Financial help for autistic child: How to reduce medical bills

Financial help with medical bills is a very popular topic among autism families. Healthcare is the #1 cause of bankruptcy in the United States, and it can be hard to predict what care will cost.¹ This is due to a variety of reasons, but what’s probably most pressing for you is how to deal with that surprise bill that has landed on your kitchen counter. 

Here are a few steps to make sure you are paying the appropriate amount your child’s care:

Check the Billed Amount 

The first step in dealing with that $1,000 charge is to verify that the healthcare provider is billing you the correct amount. Start by checking the explanation of benefits (EOB - a written explanation of what you owe) from your health insurance. This EOB is either sent to you in the mail or can be found by logging into your health insurance website and navigating to the claims page. 

There are a few sections of an EOB:

1. amount billed, what the provider charged for the service 
2. allowed amount, the agreed upon rate with the health insurance company 
3. plan discounts, how much money you saved with the contracted in-network rate
4. plan paid, the amount that your insurance company paid 
5. patient responsibility, this is what matters to you

Check to make sure that this number matches what you’re being billed, if it doesn’t match then call the provider to figure out what’s going on. 

Sometimes providers will charge you the full amount billed, and then send you a corrected bill with a new owed amount after insurance has processed the bill. Checking the explanation of benefits is key to make sure that you do not overpay. An in-network provider is not allowed to bill you more than the listed patient responsibility on (this is called balance billing). 

Talk to Your Provider

Nearly half of Americans are unable to cover an unexpected $1000 expense. Healthcare providers are used to working with families to help them cover costs.

Typically there are three steps to reduce your healthcare bill: 

1. Ask your provider for an itemized bill. You can do this immediately after your visit or a few weeks later. Sometimes hospitals will accidentally bill for the same service twice or charge you for a medication like Ibuprofen that you were offered but never accepted. You know better than anyone what services you received so especially for larger expenses, it’s a good idea to double check the itemized bill.
2. Look into payment plans. For most healthcare bills, hospitals are accustomed to offering payment plans. Ask to talk with someone in the billing or financial services department. Instead of paying that $1,000 all at once, you can pay it off over a series of months. This plan is usually interest free and allows you to cover your daily needs while chipping away at this larger expense.
3. Negotiate. For expensive healthcare procedures such as intensive behavioral interventions, providers are used to negotiating the patient's responsibility. Many people are unable to afford this expense so providers are forced to send the bill to collections who then receive a portion of the payment if it is ever received.

Follow these tips to negotiate and maximize your discount:

• Call the number on the healthcare bill and ask to speak with someone about the charges. “Kill them with kindness” applies here, no one will offer an optional discount to someone who’s screaming at them.
• If your health insurance has already paid a portion of the bill (say you owe 20% of the total and your health insurance covered 80%) ask the hospital/clinic if they would accept a discounted rate. Explain that they’ve already received $800 from the health insurance company and ask if there is any way they could waive part or all of the remaining patient balance.
• Offer to pay the charges all at once if they’ll give you a discount on the balance. Hospitals are usually eager to accept the majority of a large bill all at once and call it even, since the alternative for them is months of pestering or sending it to collections. While this tactic does not always work, for large bills facilities are oftentimes willing to give a 10% discount. It doesn't hurt to ask. 

If you ever need recurring medical services, it’s worth having a conversation with your provider on their standard rate. A provider might charge $250 to the insurance company for a speech therapy visit and that $250 is applied to your deductible. If you are unable or unwilling to pay $250 each time until your deductible is met, you could work with your provider to see if they’d accept a $100 payment for each visit instead. Providers who you see on a recurring basis may be willing to setup a special rate for you since it allows them to keep your business and allows you to receive the services that your child needs at an affordable rate. 

Medication Discounts 

Medications are oftentimes a financial burden, especially when they are expensive brand name medications. Typically a high-deductible health plan even with pharmacy coverage won’t pay for any medications (unless they are considered preventative) until you have met your deductible. It can quickly become a financial drain to pay hundreds of dollars each month for recurring medications. 

Here are two ways you might be able to save on medications:

1. Manufacturer discounts: While these are usually only available for high-cost medications many manufacturers offer rebates or discounts on their medications. For example, Janssen has a discount program for their medication for children with autism here. Google “medication name, manufacturer discount” to see if they offer any assistance.
2. Coupons: GoodRx can help you save at the pharmacy. GoodRx offers coupons for medications and when used at the time of purchase can result in paying only a fraction of the total cost. As a word of warning however, when GoodRx discounts are used the cost of the medication does not apply toward your health insurance deductible. As an example, if your insurance has a $500 deductible and your medication costs $100 per month, it would take 5 months for your deductible to be met and for your insurance to start paying for the medication. However, if the GoodRx coupon reduces the cost to $80 a month, that $80 does not apply to your deductible. If you expect to meet your deductible during the year, decide if the reduced rate is worth the savings or if you would rather pay the full price and meet your deductible sooner. 

Conclusion 

It’s difficult to understand how much healthcare costs. Although some expenses are rigid, by using the strategies outlined above, you can be confident that you are paying the appropriate amount for your child’s healthcare.