woman standing with trees facing away from camera
breast ultrasound patient, Photo by AZGAN MjESHTRI on Unsplash

This interesting piece of writing comes to us courtesy of Reddit, which calls itself “the front page of the internet.” She posted it on the subreddit channel r/self.povertyfinance. I saw it and reached out to her to ask if we could re-post on our blog because we are interested in her perspective. She agreed. She lives in Kansas, and we agreed we would not blow her anonymity by using her name or Reddit handle, which aren’t necessary to see her perspective.


Some things I have observed by using our shitshow of a healthcare system (US) self.povertyfinance

Some background: my husband and I live in the US. He has several chronic medical conditions that require doctor supervision and occasional hospitalization. As such, we’ve become pretty familiar with our horror of a healthcare system. Here are some things I’ve learned the hard way; I hope maybe knowing them beforehand might save some of you some money:

1) In some situations it saves you money to not even use your health insurance, especially if you have the ability to pay for a procedure in full ahead of time and/or you’re not sure if your insurance will cover the procedure. Example: My insurance doesn’t cover doctor visits. If I can swing it, I request the doctor visit bill to not be submitted to insurance and I pay in full and receive a cash discount of 20-30%. Just know: sometimes the cash discount doesn’t apply if your insurance company is involved in the process at all, even if it’s simply to decline to pay on your claim.

2) Many hospitals and clinics provide financial aid, or care on a sliding scale. Some of them don’t apply a discount to already existing bills though, so be sure to inquire about any financial assistance you might need ahead of time. I know that in an emergency this isn’t possible, anything involving emergency care they are more lenient about.

3) Most clinics and hospitals offer financial aid or care on a sliding scale according to income. You might even be able to get a discount on your bill by just telling them you can’t pay the full amount. I’ve noticed that your experience with the financial aid office can vary greatly, down to which person you talk to and if they’re in a good mood. I’ve had the best experiences when I went in to talk to them personally.

4) When applying for financial aid, you might have to provide income, tax, and bank account information. Some places even require you to prove that you were denied Medicaid. Be aware that what is on your bank statement can be used against you. Example: I provided tax information to a hospital proving that our income was low enough to qualify for a reduction in charges. However, I had just gotten our tax refund and had put it in our bank account, making it look like we had more money than we did. I thought that the hospital wouldn’t count tax refund money as income, because it’s not, but they did and I ended up owing the full amount.

5) In my experience, the most likely hospitals to work with you on your bill are not-for-profit hospitals. Avoid for-profit hospitals in rough towns. These hospitals are struggling already, and since a lot of their patients are Medicare, Medicaid, or simply just don’t pay their bills the hospital has to squeeze private pay patients to make up the difference. You WILL be charged more at these hospitals and they will be less likely to work with you on payment.

6) Also in my experience: it is a myth that you can ‘just pay a little bit at a time’ on your hospital bill and not be sent to collections. Remember: in the United States hospitals and clinics are run just like any other business. They are beholden to shareholders and they don’t give a shit about your personal hardships. The only reason they might work with you on a bill is for the tax write-off, or if they truly believe that you aren’t worth the trouble of suing. Go into negotiations with this in mind.

7) If you can’t pay, they might forward your account to an agency that isn’t technically a collection agency, but they might charge interest. In my case it was 12%. At this point your account will still be in good standing, but the interest on top of having to adhere to their payment arrangement might not be worth it. Interestingly, a collections agency is less likely to charge you interest and more likely to agree to more manageable payments.

8) Some states observe the ‘writ of necessities’, which could make you liable for your spouse’s medical debt.

This is just a short list of things that I personally observed. I hope that at least it can help open peoples eyes to the deep shit that being in poor health in this country puts you in. Sorry for any mistakes, I’m on mobile.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...