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A Survivor’s Guide to Medical Debt

A Survivor’s Guide to Medical Debt
Suicide attempt survivors often deal with high medical bills from subsequent health care. Here’s a helpful guide for how to start navigating them.

The last thing suicide attempt survivors think about in the first days and weeks of recovery is their medical bills. And yet as Elemental reported on Monday, many Americans who attempt suicide face the stress of paying off bills for their medical care.
Elemental spent several months reporting on self-harm and medical debt and asked a combination of suicide attempt survivors and health experts for some best practices for survivors looking for help with their medical bills. As one expert we spoke to put it: “A bill is a starting place, not the end of a sentence.”

  1. Find an advocate
    One of the hardest parts of dealing with medical debt is picking up the phone to call the hospital billing department, debt collector, or insurance company. Finding a family member, friend, mental health advocate, or community group that helps with financial counseling who is willing to sit with you while you make calls about your medical bills or call on your behalf can help relieve some of that anxiety. Besides, while the National Suicide Prevention Lifeline is often turned to in times of crisis, phone counselors are trained to provide referrals to organizations that can provide more specific help for navigating medical debt.
  2. Gather your documents
    Find a dedicated place, be it a shelf, drawer, or folder, to start compiling all of the documents and information you might need to start tackling your medical debt. Put your medical records, bills, and all correspondence from the hospital, ambulance service, debt collection agency, and insurance company there. You can also store notes from calls with the billing departments (including the date of the call and who you or your advocate spoke with). If you think you might be eligible for financial assistance, you can also start to gather recent pay stubs, W-2s, and tax returns. Having a one-stop spot means these documents can also be easily passed along to your advocate.
  3. Understand your insurance
    While your hospital or doctor’s billing department will be in communication with your insurance company, you should be too. Understanding how your insurance, if you have it, works — and what it will and will not cover — is an important part of the medical bill process. It’s also worthwhile to look into whether where you received care is considered in-network or out-of-network for your insurance plan.
  4. Prepare to negotiate
    Your medical provider or debt collection agency will likely be eager to get a payment from you as soon as possible. They may urge you to remove money from your retirement account or savings, or use your credit card to quickly pay the bill. But suicide attempt survivors and health experts say it’s important to manage your medical bills in a way that causes the least harm to your financial situation. Negotiate the bill with your medical provider by seeing what charges are mistakes or can be waived altogether. You can also ask how many months your payment plan for the bill can last. If your bill has been sent to a collections agency, ask them about payment plans, and when the bill is going to be put on your credit report.
  5. See if you qualify for financial assistance
    Hospitals often work with federal, state, or county programs, and foundations, and there are sometimes grants available to help people with income limitations who may not be able to pay their medical bills. You’ll likely need to meet certain income requirements and provide proof of income and need. You can also ask your medical provider if they have assistance programs specifically related to mental health, and what local groups they work with to provide help with bills. Depending on the assistance available and where you live, the hospital may also be able to connect you with a case manager who can help you work out your medical bills or find other social services you qualify for, including food assistance, rent assistance, and more.
  6. Know your rights
    No matter how much you might owe for your medical bills, you still have rights that must be observed by your medical provider, an insurance company, and debt collection agencies.
    Mental health parity: This is when your insurance plan offers equitable coverage for mental health services as they would for other physical chronic health issues. While there are laws in place to enforce parity in insurance plans, some plans including short-term insurance plans do not have to follow these guidelines. The National Alliance on Mental Illness, an advocacy group focused on mental health policy, says that some potential signs to look for if your insurance plan isn’t offering parity includes: needing permission to get mental health care covered, getting denied for care that’s not deemed “medically necessary,” and lack of coverage for residential or intensive outpatient mental health treatment compared to other health conditions.
    Debt collection: Getting calls or mail from debt collectors can be overwhelming but there are still protocols in place to protect you as a consumer. The federal Consumer Financial Protection Bureau says some signs of debt collector harassment include misrepresenting the amount you owe, threatening to have you arrested, not identifying themselves as debt collectors, and threatening violence or harm. If you want to take steps to fight the charges, letters are often better than phone calls. The CFPB has sample templates that can be used to correspond with debt collection agencies disputing the debt or asking for more information.
    If you do have questions about what your rights are or want to file a complaint, you can contact your state attorney general’s office about issues with a debt collection agency or insurance company. You can also reach out to your state insurance commissioner’s office which typically oversees how health insurance companies are operating.
  7. Make a WRAP plan
    Making a Wellness Recovery Action Plan (WRAP) when you’re ready can also help if things become overwhelming or if you find yourself in a medical debt crisis again. The WRAP plan, first created in 1997 by Mary Ellen Copeland, Ph.D., helps people create a special plan before, during, and after a crisis on what they can do to keep themselves safe and healthy. Some of the questions include designating people to handle certain things like bills or getting you to appointments, identifying what medications you need, reflecting on what you need from people around you, and what you can do on your own.
  8. Prepare your list of questions
    Knowing what you want to ask can help you stay on track when talking to medical providers, insurance companies, and debt collectors. Here are some sample questions to help get you started depending on your situation:
    Can you provide an itemized bill of what I’m being charged for?
    Can you walk me through each item I’m being billed for and why?
    I’m planning on talking to my insurance company about my bill. Can you provide me with the medical billing codes used for each item?
    Who else can I speak with if I do not agree with the charges on my bill?
    This bill is showing a procedure or care that I actually didn’t have done when I was there. How do we remove this from the bill?
    How soon is this bill due?
    When will this bill be sent to a debt collector? Since I’m still negotiating my bill with your department, will it still be sent to collections by this date?
    Your billing department mistakenly charged me for something and reported the bill to the three major credit bureaus. Who can I speak with about getting it removed from my credit report? Can I get written confirmation the billing department will agree to do this?
    Are there payment plans available if I cannot pay the bill in full right now?
    I do not qualify for your hospital’s financial assistance program. Where have other patients found assistance with their bills?
    I do not have the ability to pay my bill in full. Which charges on the bill can be waived by the hospital?
    You’re denying coverage of care for my suicide attempt because it wasn’t considered “medically necessary.” Can you point me to the criteria used to determine what mental health care is considered “medically necessary”?
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