I have a high deductible health plan and I’m struggling to get the medical care I need. I’m supposed to have knee replacement surgery but have put it off because I can’t afford it. Is there any way I can get help paying for my surgery?
Sacrificing necessary medical care to avoid costs is something no one should have to do, but unfortunately, you're not alone. In 2014, 28% of insured Americans avoided some aspect of medical care due to cost, according to the Commonwealth Fund, a private health care foundation.
With a high deductible health plan (HDHP) and a limited amount of money set aside for health care costs, a pressing medical need such as your knee-replacement surgery can make that deductible seem insurmountable. But forgoing care is not the answer. I have some ideas that may make the cost of your procedure easier to manage.
Enroll in a Health Savings Account.
Health Savings Accounts (HSAs) are offered specifically to help people with HDHPs manage their health care costs. You can generally open one through your employer — if that’s how you get your insurance — and sometimes employers even contribute funds to the accounts. But if you can’t get an HSA through your job, you can open one through a local bank branch or online.
HSAs allow you to set aside tax-free money for health care expenses. You won’t pay payroll taxes on the money you contribute and you won’t be taxed for making withdrawals. On top of that, the funds will grow tax-free while in the account.
You don’t have to wait for open enrollment to open an account. But it takes time to fund an HSA, so using this approach may mean delaying your surgery as your budget to make contributions to the account.
Shop for surgery as you would any other major purchase.
People take months to buy a home — not only vetting a house’s structure, location and history of ownership, but also going back and forth to settle on a price. However, when it comes to our health, we tend to be far more trusting. We often get care where we're told to and may not realize we can take control over at least some financial aspects of our medical care.
I’d encourage you to shop for health care as you would any other major purchase — by being savvy and cautious. Compare prices for knee replacement surgeries at surrounding hospitals, and examine hospital rankings through services like Healthgrades. If you don’t get the help you seek, or you believe a hospital other than one your doctor is associated with can provide better care at a better price, it’s OK to take your business elsewhere.
A word of warning: When shopping for major medical treatment, perhaps the biggest precaution you should take is ensuring that the facility and doctor(s) you’ll work with are part of your insurance plan’s network. Use your insurer’s website or call for verification to avoid any surprise out-of-network medical bills.
Research payment options.
Different hospitals and doctors have different billing policies. Research these policies in advance, so you’ll know what you’re in for after the surgery.
Find out how much will be due upfront and what options are available for you to pay off the balance. Some large medical institutions extend lines of credit to help make major medical expenses more manageable, while smaller ones may allow you to make direct payments over the course of the year following your procedure. Keep these policies and practices in mind when choosing a hospital.
Ask about charity care.
Charity care is the term used to describe free or reduced-price care given to low-income patients, generally to those who are uninsured. But with a significant percentage of insured patients avoiding health care due to costs, there’s been a push to allow those patients access to similar programs. As a result, some hospitals have begun offering charity care to those considered underinsured.
In many cases, you won't know if your hospital offers these services unless you ask. Contact the hospital’s billing office and ask who administrates its financial assistance programs. Be open about your struggle to afford the procedure and see what options might be available to you. Even if the hospital can’t help, it may be able to refer you to a local nonprofit that can.
Negotiate medical bills after the surgery.
Most billing offices are willing to set up payment arrangements with patients. And often, if a patient shows the initiative to take care of his or her balances, they’ll reduce the bill — sometimes considerably.
When you call to negotiate an existing bill, express your desire to pay but explain your financial hardship. If the person on the other end of the line doesn’t seem willing or able to negotiate, ask for his or her supervisor.
You can say things like:
- “I would like to take care of this bill, but the total due is unmanageable. If you’re able to knock 20% off, I could make a large payment today.”
- “I have several bills from this single procedure. In order to budget for all of them, I have to get my total due down. How much of a discount can you offer on this balance?”
Remember, this is a negotiation. If you don’t believe the billing representative is doing everything he or she can don’t be afraid to call back later and try again. Though the process may get stressful, remain tactful and polite throughout; a good disposition can go a long way toward getting positive results.
High deductible health plans aren’t all bad news: They typically come with lower monthly premiums. However, when you have a major health expense, coming up with the money to cover your deductible all at once can seem overwhelming.
The good news: The growing popularity of these plans means many medical providers are willing to work with patients under financial stress. For patients, the trick lies in navigating the system and identifying where there are opportunities to save.
I founded NerdWallet Health to help patients make smarter decisions and save more money on their health care. I have been passionate about health care for many years, believing that with better health we can all achieve more.
Personal FinanceI write about the intersection between your healthcare and your money.