Helping Patients With Sudden Medical Bills

Unexpected medical bills continue to be a massive burden on countless patients across the United States. This is a problem that physicians and healthcare providers cannot solve alone. However, there are some efforts that can be made to offer marginal assistance to patients burdened by oppressive bills or facing expensive care.

It’s a widely accepted problem at this point that many Americans don’t have the means to address out-of-pocket medical expenses. While more people have access to health insurance now than some years ago, and there is some political momentum toward more equitable insurance solutions, the fact remains that costs related to medical procedures and medications often run to unreasonable levels. And even the knowledge that this can happen is proving to be a barrier to care. Nearly one in four Americans are actually neglecting to seek medical care because of concerns about costs.

This problem is caused largely by the sudden medical bills that plague American patients. While the initial price tag of care can be hefty, and medications can be almost shockingly expensive, a significant percentage of these costs is often reduced by insurance. It is the balance billing, however, that shocks patients. This is essentially the amount not covered by insurance, and it can be enough to send people into debt — even where some fairly simple services or procedures are concerned. This is in some respects a problem without a solution. It’s an immensely complex issue, founded on a variety of smaller problems and offering no clear one-step solution. Issues with drug prices, the cost of care, and the effectiveness will ultimately be addressed by lawmakers and in the halls of congress. Where physician leaders can offer some small assistance, however, is in helping patients to anticipate and deal with sudden medical bills.

Openness About Costs & Care

Until there is meaningful, structural change in how medical expenses are handled in this country, one way that physician leaders and care providers can work to improve the situation is by advising patients honestly about costs and care. This isn’t meant to help with paying bills, but rather with keeping them lower in the first place.

In a piece about physicians’ role in protecting patients financially , the AMA Journal of Ethics pointed out that physicians need to be prepared to advise patients in ways regarding unnecessary expensive services or less expensive alternatives.

On the one hand, this means responsibly explaining to patients when a certain desired method of care — such as a requested MRI when other diagnostic processes will do — are not necessary and will only increase expenses. On the other hand, it can also mean openly and honestly suggesting affordable alternatives if out-of-pocket expenses are a potential issue. “If less expensive alternatives do not produce the best or standard care,” the piece puts forth, “patients should still have the opportunity to choose them as long as they know full well what the anticipated trade-off is.”

These points are not meant to suggest that necessary procedures should be avoided, nor that patients should be dissuaded from seeking the care they deserve. However, physicians need to be trained to provide open assessments. If a procedure is more expensive than it is necessary, the patient should be made aware. And if cost is going to prohibit the patient from seeking the best treatment, an affordable alternative should at least be offered, even if it may be less effective.

General Recommendations For Covering Costs

When it comes to recommendations for patients dealing with medical bills, physicians need to be careful. It can be irresponsible, and a potential conflict of interest, to offer specific suggestions. Furthermore, physicians can’t be expected to maintain expertise in financial patient support. That said however, it may be helpful for healthcare providers to gain confidence in suggesting broader solutions — such as support for specific conditions, or financial options.

Regarding the former, things largely depend on the condition or healthcare needs at hand. Patients dealing with certain maladies — cancers, chronic diseases, autoimmune disorders, and rare conditions — will often be able to find significant resources designed to help people like them with some of the oppressive costs that can arise. While it remains true that healthcare providers should maintain some distance with regard to specific suggestions, highlighting the general availability of these resources can be some small help.

Informing patients on adjustments to their healthcare plans is also something physicians and other healthcare providers can do. The ongoing health crisis, for instance, has spurred the passing of the CARES Act. This is something everyone should be aware of as it can help people offset some of their medical costs with their Health Savings Account (HSA). Patients can now use their HSAs to cover over-the-counter medicines and feminine hygiene products. This applies to related medical expenses incurred since January 1 of this year, which patients can reimburse themselves for with their HSA. This also makes HSA holders eligible to use the money in their account to purchase thermometers, batteries for medical devices, first-aid supplies, and even cold and allergy medicines. The CARES Act also increases flexibility for retirement plan withdrawals for people who are financially impacted by the pandemic. IRA holders may make an early withdrawal without the 10% penalty. Keeping patients up to date with these new changes is key, as even small adjustments to policies can be of great help during a time of health and economic crisis.

Staying Updated On Legal Change

The final suggestion is that physicians and other healthcare providers also make an effort to stay up-to-date on legal changes and legislative progress related to surprise medical bills, and healthcare costs in general. It is not, to be clear, any physician’s primary responsibility to update patients on legal battles related to medical care. However, being able to answer questions accurately and offer clarity where possible can help to put patients at ease regarding costs.

As an example, an intensifying legislative battle over surprise medical bills just last summer. In the time since, some action has actually been taken on this front (though there is debate over whether it is effective or largely symbolic). The point as far as this discussion is concerned, however, is that groups representing hospitals and physicians were involved in this fight, and actively pushing for changes to billing and insurance systems. Without arguing for any one side in this particular dispute, it does seem apparent that the broader conversation was directly relevant to healthcare providers.

Regarding this example and others like it, providers who are able to maintain awareness about any potential changes to billing structures will — it stands to reason — be able to inform patients about relevant topics most accurately.

Combined, these efforts can lead to slight improvements in where the average patient stands with regard to unexpected medical costs. Physicians cannot solve this problem in its entirety, and shouldn’t try to. A conscientious approach armed with openness, general suggestions, and up-to-date perspective can still go a long way though.

Genevieve Gordon is a medical student seeking a surgical residency. She is based in Seattle, and spends what extra time she has researching and occasionally writing about medical industry trends and aspirations.

1. Nearly 1 in 4 Americans are skipping medical care because of the cost. CNBC; https://www.cnbc.com/2020/03/11/nearly-1-in-4-americans-are-skipping-medical-care-because-of-the-cost.html Accessed July 15, 2020.

2. Analysis: Sudden Medical Bills Surprising, But Not Fun. Physician Leader; https://www.physicianleaders.org/news/analysis-sudden-medical-bills-surprising-but-no-fun Accessed July 15, 2020.

3. Physicians’ Role In Protecting Patients’ Financial Well-Being. AMA Journal of Ethics; https://journalofethics.ama-assn.org/article/physicians-role-protecting-patients-financial-well-being/2013-02 Accessed July 15, 2020.

4. Covid-19 and The CARES Act Have Changed Some HSA and HDHP Rules; https://www.marcus.com/us/en/resources/personal-finance/hsa-covid19-cares-act

5. Physician, hospital groups gear up for high on surprise medical bills. Modern Healthcare; https://www.modernhealthcare.com/politics-policy/physician-hospital-groups-gear-up-fight-surprise-medical-bills