Money Rehab with Nicole Lapin - 411 on Hospital Bills and Medical Debt

Episode Date: November 12, 2021

Getting a life-altering medical diagnosis is tough enough without the additional financial toll. Today, Nicole talks to Shelly Rosenfeld, Co-Director of the Cancer Legal Resource Center about the financial resources available to people dealing with hospital bills. To learn more, or get aid from, the Cancer Legal Resource Center, click here: https://thedrlc.org/cancer/

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Well, it doesn't. Charge for wasting our time. I will take a check. Like an old school check. You recognize her from anchoring on CNN, CNBC, and Bloomberg. The only financial expert you don't need a dictionary to understand. Nicole Lappin. I'm sure I don't need to tell you about the show Breaking Bad.

If you're like me, even if you didn't watch it, I'm sure you're familiar with the plot line. Breaking Bad was a hugely popular show that starred Bryan Cranston making meth in his underwear. The whole cooking meth thing started because Bryan Cranston's character was diagnosed with cancer and couldn't afford treatment. When I read about the show, I couldn't get past the fact that a believable premise of a show set in the most powerful country in the world is that someone needs to sell drugs in order to afford life-saving health care. In Canada, where there's universal health care, Breaking Bad would be like one episode. Bryan Cranston's character diagnosed with cancer.

He gets treatment. Boom. The end. But because the show was set in the United States, there needs to be five seasons of absolutely hellish circumstances. The kicker is that Breaking Bad is actually pretty believable. Healthcare is expensive and only getting more expensive in the U.S., which means that Americans are shouldering more and more medical debt. Right now, there's $140 billion of medical debt

outstanding in the United States. To tackle the topic of navigating medical debt and bringing on a special guest, Shelley, welcome to Money Rehab. Thanks. I'm glad to be here. We grew up together and you've done so many amazing things as evidenced by your background since then. Can we start by just having you introduce yourself to our Money Rehab listeners and then telling them a little bit about what you do now? Happy to do so. I'm Shelly Rosenfeld, and I'm a lawyer. I work as a co-director for the Cancer Legal Resource Center. We're actually a program of the 501c3 Nonprofit Disability Rights Legal Center, and we provide free legal resources to anyone affected by cancer,

whether it's a patient, a caregiver, a doctor, anyone that has any questions nationwide, again, for free. And everything we do to help is confidential. I used to be a journalist actually. And one of the reasons that I do what I do and why I became a journalist is because I really believe that so many aspects of life that can seem really intimidating can be broken down in a clear way. And the best way to understand something and to impart it to someone else is to really get down to the big picture and then kind of fill in a little bit more of the details. So what better way as my course of a career has gone has been to educate people about their rights now as a lawyer, but using my journalism background. Yeah, of course. And I love the fact that you don't use

legal jargon because there's so much of that. I try to not use financial jargon because there's also so much of that. I think that's what really stands in a lot of folks' way when they're trying to educate themselves about the law or about finances. So, amen. It's awesome that you're doing that. It's speaking in real English that we can understand because the areas that you straddle are so important for folks' health and wealth. So when you reached out, you told us that a lot of people with cancer contact you and your organization for legal resources related to the financial toll of cancer specifically. Can you tell me a little bit more about the financial challenges that someone is up against if they have a serious illness like cancer? Sure. And just for the context, the Cancer Legal Resource Center, we're a program of a larger nonprofit. There's a Disability Rights Legal Center. That's a 501c3 nonprofit. So a lot of people that contact us, we don't charge ever for anything. So a lot of people that contact us come from a variety of

different backgrounds and circumstances. So one important issue that people call about is what's called very commonly as financial toxicity. Essentially, the non-medical side effects of treatment that affects someone's finances. And that can be a really huge deal. Even if someone is employed and has the best insurance, cancer is an expensive illness. And when we talk about cancer, I could also include other serious illnesses because it's not just about one particular hospital visit or one particular moment. It can be ongoing treatment. And unfortunately, in some cases, a person would come back perhaps and have a relapse or have a recurring illness and have to continue on treatment.

So there are a lot of different aspects, whether it's paying for a doctor visit, paying for really expensive treatments, and also, of course, wanting to keep their job and wanting to keep their insurance, even with all those challenges. What is the average cost of cancer treatment? That is a really good question. There are so many different types of cancer, so many different ways that people might have just one surgery. They may have, if it's an advanced stage of cancer, may have more serious treatment. So it's really hard to put one particular range on it.

But I will say as follows, that there are studies that show that the number one reason that people file for bankruptcies is because of medical debt. And so it is huge. If that is driving people to declare bankruptcy or really causing people to give up their home or to take on really massive debt, it could be huge. Yeah. Not only bankruptcy, but the biggest debt in collections, as you know, is medical debt, which just infuriates me because it's nobody's fault that, God forbid, they get cancer. And especially if they have insurance, they think that they're doing everything right for themselves and their families. You mentioned that even people who

have insurance have to seek financial help from this idea of financial toxicity because of a serious illness. How much is typically covered by insurance? I know there's a lot of different types of cancers and a lot of different types of illnesses, but what have you been seeing as the issue there? So a lot of people that contact us are concerned just in terms of how much is their health insurance going to cover. But just to kind of break it down, so a lot of people are familiar with co-pays. Every time they go to their doctor, they have to pay that amount. Now, there's also the deductible aspect. So depending on the insurance and what the deductible is, a lot of people with

cancer, unfortunately, will have to meet and exceed their deductible. That's when there's more support that kicks in. If a doctor is in your network, then the insurance company will pay a percentage. That depends, of course. You're on the hook for a little bit up to generally a certain cap, and then more of the insurance might kick in. A really crucial aspect of that, if someone has cancer or another serious illness, they really want to keep their insurance. And so keeping that, a lot of people get insurance through their job. So keeping their job is crucial, but that's precisely the time when it's hardest to keep their job. Anyone going through any type of medical treatment that is serious,

there's an emotional toll, there's a physical toll. And sometimes the last thing that someone feels that they can do is be present for their job, work hard, and have that stamina. So part of what we do when someone calls us and they're saying, I don't know how I'm going to pay for my cancer treatment, or oftentimes people call us after they've already had that trouble for some time, we'll kind of attack it in a multi-pronged way in terms of, do you have insurance through your job? Here's what you can do if you need to take time off and still keep your job and your insurance.

There's something called the Family and Medical Leave Act. Now, of course, someone has to be working at their job for at least 12 months. And that can be a challenge for people if they're just starting a new job. But if someone does have a job that they've been at for 12 or more months and they need to take additional time off to get treatment, they can keep their health insurance and their job open for 12 weeks. Their employer has to do that. They're not going to get paid. And that's obviously a huge challenge, but having their job open when they come back and having their health insurance can make a big difference for someone. And the person can take time off to recover, hopefully to go through treatment. But if someone doesn't need

those 12 weeks all at once, they can take it here and there. Maybe it's for, you know, a few days after chemo or a few days after some treatment and just to get their bearings and then show up at work. So there are things out there. For example, somebody might not even know they've used up their sick days. They're concerned about losing their job because they can't afford to lose their health insurance. That's one way that we already can think about, okay, there's something on the books. There's definitely a lot of problems out there, but there are some solutions that can get you closer to the outcome that you're hoping for. And if someone just becomes unable to work even

past those 12 weeks, what are some of the options for income replacement you suggest? Sure. So that's a really good point. For some people, they're really trying to stay at their job. Their job has accommodated them. They've used up their sick days. They've used up their FMLA. And now their doctor is telling them, or maybe even at the outset, their doctor is telling them, this is what the treatment roadmap looks like. You never know, but it looks like you're not going to be able to work for perhaps 12 months or longer. So there's something through the Social Security Administration, and a lot of people might be looking at their paycheck each time and seeing money coming out for Social Security. Well, this is where you might find out a little bit more. There's something

called SSDI and SSI. Now, they both basically use the same definition of disability, where essentially it's someone that can't work either a physical or mental impairment for 12 or more months. So a lot of people might not know that certainly a serious illness can come into play. But SSDI is Social Security Disability Insurance. disability insurance. And if you've worked for five over the last 10 years and paid social security taxes, and that could be whether you're working for someone else or on your own, the amount that you get will be based in part on your work history and your income. So it does range. But that's something that will, you know, you won't be at your job, but you will be getting money from the government to pay. In some cases, if someone is denied Social Security, they can appeal.

There is an appeals process. And I would highly encourage anyone that is denied to appeal. It is really important. But then if someone, let's say, has way more limited resources, there's something called SSI, Supplemental Security Income. It is for someone who's disabled and has limited income and resources. That is another route. If somebody doesn't have that work history or is, for example, has minimal resources, that will also be an option that someone can pursue, Social Security security income. And so if someone is concerned about long-term not being able to work, I would highly suggest looking into those.

And also I should mention some states have their own short-term disability programs. So that is also something to look at. I talk about the federal baseline, but states can always go beyond that. So it's worth just taking a quick look. And what I always believe, especially when someone has a serious illness, if there is one person that you trust, whether it's a family member,, coming with you to an appointment, this is one of those things that someone can help you look up and start to think through a plan of approaching because it can be overwhelming. But at least if you know something is out there, then you can dig a little bit deeper if you're ever faced with this situation. Hold on to your wallets, boys and girls. Money Rehab will be right back. Now for some more Money Rehab. Of course, I am a big fan of negotiating everything, including medical debt. Are there any tips or tricks that you've seen work if people are, first of all, thinking, I can't believe it's negotiable? And second of all, like,

what do I do? I think a big part, whether you're talking to your insurance company and trying to get something covered, or if you're talking to somebody at the hospital, build that positive rapport. These are oftentimes people that you'll have to interact with again. If somebody isn't helpful, you may want to write down their name to hopefully you won't get a chance to talk to them again. Try to call back, try to speak with someone else. And if they are helpful, write down their name, give them a compliment, figure out when are their work hours roughly. And if you can't get a direct extension, maybe find out what's the easiest way to get a hold of them. And positive rapport can go a long way because sometimes it's that extra mile. I can't tell you how many times I've heard stories from people that someone who's part of the insurance company will just give them a little tip.

You know, they usually deny this on the first try, but if you appeal, there's a good chance they'll approve it. Or did you ever think about calling your doctor's office and seeing if your medication from the pharmaceutical company has a patient assistance program, they'll just throw out some little helpful tips, just like you're talking to a friend. We're all human beings after all. And sometimes if you just tell them, you know, I'm going through a lot right now. I could, if there's anything else, try, you know, have those gears running, try to, you know, help me out. If there's any other program, they might just, they might just remember something that they had forgotten and they know you really appreciate

it. So having that rapport also saves you the time of explaining your situation again. Oh, I talked to you yesterday about such and such. And you don't have to go through the whole timeline. Write things down too. I mean, I know that someone dealing with even not a serious illness, you know, we forget. And it's important to say, well, you know, we talked about this yesterday at around this time. And, you know, here's what we covered.

And having that can kind of help someone refresh their memory. And if they've told you something's covered, maybe you could, you know, work beyond that and get that indeed covered. So I think that's a huge aspect of just remembering who you're talking to and getting someone that's helpful. In your experience, it seems like you've seen a lot of debt collectors show some sympathy for cancer patients. Yes. And certainly, you know, once it goes to collections, there are rules in place where a collector can't call and harass someone in the middle of the night. There are laws out there. Certainly, if someone is saying that you owe something from collections or identifying themselves as such, ask to see it in writing. I think that's huge because a lot of times when

someone's accumulating medical debt and feeling overwhelmed, it just feels like the world is turning against you and everything that can go wrong will. So if someone calls and says, you got to pay this or the hospital won't talk to you again, you might just think it's true. Whereas, you know, it's wrong. And so I would say, ask to see it in writing, say, you know, okay, I'd like to just make sure to review everything, make sure that they send it to you so you can see if it's legitimate or not. Don't give out information just because someone's asking for it. Try to find a little bit more and see if it's legitimate or not. Don't give out information just because someone's asking for it. Try to find a little bit more and see if it's someone who's taking advantage

or if someone really is just, you know, a scammer and isn't even a collection. So I think that there's a lot out there that people, especially vulnerable people that may owe some money and think that, you know, they're dealing with so much, they just want to pay off collections. Make sure that it's legitimate. And, you know, if they're dealing with so much, they just want to pay off collections, make sure that it's legitimate. And if they're calling out weird hours or making very serious threats, there are laws to protect consumers out there. And so these are all types of things that hopefully someone just knows that are out there. And if they feel like something's

wrong, they can look a little bit deeper and find out those solutions. The clients that you meet with are in such dire straits. You mentioned that many of your clients go through bankruptcy. Is that an option that you recommend to clients who simply can't pay these bills? What are the pros and cons of doing that? Sure. So yes, bankruptcy is something that, for example, we'll cover in presentations just because it's something that someone perhaps should know about. But we really hope that it doesn't get to that point. We always say, and I'm by no means a financial expert, but when we say with dealing with debt, that there's a good idea to think about secure debt versus unsecured debt, what's

a necessary expense versus a luxury. And there might be a way where you can prioritize paying off your home or your car, which is secured debt. It's secured by those items. Whereas a medical bill that is unsecured debt, paying off what you need to, again, not neglecting it completely so that it would prevent you from getting care, but maybe figuring out a way how to manage that while you prioritize your expenses and hopefully can avoid going into bankruptcy. I also recommend someone looking into COVID-related protections if they ever come up for pandemic protections. They could also help someone with cancer, if they ever come up for pandemic protections.

They could also help someone with cancer, whether it's managing bills, whether it's preventing eviction in some circumstances. I know a lot of those are fading away, but just to know that there are options out there that somebody hopefully can avoid, for example, bankruptcy and doing that, but sometimes that is unnecessary aspect. And so we oftentimes, hopefully, will tell someone if they can avoid bankruptcy, it's a good idea. But if they need

to, that's something that we can certainly help give them some basic information and also look at whether that's something they want to consider. But hopefully, they won't have to get to that point. At least by then, they're prioritizing expenses. They're looking, maybe there are some types of organizations that can provide some financial assistance out there. So you guys are the only ones that are really free. I can say that we are really free. There are other organizations that don't charge. We

don't provide financial support. We don't send anyone a check for $500 to help pay for treatment, but we can do research about other organizations. I will say also, if someone feels like they need a lawyer, we provide resources about legal aids in that person's area of someone's low income. So for example, someone might feel like they need to talk to a lawyer for some kind of appeal or if they're dealing with issues at work where they need some accommodations and their employer is treating them really differently because they need to take time off for treatment, for example. So we will oftentimes refer to someone, to a legal aid in someone's area where we know that there might be a very nominal charge or just even free if the person qualifies. We also have something kind of neat where we have something

called a professional panel where lawyers across the country volunteer pro bono to give half hour for free consultation for someone that comes to the CLRC, the Cancer Legal Resource Center for Help. Now, if somebody wants to work long-term with that lawyer, they can work something out for them. But if someone, for example, is in California or in Alabama and, you know, they need, they're having an issue with their doctor, it's a medical malpractice issue. And they, they come to us for resources. We provide them those free resources. And there's someone that is licensed in that area. We'll refer out to someone who could at least talk to them for half hour for free. But we are, yes, we are 100% free no matter what. You could be really rich and call us and we still won't charge you.

Or you could be really poor and call us and we won't charge you. So that is what we do. But because we help so many people, we can't actually go to court for you. And we don't send you money to help pay for treatment. But we can find out at least some resources that might be helpful or some organizations relating to someone's diagnosis that might be able to provide at least some resources that might be helpful or some organizations relating to someone's diagnosis that might be able to provide at least more support resources. It can take a long time, but hopefully, you know, you can at least avoid the scams

and hopefully find out more support. Talk to people that have a similar diagnosis. If you feel comfortable through their support organizations, find out what they've done. A lot of times, you know, if it's worked for them, it might work for you. For today's tip, you can take straight to the bank. When you have a loved one who has been diagnosed with a medical condition, of course, you want to help, but it's hard to know exactly how to be the most helpful. My biggest piece of advice is simply to ask. I love asking, how can I be most helpful in pretty much all situations, but especially in situations when a loved one is thrust into a position where they feel out of control. Because by asking them to tell you what they need, you're giving them some agency back.

If they're not sure what exactly they need, I love Shelly's recommendation to offer to negotiate bills and call insurance companies for them. With these high medical bills, time as well as money can be a huge limiting factor. So give your loved one a helping hand and some time back. If you're interested in learning more or even getting some aid from Shelly's organization, you can follow the link in the show notes. Money Rehab is a production of iHeartRadio. I'm your host, Nicole Lappin. Our producers in the show notes. rehab team, Michelle Lanz for her development work, Catherine Law for her production and writing magic, and Brandon Dickert for his editing, engineering, and sound design. And as always, thanks to you for finally investing in yourself so that you can get it together and get it all.