Upset about healthcare in the U.S.? You’re not alone — the recent shooting of the UnitedHealthcare CEO on the street in Manhattan has brought a wave of public outrage over the healthcare system in the United States.
Many of us feel that we have been on the wrong side of an interaction with the healthcare system — a surprise bill, a denial of care, a medication we can’t afford, a loved one who can’t get the care she needs.
Here are some tools: We’re listing six specific ways to fight back, and a compilation of other useful resources. Also, check out our website for other answers — use the “search” function to see what’s on our site about an issue you care about.
1. Ask how much that will cost
Yes, you can ask how much stuff costs in healthcare. We know, it feels like it’s somehow wrong — a doctor may make you feel like you are a criminal for asking. But why? Ask. If we all ask, this will become normal. Here’s our handbook on how to ask.
2. Shop around for meds; buy on cash
Shop around for medications. And consider buying on cash, without your insurance. That’s right — you can ask “How much will that cost me? How much is that on cash?” I buy medications from Mark Cuban Cost Plus Drugs — they carry mostly generics, and the price difference can be dramatic. I’ve found that my insurance gives me a price of $68 for a common prescription, olmesartan with HCTZ, which I can buy for $10 for cash at Mark Cuban Cost Plus Drugs. Or another prescription, lisinopril — it would cost $56.55 at my drugstore with insurance, but $13.60 on cash at Mark Cuban Cost Plus. There are other ways to save too — quite often we hear that Costco has low prices for prescriptions, for instance. Here’s our handbook on how to save on prescriptions.
3. Challenge any denial
If your insurance company denies a medication or a test or a treatment, challenge it.
You can find the specific ways to challenge on your medical bill or your insurance company’s statement or “Explanation of Benefits.” A recent survey found that 18% of Americans experienced claims denials in a given year.
Don’t take “no” for an answer. You can also go to the state Department of Insurance, the Consumer Finance Protection Bureau, the state Attorney General, the National Association of Insurance Commissioners.
If you don’t have success, you can ask the insurer for more answers. Here’s a ProPublica story explaining how to get your detailed claim file from the insurer. You might find fodder for an argument there.
There is also a fairly new website designed to help you challenge denials, set up by Holden Karau, a Canadian data scientist who moved to the U.S. and was appalled at the difficulty of challenges. Karau built a system on AI that makes a challenge easier at FightHealthInsurance.
Here’s our handbook on how to appeal a bill or claim.
4. Do your research
Check our blog for your topic: Search on “breast biopsy cost” or “lipoma excision cost” or anything else — a medication, a procedure, a CT scan? Chances are we have written about it.
Also, Reddit is a great place to find crowdsourced answers — but of course take into account that these answers are useful for research purposes but not definitive.
5. Share knowledge with others
Consider sharing your research and your solutions with your friends and neighbors, or with others who are in a similar situation. In my New York City suburbs, we have a Facebook group where you can ask questions about insurers or providers. Many online groups exist to bring people together over things like financing fertility or treatment of rare diseases and conditions. It’s called “peer-to-peer health,” and it’s amazingly powerful.
Also, again, don’t overlook Reddit.
6. Don’t let officialdom off the hook
Of course it’s easy to blame the insurers. But there are others involved as well.
Tell your elected representatives (state and federal) and regulators (state and federal) that they’re not doing their jobs, and you expect better. Sure, the insurers and the hospitals and the middlemen seem to be raking in the money. But it is true that the job of for-profit companies is to make money. The job of our elected officials and regulators and courts is to protect us. They get campaign finance money from big healthcare players.
Write to representatives and regulators. Call them. Join advocacy efforts with a group you trust and respect — a patient group, like Long Covid Justice, or a community service group like TexasAppleseed or the Community Service Society of New York.
The Centers for Medicare & Medicaid Services has a help desk and hotline for the No Surprises Act. Also, many states have a consumer assistance program, or several programs. Here’s a helpful CMS map with resources for those programs.
We have a lot of other tools on our website too. Check the site for other answers — use the “search” to see what’s on our site about an issue you care about. Or look at the “resources” section on the front page in the top navigation bar under our logo — how to get financial aid and grants, how to argue a bill, how to buy insurance, how to find out what stuff costs, how much does Medicare cost, how to read a bill or explanation of benefits.
By the way, it’s not just the insurers that are focused on their bottom line. There are plenty of others who are indulging in bad behavior. Hospitals (marking up bills and paying a lot for executives), doctors (we give them a pass often because they’re our chief touchpoint with the system), Big Pharma (looked at your prescription bills lately?), the middlemen, the middlemen to the middlemen and the middlemen to the middlemen to the middlemen. If we blame only insurers, we give others a pass.
And then, pay it forward
Send us an email about your experiences at info@clearhealthcosts.com. Ask us a question, or tell us your successes!
We have helped a lot of people save a lot of money. She saved $3,786 on an MRI. He saved $2,000-plus on a CT scan.
We are good at helping people and good at writing about their experiences, in a way that others can benefit.
More resources
Here are some resources.
- DollarFor is a nonprofit that specializes in making sure people get any financial aid they are entitled to from a hospital. It’s worth checking if you are eligible; the guidelines can be more forgiving than you think. In many cases, free and discounted care is available for people with income up to 400% of the federal poverty level, which is $58,000 for an individual and $120,000 for a family of four.
- Some grants are available for healthcare. Here’s a rundown.
- Know your rights for debt collection. State laws are very different: Some states have laws protecting your primary home, your car and even your livestock from collection activities; some protect your bank account, your paycheck or your child support. This National Consumer Law Center report shows state-by-state protections for what can and cannot be confiscated by a debt collector..
- Scare tactics are not uncommon; don’t give in. Collection activities are governed by the federal Fair Debt Collection Practices Act – what debt collectors can do and how. They can’t call you in the middle of the night, or threaten to go to your employer and describe you as a deadbeat.
- It’s up to you to guard your credit: The federal Fair Credit Reporting Act covers how debt collection is reported in credit reports. If a creditor is putting multiple negative reports on your record, they may be breaking or bending the law. A bad credit report may mean that you’ll pay more for your mortgage, your credit card and your car loan.
- Did you get sued for an overdue debt? Don’t ignore the legal paperwork. If you ignore it, chances are it will only get worse. Put your challenge in writing. Show up in court if need be.
- A new federal law also is designed to protect people against surprise medical bills. The U.S. Public Interest Research Group wrote this: Surprise Billing Patient Protections
- Need more details? The National Consumer Law Center collects Consumer Debt Advice (includes articles about medical debt). The Consumer Finance Protection Bureau has these consumer tools on debt protection.
- Need help? A number of organizations can help people with medical and other bills in collection. They may be state or local organizations. In New York City, the Community Service Society of New York will help you argue a bill. In Texas, and other states, the Legal Aid folks may be your best bet: Texas Rio Grande Legal Aid or Lone Star Legal Aid. Legal Aid Society of Cleveland is another, or Legal Services of Alabama. A list of resources collected by the Consumer Finance Protection Bureau is here.
- The Consumer Finance Protection Bureau accepts complaints and queries the companies that are named. You can complain in their online form or by phone at (855) 411-2372. The process is described on this page.
