“What did the doctor say?” A diagnosis of a serious illness can be life changing. The need to understand treatment options and to receive medical care is often overwhelming. A new diagnosis can impact not only your day-to-day routine, but also the people who are close to you.

Finances can also be impacted. In fact, one of the areas that a hospital support group asks patients to describe is their level of ‘financial stress.’

The goal of this article is to help you identify and manage potential sources of financial stress that can arise from health issues, from understanding resources to managing your health care coverage. This stress can come from (1) the additional cost of medical care and medicine, (2) the possibility of reduced ability to work, (3) the need to maintain health insurance, and (4) ancillary expenses (e.g. help with transportation, meals, household chores, and child care).

Sources of Support

To help mitigate financial stress, here is a brief description of possible sources of funding and support available to you:

  • Income from work: Part of your discussion with human resources should address any need to reduce your work schedule and how doing so will affect income. If your health insurance is through your employer, ensure that premiums will be covered every month.
  • Savings: Use medical expense accounts, such as an FSA and HSA first. Then consider using your bank accounts and emergency fund. Tap investments only if needed. A fiduciary financial advisor can help you determine the appropriate accounts to utilize. Check with your healthcare provider to determine if a payment plan is available.
  • Disability insurance: Find out if you have short- or long-term coverage and what the criteria are for benefits. You will need to ask your doctors to complete certain forms to determine eligibility.
  • Personal network for support: Create awareness through sites like Caring Bridge, and coordinate the delivery of meals through a site like Meal Train.

Medical Insurance

In addition to the above resources, medical insurance will be an important source of funding for expenses. There are several moving parts when it comes to medical insurance. These considerations are highlighted below as a starting point to understanding your coverages and costs.

First, it is necessary to know the details of the insurance you have in order to understand common insurance terminology and feel confident that you are receiving accurate coverage. Be familiar with the “deductible,” “coinsurance,” and the “out-of-pocket maximum.” Read examples of how these work together. Check to see if your desired provider is “in-network” or “out-of-network” and if there are separate deductibles. This is fundamental in helping choose who will be on your care team.

Second, keep in mind that additional paperwork such as a pre-authorization may be needed. Generally, a medical office takes steps to contact your insurance provider to see if you are covered. However, the patient also needs to be his or her own advocate or have someone who can help. Discuss this with your doctor’s office. Understand the description of services, and call the insurance company to see if a pre-authorization request is needed. If it is, check on its status and find out if the insurance company is waiting on anything further from a doctor so you or your advocate can follow up. Staying on top of insurance authorization requirements can directly impact the schedule of care, so know that this needs to be part of your care plan.

Third, there will be paperwork to manage. Know where you will file medical bills received from your specialists for office visits, and from other providers for procedures or tests, until you can look at them for accuracy. If your medical bills are substantial, you may be eligible to take a medical expense deduction on your tax return, and these records will help.

Finally, understand your bills. The health insurance company will send an “explanation of benefits” statement, which is a key document to show how a medical service will be paid for.  Look for specific items in the bills and the explanation of benefits: (1) confirm date of service, (2) identify the main service provided, (3) check any amounts received from insurance, (4) verify any out-of-network providers, and (5) monitor the due date of any amount billed. Keep all your bills as organized as possible (for example: by doctor, paid or unpaid).

If there are any notes you do not understand, or something that does not match the bill you received, set aside some time to make calls to billing departments of the provider and the insurance company.

Reach out for help

Don’t be concerned if you need to talk through any of these concepts a few times with someone- a diagnosis of serious illness is usually the first time someone needs to understand complex medical billing, in addition to the details of disability insurance coverages, and other resources available. Remember, there are sources of funding that can help support you during times of illness, even if they seem complicated.

On behalf of Savant, we wish you good health.

Author Ambari Prakash Pinto Financial Advisor

Ambari earned a bachelor of arts degree in political science from the University of Vermont and a juris doctorate degree from Georgetown University Law Center. She is conversant in Spanish and Hindi.

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