What to Know About Medical Debt
March 19, 2024
Presentation for BAILA
Shelly Tsai, Staff Attorney
Health Consumer Center
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Presentation Overview
Introduction
Medi-Cal Updates
Medical Debt
Definition
Advocacy Tips
Billing Protections
Debt Collection
Litigation
Referral
Neighborhood Legal Services
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Health Consumer Center
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Medical Debt Project
WE DON’T:
WE CAN:
WE PRIORITIZE:
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Eligibility for fullscope Medi-Cal regardless of immigration status
1
Asset test for Medi-Cal program eliminated
2
Medi-Cal enhanced care management & community supports
3
Medi-Cal
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What is Medical Debt?
Uninsured
Underinsured
Fully Insured
Amount owed after receiving medical services or goods
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Avoiding Medical Debt
Use network providers or obtain permission to go outside the network
As your plan’s Member Services or care coordinator for help.
Use county medical facilities
When in doubt, go to county facilities for lower rates.
Purchase travel insurance if you are going out-of-state or going abroad.
Pay no more than in-network cost-sharing for emergency medical services received within the U.S.A.
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Avoiding Medical Debt
Avoid using ambulance if possible
Have family member or friend drive to the hospital.
Timely file an appeal
File an appeal if the plan denied the request to go out-of-network or refuses to cover for services.
Do not sign paperwork you do not understand
If possible, ask for time to review the document. Request translated copy in your primary language.
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Advocacy Tips for Medical Bills
01
Know your rights (leverage).
02
Document all disputes in writing.
03
Don’t rush to pay a bill if you just received the services.
04
Don’t pay a bill for medical services from more than 4 years ago without first seeking legal advice.
05
It’s never too late to negotiate, but the longer you wait, the more limited your options.
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Advocacy Tips for Medical Bills
Check
Check the bills for mistakes.
Compare
Compare your bill with the insurer’s explanation of benefits.
Appeal
Appeal your insurer’s decisions if you think they should be paying more.
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State law requires California hospitals to send a notice with an application for the hospital financial assistance program before sending the account to collections.
Hospital Billing Protections
State law prohibits credit reporting or bringing a nonpayment lawsuit for 180 days from initial billing for a hospital stay.
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Hospital Billing Protections (cont’d)
State law limits expected payment for services (income at or below 400% FPL) at Medicare or Medi-Cal rate, whichever is greater.
Federal law prohibits hospitals and emergency physicians from billing insured patients beyond their in-network cost-sharing amount even if they do not contract with the insurer.
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Hospital Financial Assistance
Apply for hospital financial assistance program if you cannot pay the bill.
California hospitals must offer financial assistance (for free or discounted care) to patients with limited means to pay.
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Ambulance Bills
Effective 1/1/2024:
Some ambulance companies may offer their version of financial assistance.
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Balance Billing
Balance billing is when a healthcare provider bills a patient for the difference between the amount they charge and the amount that the patient's insurance approves.
Provider’s OON:
Balance Bill: $4,500 ($7,000 - $2,500)
Patient Billed: Balance Bill + OON Coinsurance
Example:
PPO Plan
Anesthesiologist Charged: $7,000
Insurance Allowed: $2,500
Co-Insurance (out-of-network): 40%
Co-Insurance (network): 20%
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California No Surprise Bill Protections
A surprise medical bill is an unexpected bill from an out-of-network provider or at an out-of-network facility.
Patients are only billed for their in-network cost-sharing, and no more than that, when they select an in-network facility for non-emergency medical care. This applies even if a provider is out-of-network (e.g., anesthesiologist, radiologist, surgeon, etc.)
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Medical Financing Protections
Credit Card Arranged / Established by the Medical Provider
Must give a written translation of the proposed contract in the language (Spanish, Chinese, Tagalog, Vietnamese, Korean) used in negotiations. Otherwise, the contract is not enforceable under California law.
Must provide a copy of the treatment plan and a list of services that are being charged in advance.
Must tell the patient how much the insurance plan will cover for each service or that a particular service is not covered by insurance.
At patient’s request, must refund to the lender (i.e., credit card) within 15 business days for costs that has not been incurred.
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Debt Collections
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Lawsuit
Consult with a lawyer as soon as possible.
Timely respond to the lawsuit if appropriate. Generally, 30 days to respond.
If hospital debt, can still submit the financial assistance application.
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Judgment enforced by garnishment of wages or levying assets.
Judgment debtor may request the court exempt some or all property from collection of a judgment.
Judgment
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Enforcement of Judgment
Starting 1/1/2023: a judgment can only be renewed once for 5 years and capped and capped at 5% if:
Starting 9/1/2023: maximum amount to withhold (if any) for wage garnishment is the lesser of two amounts:
20% of the employee’s disposable earnings for the week; or
40% of the difference between the employee’s disposable earnings for that week, and the applicable minimum wage for that week.
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How to Refer to HCC
(1) Phone:1-800-896-3202, Mondays through Fridays 9 AM-5 PM
(2) Email: hccreferral@nlsla.org Provide: name of consumer (or contact person), phone number, short description of the problem, and any language support or accommodation needed.
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Questions
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