negotiated rates.
If you are having difficulty, New Choice Health is one of several websites that can help you find these figures. With a modest effort you will be successful in determining how much doctors and local hospitals charge and the size discount normally given to an insurer. You will also be able to see a listing of a ‘fair’ self-pay price, which is normally considered a small amount above the fee normally received from an insurer.
How to negotiate before treatment
For procedures that are done on a non-emergency basis, prepare for your negotiation by determining price reference points charged for the procedure or service. Before you schedule the procedure, visit the doctor’s office, or hospital, and ask to speak with the business office, or patient business representative.
Explain to the representative that the estimate for the Parkinson’s treatments are high, and would they please make a reduction? This is an effective strategy for those in a competitive market, with many doctors and hospitals capable of providing the treatment. In an area where this is not the case, another approach, along the lines of: ‘I simply cannot afford to pay this amount. Can you please make a reduction”, would be a good strategy.
There are endless variations of negotiation strategies, and the key is to use one you are comfortable with. If you simply cannot do it, then bring a family member who can. It’s best to take a non-emotional approach, keeping the conversation and negation focused on the payment options.
How to negotiate after treatment
If the procedure or services have been completed by the doctor or hospital, the negation process is similar, but with subtle and important differences. The first of these is the absence of choice. The part of your negotiating strategy that included the option to go elsewhere is no longer needed. The other difference is the simple fact that what is done – is done. The doctor or hospital no longer view you and the services needed as representing a financial opportunity which they would like to get the as much out of as is ethically reasonable.
Now, you represent a debt that they want to recover, and they will do whatever is possible to get the most they can from that debt. In most cases, doctors and hospitals have extended payment plans, sometimes with interest and sometimes without. While a full payment of the settled amount can be an important negotiation tool, if that is not possible a payment plan for the settled amount is a common request, and normally granted.
Healthcare providers, as mentioned, are understanding of the predicament many of their patients find themselves in and are willing to discuss and negotiate bills. But, bear in mind, this goodwill is usually limited to one negotiation. Failure to meet the agreement frequently will likely result in quick collection action.
It’s also the case that both hospitals and doctors do not want to attempt legal remedies to collect a debt. Collection services take as much as 50% of the collected amount, plus any costs incurred in the collection. On an average basis, the total received from all collected accounts may be in range of 25%, and the health care provider may wait a considerable period of time to be paid from the collection agency. If you make an offer of 35%, there is a good chance it will be accepted, and a better chance if you can offer immediate payment.
If an offer has been agreed to, and for one reason or another payment is not made, be certain to have the agreement put in writing. This may seem obvious, but with healthcare providers, we tend to forget the need to secure basic protections.
“Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.” - Los Angeles Times
Dealing with collection agencies
If your account has been sent to a third party collection agencies, there are plenty of options still available.
Credit.com tells us:
“How you ultimately resolve a debt with a contingency debt collector is going to depend on: your monthly cash flow that can be used to make payments; the parameters the collector has to work with on their end; and even by the date on the calendar.”
Credit.com goes on to say:
“Setting up a payment arrangement you can afford given your monthly budget is not all that difficult. And if the collector can get you set up with a payment, they often get to retain the account while your payments are being made. This means your interests and the collector’s are aligned when you are actively looking for a solution.”
Be realistic in your plan. It is easy under the pressure of negotiating to agree to a price that may reflect a big discount, but is still outside your means. Be completely honest about what you can pay, and how long you will need to pay it.
Payment as a negotiating tool
Most experts advise against using credit cards for payment. CBS News tells us:
“Forgo the credit card if you think you might be asking for a discount later. Using plastic puts you in a weaker bargaining position with the hospital. ‘We recommend against credit cards, because the hospital loses any interest in negotiating with you’ once they have your money, says Carol Pryor, policy director at The Access Project. And your bills could be even higher if you end up paying interest on the charges.”
If the procedure has been done, using a credit card is a valid option.
Getting help
Some of us simply are not comfortable negotiating anything, let alone a hospital bill or a bill to a doctor that we have come to depend upon and trust. This does not change the need for relief, but it does change the strategy. There are services like Medical Billing Advocates of America, who will negotiate on your behalf for a fee. There are nonprofit advocates as well, and an attorney is usually an excellent choice.
The Federal Trade Commission (FTC) says that:
Reputable credit counseling organizations can advise you on managing your money and debts, help you develop a budget, and offer free educational materials and workshops. Their counselors are certified and trained in consumer credit, money and debt management, and budgeting. They discuss your entire financial situation with you, and help you develop a personalized plan to deal with your money problems. An initial counseling session typically lasts an hour, with an offer of follow-up sessions
The los Angeles Times provides this advice:
Seek help and file complaints. If your bill is large or you're having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America (www.billadvocates.com) and Health Proponent (www.healthproponent.com) can help you fight charges or lower your bill.
If you're being stonewalled by your healthcare provider, and your insurer hasn't helped, Quincy of Consumers Union suggests filing a complaint with your state's department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting healthhelp.ca.gov. Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit http://www.insurance.ca.gov. If your provider isn't contracted with your insurer, your state's attorney general's office is a place to turn for help.
Government Resources that help with medical bills:
If you are receiving Medicare and need assistance. contact the Centers for Medicare and Medicaid Services (CMS) or view Programs to Help You Pay Medical Expenses. You can also call or write to CMS
Phone: 1-877-267-2323 or 1-410-786-3000
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore MD 21244-1850 |
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