How to handle non-stop "piddly" medical bills

[historically accurate]

It's been a rough 4 years for us medically. I have thousands of dollars that I am paying on already.

However, this year has been a lot of "exploratory" appointments for us - ie: "Have you seen a G-I? Gyno? This specialist? That specialist?" I am being absolutely buried in co-pays and MRI/XRay/EKG/EEG bills. None are big enough to allow for a payment plan, but they add up quickly.

I am starting to get the calls that this one is overdue, and "Just give us a credit card # today." Well, that would be fine and good, but we can only afford so much. I am currently paying 2 a week (at least $80), which is putting us behind both in our regular budget, especially with all of the prices going up, and in the medical bills. 

I've tried explaining that yes, it's just $40 to X doctor, but I owe $40 to 5 different doctors, as well as $170 or $500 here and there. None of the doctors seem to care, and I get that, but I can only do so much. 

How do you handle multiple little debts? Do I just field the calls and continue to tell them they'll get paid when they get paid? Or what? 

Edited June 22, 2022 by historically accurate

[Katy]

Say, “I need to set up a payment plan,” and make it for whatever you can actually afford, even if it’s $10/month.  
 

You calculate what you can afford like this: Make a list of all your medical debts and remaining balances. Figure out what percentage of total medical debt each is. Figure out what you can reasonably afford to pay towards each. Round the dollar amount towards each down. Apply whatever the remainder is towards the smallest dollar amount. 
 

As an example: 

If you owe $500 total but can only afford $200/month and you owe $25 at one place, $40 at 3 places, $150 at one place, and $205 at one place it breaks down like this: 

• $25 is 5% or $10/month.
• $40 is 8% at 3 places or $16/each per month.
• $150 is 30% is $60/month. 

• $205 is 41% or $80/month. 
 

Added together that leaves an extra $2/month that I would apply to the smallest debt, to make the $25 one $12/month. When you pay off that pick the next smallest to apply that $12/month to. 
 

[Katy]

Oh yes, and base your plan off of what you can reasonably afford. Do not stretch yourself here. If you have extra money you can always pay more than your plan. Make you total budget small enough that you’re sure you can actually pay it without as much stress. 

[happi duck]

It sounds like the individual smaller bills won't accept partial payment?  If they won't, do they fall under any sort of common umbrella like medical group or hospital system?  Maybe the umbrella could consolidate them for payments to work?

Many (hugs)

[Scarlett]

I feel your pain. 
 

Our deductible is 3k each.  Once we reach 3k insurance pays 100% but nothing until it reaches 3k.  So this year Dh and I both reached 3k early in the year. So now I am figuring out how to get 6k paid off between our various doctors and clinics and hospitals. 

It is pretty stressful.  Thankfully we have an HSA that between us and dhs employer gets almost $400 a month deposited….so every month I have to figure out what to pay with that $400.  So it will end up that I finish paying the 6k about the time the year is over.  Then we start all over again.  I am hopeful that at least I canjust avoid doctors completely next year.  

[Spryte]

I think Katy laid out a good plan.

One of our kids was hospitalized at an out of networking hospital in a neighboring city. They offered a service that worked with all the various billing parties and helped us come up with a plan to pay off the total. If you’re going through one hospital system, you might be able to call and ask them about anything similar.

[TechWife]

In the past few months I’ve seen four specialists and had numerous lab tests and radiology procedures done, I totally understand what you’re saying. 

I think being as prepared as you can be and proactive with conversations will go a long way. Being prepared for these phone calls is half the battle. They never come at a good time. You don’t like getting them and the person calling you doesn’t like making them. 

This advice is about developing a procedure that will  both help you budget and reduce your stress by having a plan & procedure in place. 
Have a master list of medical debt owed that shows the provider, total amt owed, monthly amt owed if you have any payment plans set up, and the due date of each bill, along with the full total of medical debt you’re carrying atm. Remember to add anything new (expenses or payments) as they occur. Separately have a similar list for any ongoing medical expenses, such as medications. Decide and write down the total amount you can pay towards the medical debt each month. 

Have a document, notebook, notepad or whatever that is dedicated to this task as well. This is for you to make notes in of every bill received, every conversation you have and any other correspondence. Have a separate page for each provider so you have all pertinent notes in one place. If you use a physical notebook, you can physically staple correspondence to a page as you receive it if you want to, or keep it on a specific place like you’re probably already doing. If you keep it in a separate file, make a note in your notebook of the day you received it, the date on the letter or bill date and what it is. For example, when you get a bill, on page for the orthopedist write bill received 6/22/22 bill date 6/15/22. This will help you find it when you need it.

As I’ve written this out, I remembered how much scripting has helped me in new or stressful situations and I started imagining how I might have these conversations if it were me. I’ve included those “scripts” as examples of what I mean, so please don’t think I’m trying to dictate what you say, it’s just an example. 

For bills you have on hand right  now - when someone calls you. Pull out your info and simply give them the total amount of medical debt you are carrying. Then proactively offer a payment dafe. “Thanks for reaching out Amy. I do have that bill. Right now we have a total of $3,400 of medical debt. I’ve set aside $150 each month towards paying it off. Based on that, I can pay this bill for $42.75 in full on October 16 of this year. How does that sound?”

If they can’t make that decision, ask them who could and could you please have their contact info? Go as far up the food chain as you can. 

When you receive a bill or any correspondence - either new or bills you are carrying over, pick up the phone and proactively have the same conversation with a billing representative or office manager. 
Key to this will be record keeping. 
On your monthly total - keep track of how much of that dedicated debt reduction amount you have committed. When you have committed all of it, move to promising to pay the following month. If there’s any left over that you haven’t committed (there may be when you first start this), move to paying your oldest bills first and work your way forward.  

Note any new due dates or changes in amounts owed that result from these conversations on your summary sheet to make it easier for you to follow through. Your summary sheet may seem daunting and it will be ever changing when you look at it as a whole, but try to look at it in pieces or chunks. Give yourself a pat on the back when you get those pieces and chunks taken care of. Great - the orthopedist is paid! Followed by Wow, all of those broken leg expenses are paid off now! 

Document for the paper trail and use the info to build rapport. Call people by their names. If there’s any chit chat and anything memorable comes out, you can make a quick note of it and circle back to it the next time you talk. “Hi Amy. Yes, we’re right on schedule to pay that bill in full in October like we discussed the last time we talked. I haven’t forgotten! You were getting ready to go to the beach the last time we talked, how was your trip? Did you have good weather? Great to talk to you. Thanks for reaching out.” 

 

[Pawz4me]

If all the bills, or a good part of them, are through the same hospital/medical system then it's likely they can be grouped together under a payment plan.

[kbutton]

I don't have practical advice except to say that you need to develop thick skin if they badger you with messages all the time.

We pay our bills as soon as it's convenient after we get them--which means, when I have another utility bill or something due that makes it worth my time (never more than a couple of weeks). If I just paid everything for the next two weeks, I don't break out my checkbook for a medical bill that just came; often the thing I am being billed for is months old, and if they were that eager, they could've nagged my insurance instead of me. I can't help how fast or how slow the other parties in the process do their thing. Not my problem.

But one system lately...mmmm...they sent me messages every few days for a service that they gave me a price on, and I paid for the same day that it happened. It's not my problem that they shorted themselves $25 the first time. I mean, I owe it, and that's fine, but I demonstrated good faith by paying for the whole procedure the day it occurred, and the bill barely hit my mailbox. I do not need to be nagged about their underestimate. The nagging via e-mail and "go check MyChart" to pay your bill has been at a level that I might opt out of using their facilities forevermore, if I have a choice (and they are literally within walking distance if there was a sidewalk going to their facility!). It was totally inappropriate.

So, filter out what is nagging vs. a real problem. If they are sending you nasty-grams before the paper copy arrives in the mail, that's just very bad customer service that you can ignore. Don't sway to the pressure! 

[stephanier.1765]

I'm about to stop PT for the same reason. Almost every doctor I see is a long drive from me so the price of gas is another factor bearing on my medical bills. I need to stop something because it's getting out of hand. I'm so sorry you are having to deal with all this. Hugs!

Edited June 22, 2022 by stephanier.1765

[historically accurate]

Unfortunately, it is mainly 3 different people in the family and 4 different medical groups, so they won't combine. Also, unfortunately, I cannot send partial payments for anything under $100 at 3 of the 4 groups. 

I think I can handle TechWife's proposition. I already have a spreadsheet I update every time someone goes to the doctor and then update every week with our insurance information as it becomes available. I color it blue when a bill shows up with the date, and then I turn it yellow with a note of date and check# when paid. I can figure out a plan beyond the next week or two hopefully.

Thanks all!

[ktgrok]

Have you applied for a care credit card? They are zero interest for the first 6 months, usually, i think. And you could pay a couple of the bills with that, to consolidate them, then pay what you can towards the card. So you have fewer to keep track of, and are not trying to make 10 different payment plans. 

[prairiewindmomma]

TechWife did a good job of describing the bills as part of aftercare.

Have you tried handling the triage funnel up front in terms of appointments? 

"I see you are recommending test xyz. What will that tell us? How would that shape treatment compared to if we didn't know that bit of information? I'm making decisions between eating and paying medical bills. What are our options?"

Because, the reality is, some testing and imaging is just simply CYA from a medical malpractice perspective. Some stuff is absolutely necessary. Some stuff can get kicked down the road a bit. Some stuff might get all bundled together and done in a hospital setting (ie when someone is inpatient already) so that you have one bill coming out of it instead of 8.  

A lot of doctors don't ever stop to think about how necessary a bit of info is. So, if you aren't already asking questions, here's a nod that it's absolutely ok to do so.

[prairiewindmomma]

2 minutes ago, ktgrok said:

Have you applied for a care credit card? They are zero interest for the first 6 months, usually, i think. And you could pay a couple of the bills with that, to consolidate them, then pay what you can towards the card. So you have fewer to keep track of, and are not trying to make 10 different payment plans. 

Oh, I REALLY don't recommend consolidation. You lose all kinds of consumer protections. You also end up paying more in interest.

Seriously, caveat emptor. This is designed to benefit the medical office, not you.

[ktgrok]

18 minutes ago, prairiewindmomma said:

Oh, I REALLY don't recommend consolidation. You lose all kinds of consumer protections. You also end up paying more in interest.

Seriously, caveat emptor. This is designed to benefit the medical office, not you.

If she's able to pay it off in 6 months, there is no interest. It's just for medical bills. I'm not sure what kind of consumer protections you mean, though?

[TechWife]

Relevant story posted to NPR. 
https://www.npr.org/sections/health-shots/2022/06/16/1104969627/medical-debt-upended-their-lives-heres-what-it-took-from-them#allyson-ward

[prairiewindmomma]

18 minutes ago, ktgrok said:

If she's able to pay it off in 6 months, there is no interest. It's just for medical bills. I'm not sure what kind of consumer protections you mean, though?

Um, for starters:

Beginning July 1, 2022, for the three major credit industries, paid medical bills are no longer included on credit reports. Unpaid medical bills are only reported on credit reports if they have remained unpaid for at least 12 months. Additionally, bills under $500 will not be listed on credit reports, paid or unpaid. If she consolidates, she's moving a bunch of low bills (she describes them as generally being under $500) to a higher bill that would be listable.

[Katy]

1 hour ago, historically accurate said:

Unfortunately, it is mainly 3 different people in the family and 4 different medical groups, so they won't combine. Also, unfortunately, I cannot send partial payments for anything under $100 at 3 of the 4 groups. 

I think I can handle TechWife's proposition. I already have a spreadsheet I update every time someone goes to the doctor and then update every week with our insurance information as it becomes available. I color it blue when a bill shows up with the date, and then I turn it yellow with a note of date and check# when paid. I can figure out a plan beyond the next week or two hopefully.

Thanks all!

Yes you can. Just because the clerks who take the phone calls don’t have the authority to approve them doesn’t mean you can’t.  Send by mail a letter with the check that says you cannot afford to pay the balance and need to make a payment arrangement. That cashing this check (number ____) is agreement to your payment plan of $12/month or whatever you say. Mark the check on the memo line “conditionally cashed.”

Them cashing the check means they agree to the payment plan. 

[ktgrok]

23 minutes ago, prairiewindmomma said:

Um, for starters:

Beginning July 1, 2022, for the three major credit industries, paid medical bills are no longer included on credit reports. Unpaid medical bills are only reported on credit reports if they have remained unpaid for at least 12 months. Additionally, bills under $500 will not be listed on credit reports, paid or unpaid. If she consolidates, she's moving a bunch of low bills (she describes them as generally being under $500) to a higher bill that would be listable.

Ah, was unaware of the new changes. That's fantastic!

[Katy]

You can also use the same process to settle a debt but obviously if you ever want to go to any of those providers again you must make payment arrangements. 

[prairiewindmomma]

Part of the challenge, I think, is that these aren't one and done bills....they are providers she needs to maintain a good relationship with because there is on-going care. Additionally, consolidation doesn't address the fact that these bills continue to accumulate. If she were to consolidate, that's just a line in the sand of the past. It doesn't address the fact that she is continuing to generate bills.  She'll then owe the consolidation amount, subject to heavy interest rates after expiration, AND all of the new copays and coinsurance.

 

[Ann.without.an.e]

I'm really sorry. Are they all the same hospital network? Often within a network you can group them into one bundle and do a monthly payment plan. It is usually third party and no interest if paid monthly. They pay your providers and you pay them

Edited June 22, 2022 by Ann.without.an.e

[ktgrok]

1 hour ago, prairiewindmomma said:

Part of the challenge, I think, is that these aren't one and done bills....they are providers she needs to maintain a good relationship with because there is on-going care. Additionally, consolidation doesn't address the fact that these bills continue to accumulate. If she were to consolidate, that's just a line in the sand of the past. It doesn't address the fact that she is continuing to generate bills.  She'll then owe the consolidation amount, subject to heavy interest rates after expiration, AND all of the new copays and coinsurance.

 

yes my suggestion of carecredit was if she could afford the bills, but just not to pay all of them in the same week/month kind of thing. Like, she could afford them if they were all on a payment plan, but since none would DO a payment plan she was having to pay the full amount on each at the same time, or have them go to collections. In that specific scenario, a care credit card would let her create her own "payment plan" over 6 months, and keep in the good graces of the medical offices. 

[Katy]

Doing a payment plan by mail isn’t even something to be ashamed about. If you had half a million dollars of medical debt and a half million dollar a year family income, you’d pay a lawyer to set out a four year repayment plan that would work out the same way. 

“We have a budget of $10,000 a month towards medical debt and the amount due is 2% of our medical debt, so we’ll be paying you $200 per month.” 

Frankly corporate financial restructuring works the same way. Sorry if this is boring. I had an ex boyfriend who worked in finance and for some reason it’s all coming back to me. Anyway at one point I was very sick, disabled and single and had to do something similar on his advice. It worked. There was one company who tried to put it on my credit report, but I sent a copy of the letter with the conditional cash notation and a copy of the cashed checks and the credit bureau agreed with me that the hospital had accepted my payment arrangement and I’d not been behind. It was removed from my credit report. The debt collection department at the hospital stopped calling me. It never got sent to a collection agency.