What I Learned About Negotiating Away Medical Debt

Save this one, folks, until we get Medicare for All

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Gonna frame this

Longtime readers of this newsletter, and people who enjoy my oversharing on Instagram, are probably aware that I had a terrible, near-fatal, medical emergency earlier this year. Being admitted to the hospital while living a whole hemisphere away from my family was one of my worst fears come to life, made even worse because I was in the United States where medical bills are one of the leading causes of bankruptcy. To add insult to literal injury, it occurred during one of the most challenging financial and emotional periods of my life. My sole comfort was knowing the only thing I had left to lose was my existence and I wasn’t going to let the evil universe get THAT. I resigned myself to a future where I was saddled with medical debt but still breathing.

Good news, everybody: the hospital wiped away all my bills. The real news: I had to fight for that to happen, but I achieved it. I am usually a pay-the-problem-to-go-away person but even I have my limits. And a boatload of self-righteous indignation. Since I know there are way too many people out there who might be in similar situations, and because I think it’s a travesty that the richest nation in the world doesn’t give its residents free healthcare, I’m going to share everything I learned about getting your medical bills forgiven, so (maybe) you can too.

First, a few disclaimers: This only applies to the USA, and even then it will vary by state, county, city, neighborhood, etc. For the love of God, do not consider this professional advice. This is anecdotal street smarts, at best. Talk to you lawyer, call your health insurance, contact a patient advocate, etc. for the real deal. Finally, I cannot guarantee squat.

I also want to thank friends, acquaintances and even readers who slid into my DMs or emailed me with their own tips. Your help was essential to this process.

Tip #1: Get health insurance

I know, I know, but I still get shock and awe when I tell people that YES, FREELANCERS CAN GET HEALTH INSURANCE THANKS TO THE AFFORDABLE HEALTH CARE ACT. I understand that “affordable” is a cruel joke when you are paying an average of $400 for shitty health insurance, but how many subsidies you get will depend on your state and income. I made so little my first year in New York, I got it for free. At least do the legwork to see if you can afford something. I say this because the entirety of my hospital stay cost upwards of $150K and my bills hovered around $8k—eight thousand dollars I still couldn’t afford but not the panic-attack-inducing 150K, if I had been uninsured. Get it now before subsidies expire at the end of 2025 and Trump bam-bams the ACA into oblivion.

Tip #2: Don’t pay anything until you get the very last bill

Hospitals take their sweet little time to send bills. If you have insurance, the hospital and the insurance company will spend months billing, adjusting, billing, adjusting and sending you all the ways they have billed and adjusted. Do not pay for anything until you get the very last bill. Use the time to make a plan, save up, research options, and enjoy the brief respite of knowing nothing is due yet. Do not pay until you have called the hospital and exhausted all options to have your bills lowered or forgiven. You’ll get a ton of notifications about how the bill is at risk of being sent to collections, but it takes a really long time for that to happen. Like months, maybe even a year.

Tip #3: Figure out what department should be handling your bill

From my billion calls to the hospital, I inferred that there are three different departments/processes that deal with patient bills and who was supposed to handle my case depended on factors like insurance and the what-the-fuckery that had gone down:

• Charity Care: When I first called, I asked for a charity review but the hospital informed me that was only available to uninsured patients. But, hey, if you are uninsured, now you know what to request!

• Hardship Review: For months, I talked to the billing department about a hardship review. This is for patients that do have insurance but do not have the kind of money to pay for any co-pay, deductible, extra costs bullshit.

• Risk Management: This is the department that my case was escalated to after I got the runaround from the billing department about my hardship review and I finally blew up on them, telling them under no uncertain terms that my hospital stay was directly related to certain misfortunes within the hospital itself (I’m being purposefully vague here). I don’t know why it took me getting extremely bitchy and very loud because, every time I called the hospital, I calmly stated the exact same information. But I guess sometimes folks want to see you upset in order for them to take you seriously. I don’t know! But if there is anything about your hospital stay that was fishy or prolonged because of the care you directly received from said hospital, maybe ask for Risk Management or let them know you are very upset.

Tip #4: Don’t be shy about your expenses

If they ask you for a list of daily expenses, list all of them. Yes, even your Netflix account. Yes, even your credit card debt. Alll of it. Warts and all.

Tip #5: Literally set aside time in your weekly schedule to follow up

No one is going to care about your case as much as you, and you are dealing with a labyrinthean system that is slow, bureaucratic, prone to human errors, and is both too automated and not automated enough. Constantly follow up until you see a $0.00 on your bills or a written confirmation that you have no pending charges. If you feel like you’ve made little bit of progress—say, you filed paperwork or an assistant told you they are talking to X person within billing—, reward yourself with a one or two-week break. But do not let go and let God. Your persistence is your most powerful tool.

I literally opened this document and looked at it whenever I called the hospital

Tip #6: Those numbers are fake. Act accordingly

Here is what I would have done had the hospital insisted I pay:

• Negotiate a payment plan that would not have put me under any financial duress. I was dead ass going to tell them I could only pay $10 a month, which would take me longer to pay off than years I have left on this Earth. I would have done so with zero shame too.

• Or, I would have told them I could pay a flat fee now in exchange for getting the rest of the bill forgiven. Reddit, America’s scrappy survival guide, is full of stories of people who managed to clear their medical debt that way.

Tip #7: Knowledge is power!

Here are some resources that are probably way more comprehensive than my ramblings:

• “The Medical Bill Negotiation Lab” episode from An Arm and a Leg podcast.

• New York Magazine talked to four patients who managed to fight against claims their health insurance denied.

• Find non-profits in you area that help patients deal with medical debt. I wish I could recommend one, but I’m woefully unaware of which ones are legit.

Tip #8 You can always renegotiate

Just because you negotiated one plan doesn’t mean it’s set in stone forever. If anything in your financial circumstances changes, like losing a job, get back on the phone and ask what they can do for you.

Next week, I’ll share the hardship letter I wrote to the hospital when I requested a hardship review. I don’t know how much impact it had on their decision, but I do know that the last thing you want to do when you’re preparing a 107-page PDF file to showcase your dire straits (ehem), you don’t want to spend too much time wondering how these letters are formatted. Use my sample! The letter will be behind the paywall, but if you are dealing with medical debt let me know—I’ll gift you a link.

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What I’m Reading

• I don’t have a lot of patience for sci-fi but Beautyland by Marie-Helene Bertino is the kind of genre-bending novel I can get behind because its main preoccupation is so, so human: how to navigate a world that never feels quite yours. It’s been a while since I’ve wanted to rush back into the world of a novel, and this book gives me that sense of urgency.

• Mujeres peruanas. El otro lado de la historia by Sara Beatriz Guardia is not light reading but I have a lot of catching up to do! I don’t know much about Peruvian feminist history and this book works its way up from the first Pre-Hispanic civilizations to today.

What I’m Watching

• Baby Reindeer. Finally! I know I’ve fully recovered because I can see all sorts of bodily harm on the screen with my usual detached reaction LOL.

• Ali Wong: Single Lady. Honestly, the only Divorce Content that didn’t make me want to gouge my eyes out. Finally, a celebration of the joyful, horny, chaotic freedom you get!

• Martha. I think I admire her MORE now for waving away all her marital indiscretions are “moments” LMAO.

• Will & Harper. I miss my friends. And, despite recent events, I still have a deep fondness for the States. This was a little balm for both longings.

What I’m Listening

• “Tattoo” by La Única Tropical, the best Peruvian group in any musical genre and I won’t shut up about it.

What I’m Downloading

• Season 2 of Central, “El Péndulo”, focused on Latino voters in five swing states and is one of the few media outlets that doesn’t make me want to hurl when discussing the Latino vote.

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