Every parent knows that raising a child is one of life's
most fulfilling challenges. But if your child has a
chronic illness
, condition, or disability, your role takes on an even greater
purpose. You are more than a loving parent - you're also your
child's primary health advocate.
Although the emotional price of raising a seriously ill child
can be devastating, it's only part of the picture. Even during
this difficult time, you have to consider the financial
implications of your child's illness. Some parents become
overwhelmed by medical expenses or are blindsided by unexpected
bills and additional fees. Even wealthier families can find
themselves on the brink of financial free-fall because of
accumulating medical expenses.
Even so, maintaining your family's financial health is not
impossible. With organization and careful planning, you can learn
to manage your money during a medical crisis.
Costs of Health Care
The costs of long-term health care can be staggering, and
families don't always heed them until they're hit with the
first bill or explanation of benefits that they don't
understand. "When you're faced with a child with as many
medical complications as our son, we were just worried about having
him breathe every day and the last thing we thought about were the
bills," explains Carol, whose son Dylan has spina bifida.
Some parents may think that insurance will cover all or most of
their child's medical expenses - or that being able to afford
their child's health care needs won't be a problem. But
each medical service comes with its own price tag, and parents are
often shocked to learn that hospital care,
surgical procedures
,
doctor visits
, and
laboratory tests
are separate services with separate bills. "Financially, it
was a disaster coming. Her first hospital bill, not including
surgery and
anesthesia
, was $308,000," says Kellie, whose daughter has a serious
disability. Even the typical 10% co-pay can consume a family's
financial reserves.
Some parents may overlook costs that are indirectly related to
their child's care - costs that can quickly add up. These
include missed time at work, childcare for siblings, increased
utility bills, custom transportation, and home renovations, such as
ramps for wheelchair accessibility.
There are ways to handle these costs, but you need information
to negotiate your way through the health care system.
Understanding the Health Care System
The best way to make sense of bills and prevent financial
problems is to take a proactive stance. Learn all you can about
your health plan.
Just as you want to know as much as possible about your
child's health, you should learn as much as you can about your
insurance policy. Which doctors participate in your plan? What
services are covered?
Learn the meaning of insurance language, such as:
-
co-pay:
the part or percentage of the bill you are responsible for
-
deductible:
the amount you must pay before your insurance company will pay
for services
-
referral:
your insurance company may require the primary care doctor to
refer your child to another doctor or specialist before your
insurance company will pay for services performed by another
doctor
-
precertification:
you may have to let your insurance company know in advance about
any medical tests or treatments the doctor has ordered. If you do
not precertify
before
receiving treatment, the procedure may not be covered.
-
network provider:
any doctor, hospital, or other provider of medical services who
has agreed to participate in your insurance company's network
and to offer their services at negotiated rates. Also called a
participating provider.
-
pre-existing condition:
an injury or illness that existed prior to the effective date of
your current insurance policy and therefore may not be fully
covered
-
usual, customary, and reasonable:
refers to the amount usually charged by health care providers for
services and treatments in the area where you live
Understanding your health plan's design and its policies can
ultimately save you thousands of dollars.
It can be useful to get a written copy of your policy from
the insurer. Although you may have an enrollment information book
from your employer, the actual policy provides specific details
about
your
coverage. If your insurance company has a website, you should check
it out for additional information.
Policies and bills can be confusing, but help is available.
These simple steps can help you avoid problems:
- Locate the resources available within your child's
hospital, such as a financial counselor or hospital business
office, for answers to your questions about medical
expenses.
- Ask the hospital to have a case manager assigned to your
child. If the hospital has none on staff, ask your insurance
company.
- Make your child's health care providers aware of your
plan's benefits and limitations. They can become your
partners in coordinating care with your health plan.
- Negotiate fees with the doctors, clinics, and hospital and
set up realistic payment plans.
- Organize! Keep a journal and files to record doctor visits
and any services performed (including lab work, X-rays, CT scans,
etc.) and the fees for these services so that detailed
information is easily accessible. This may seem like a lot of
work, but it will be extremely helpful when dealing with your
insurance company.
- Know your rights as a health consumer. If your insurance
company denies coverage for certain expenses, appeal the
decision. The doctors can sometimes write letters or help you
appeal to the insurance company to get certain services
covered.
- Contact your state's department of insurance if you
encounter problems with your health care coverage - especially if
you've already appealed denied or inadequate coverage.
Warning Signs of Financial Trouble
Families may struggle to meet new expenses, particularly if one
parent must stop working to care for a child. Regular monthly bills
may be put aside or ignored. Debt begins to grow, and a family that
has maintained a comfortable lifestyle can find itself headed for
trouble.
If the following questions seem all too familiar, it's time
to seek help:
- Do you spend more than you earn?
- Are you using credit for everyday purchases?
- Do you make only minimum payments on bills or skip payments
entirely?
- Are your savings inadequate or nonexistent?
- Do you use cash advances on credit cards to pay other
expenses?
- Are you getting calls from collection agencies?
- Have you received notices about utility disconnection?
Procrastination can be your worst enemy. Ignoring financial
obligations now can lead to even greater problems later, like
bankruptcy, loss of assets, and a bad credit record - all of which
can affect the entire family. Instead of putting things off,
communicate your problem as early as possible to the appropriate
person or office.
Negotiating Payments
It's vital that you stay in regular contact with the people
on the other end of your bills. As soon as possible, call
doctors' offices, billing departments, hospital business
offices, creditors, and lending institutions to explain the change
in your family's situation. Most people are willing to work
with you, but they won't know that you need help unless you
tell them.
Some offices may ask you to "put it in writing." Most
doctors or hospital social workers are happy to write a letter on
your behalf, explaining why more time is needed to pay a bill or to
appeal an insurance company decision.
Creditors can be lenient - arranging payment schedules,
accepting partial payments, and so on - but they need to hear from
you. Even if you can only make a portion of a payment, it will show
an attempt to keep up your side of the obligation.
Parents who have gone through this process advise that you:
- Notify the appropriate offices as soon as you can.
- Keep in touch with your creditors.
- Remember to record the names and phone numbers of the people
you are dealing with.
- Document the date, time, and results of your phone
communications.
- Pay something - even a small amount - on each bill each month
as a gesture of good faith.
Where to Get Help
Few people get through a catastrophic illness without needing
help of some kind. You may find it difficult to put aside your
pride and ask for help, but family and friends usually take genuine
pleasure in helping out.
Make use of your case manager, particularly in deciphering bills
and making sense of paperwork. Remember to update your case manager
with new information and stay in frequent contact. Hospital
business offices can be valuable, too, interpreting bills,
estimating costs, or contacting your insurance company on your
behalf.
Compare notes with other families who have dealt with
catastrophic health issues. Their efforts may save you time and
energy, and many parents appreciate the support of those who have
experienced similar problems.
Short- and long-term financial assistance is also available from
various sources, including private as well as government agencies.
You may be surprised by the services available and the enthusiasm
with which others embrace your needs.
Explore these private organizations:
- charitable foundations
- disease- or disability-related organizations
- civic or social welfare associations
- churches and community groups
Although not all provide financial aid, they may be able to
direct you to other sources and services.
Government organizations can also assist in the medical and
related care of your child. You don't need to be at poverty
level to qualify; you may, in fact, be eligible for programs you
never knew existed. Two such government programs that supplement
the health insurance of a chronically or seriously ill child are
Medicaid and Supplemental Security Income (SSI). As you research
various avenues of assistance, ask your case manager about these
and other options.
You can also take advantage of free financial advice and support
offered by national agencies like the Consolidated Credit
Counseling Service (CCCS). The CCCS provides certified financial
counselors who help families examine their financial picture and
overcome debt. They can negotiate with creditors on your behalf for
lower payments, reduced interest rates, and forgiveness of late
charges or penalties. You may choose to enroll in their formal debt
management program, in which case you would send one payment per
month to the CCCS office, which then prorates and disburses your
payments to creditors.
The bottom line, though, is that even as you seek financial
assistance, you will need to reduce your expenses.
Reducing Your Expenses
To ensure financial stability, you must learn to cut your
expenses by making lifestyle changes. When you have a sick child,
your priorities will shift. Going out to dinner a few times a month
may no longer be in your budget; paying the electric bill has to
be.
You may find it helpful to compare monthly costs against your
income, then eliminate any expenses that aren't completely
necessary. Other tips:
- Avoid impulse purchases.
- Eliminate "luxuries" such as cable TV.
- Switch to generic prescriptions whenever possible.
- Buy groceries in bulk and take advantage of coupons and store
specials.
- Use cash instead of credit whenever possible.
By making a conscious decision to reduce spending, acting early,
asking questions, and learning how to find and accept help, you can
protect your family's future.
Reviewed by:
Leta E. Bachman, CPAT
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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