12 Ways to Deal with Medical Debt 2016


Medical debt has grown at an astonishing pace in the last 10 years, despite available health insurance coverage in the US.  New Kaiser Report states, among those insured with medical problems, “63% report using most or all of their savings.” In recent years, it’s been reported that one in three Americans was in a family experiencing financial burden from medical care.

And now, medical debt is possibly the top reason for bankruptcy in the US. This article will provide you a few resources to help deal with medical debt.


Negotiate a lower medical bill

Find the contact number on the bill you received from the hospital. Hospitals may be able to reduce your bill.


Payment plans that fit your income level

Get all the payment terms in writing from your provider, so that you can pay according to your ability and employment. Payment plans may have interest, while others may not. Again, ask if there is a no-interest payment plan. Explain your circumstances and why it is you need assistance paying these bills in a lesser amount each month.


Charity programs at hospital or state/federal level

Some states and hospitals may have a charity program that can cover a portion of the medical debt, or all of it.  You may be qualified for financial help from your state or the federal government – call your state Medicare program.


Children’s Health Insurance Plan financial aid

CHIP – Children’s Health Insurance Plan – Children may qualify for CHIP, which can provide financial aid to them if their parents didn’t qualify for Medicaid, but can’t afford private insurance. Apply here


Local Clubs and Church Charity

Elks, Lion Clubs chapters and church charity. Your local churches may be willing to help you pay a portion of your medical bills. Call on them for help, most are looking for opportunities to do good for their neighbor and would be glad to aid you.

Google search local churches – Find local Christian churches and other charities in your area and ask if they are able to help.

Be sure to explain how dire the bills are and how they may contribute to homelessness, if they in fact endanger your family to homelessness or joblessness. If they fail to provide help or have restrictions to their charity program, ask about other churches and keep calling! Attend a meeting and afterwards politely seek help from people there, bring paperwork, and ask! Don’t be discouraged if they refuse, keep seeking help – there are lots of churches to try.


Senior Assistance Programs

Seniors Health Insurance Programs – Call the number for your state and ask for additional medical bill payment assistance.


Denied Coverage Errors

Did your insurance plan lie to you about what’s really covered? If so, and your insurer is failing to fulfill their obligations per the terms of your health insurance contract – document the discrepancy and seek advice. A lawyer may be able to help you locate the people you need to work with to get your bills paid by the health plan.

Often medical coders and individuals charged with billing duties err. For this reason, verify the figures on the medical bill. Ask for advice from someone who does billing.

Try online forums with doctors, nurses and other health care experts to contribute their expertise on your bills. You can relay the item-by-item details to them via private and secure messaging. Quora.com can answer a wide variety of billing related questions as well.


Errors in Medical Billing: Call Persistently, Email, Write, Fax, Get an Advocate

“Nerdwallet analysis found that 49 percent of Medicare claims had errors, while medical billing advocates will tell you 80 percent of the claims they analyze have errors.” (USNews). Take a look at your bill carefully and if you notice an error, call the number on the bill (if available) to have it corrected as soon as possible. The person you want to talk to is the medical billing manager. If they are non-compliant, you may need to be persistent, calling several times until something is done about it.


Call 211 the Free national resource hotline

Dial 211 – in the US this number will provide a free directory and referral service in most areas to some sort of social service organizations. Some may be able to provide temporary financial aid.


Apply to grants

Find grants at Grantwatch.com or for special needs, this list by Joyfuljourneymom.com. You may need to enlist the help of family and friends to write the grant to a group like Aubrey Rose. Seek out similar grants in your state and apply to them. The application must express the severity of your need to make an impact with these foundations.


USA.gov financial aid programs for other bills

Get help with bills from other programs on USA.gov



Fundraising can be a little extra money toward the medical debt. If you have family or friends who are tech-saavy, ask them to sit down with you and brainstorm a way to promote your fundraising page. Not everyone’s page is successful, but in time, you may be a bit relieved by a few hundred dollars of charitable support from friends and family.

If your Facebook connections are wide, or have a friend who does, it is ideal to have them share and let their friends know about the help you need and why.

Here are a few fundraising sites specifically used for medical bills by some:



It is a shame that in such a technological country, basic needs like healthcare and employment continue to bog down the majority of Americans. The government’s aid to reduce the burden of medical costs seems only to have worsened healthcare and livability. We hope the resources above, and our prayers, will help those of you who are caught with debts of a medical nature, far beyond what you should be expected to repay.

Please comment below if you seek additional resources, links or numbers – we’ll do our best to compile the info for you.











What is a Prudent Layperson?

A Prudent Lay Person (or Layperson, abbreviated PLP) is a standard for deciding if an Emergency Room visit is necessary and presenting condition(s) of the patient reasonably warrant immediate attention.

The standard defines an emergency as a condition that a prudent lay person, “who possesses an average knowledge of health and medicine” expects, may result in:

1. Serious medical harm, or:

2. Serious impairment of bodily function, or:

3: Serious dysfunction of any bodily organ.

The standard was first enacted in 1992, “spurred by incidents of patients with genuine acute illness who delayed care for fear of being stuck with the hospital bill, said John C. Nelson, MD, president-elect of the American Medical Association.” (Amednews.com)

You can learn even more here: PrudentLay: What is a Prudent Layperson?

“Prudent layperson standard.” McGraw-Hill Concise Dictionary of Modern Medicine. 2002. The McGraw-Hill Companies, Inc. 6 Jul. 2015

What is Prudent Lay?

What is Prudent Lay?
Prudent Lay Person is an individual defined as having a limited understanding of medicine and health, thus they are deemed a “lay person” – this is where the Lay part of Prudent Lay comes from.
This occupation was created in order to ensure Emergency Room (Emergency Department) claims to providers were being paid based not on the medical condition or the diagnosis of the physician but on the perceived necessity of an “average” person with limited medical knowledge. It is not based on the final condition of the member’s visit – rather it is based on the presenting symptoms and how critical they are perceived to the member.

This website is to educate and inform physicians, nurses, insurance companies and the general public regarding the Prudent Lay Person Standard and the Prudent Lay Person profession.

Where do Prudent Lay people work?
Primarily a prudent lay person is employed in health insurance companies. Since the title is unusual, many people are often curious about its origin.

Welcome to The Complete Reference to The Prudent Lay Profession – PrudentLay
Cited from Pugetsound.va.gov:

The Prudent Layperson Fact Sheet:
“In 1986, Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) governing the provision and payment of emergency medical services in Medicare participating hospitals. In 1994 a revision to the act added the “prudent layperson” definition as a standard for evaluating whether a patient has an emergency condition. The Balanced Budget Act of 1997 established the “prudent layperson” standard for Medicaid effective October 1997 and the same standard became effective for Medicare in May 1998. The Department of Veterans Affairs adopted the standard in November 1999 when the Veterans Millennium Health Care and Benefits Act prescribed the “prudent layperson” standard for evaluating emergency care as one of the criteria for authorization and payment of emergency treatment for nonservice-connected conditions. The prudent layperson definition of an emergency medical condition commonly in practice is any medical or behavioral condition of recent onset and severity, including but not limited to severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in placing the patient’s health in serious jeopardy, cause serious impairment to bodily functions, serious dysfunction of any bodily organ or part, or in the case of a behavioral condition placing the health of such person or others in serious jeopardy. This prudent layperson definition of emergency medical condition focuses on the patient’s presenting symptoms rather than the final diagnosis when determining whether to pay emergency medical claims. Note: Under the prudent layperson standard payment for emergency care is made for the initial evaluation and examination based upon the nature of the patient’s presenting complaint. Payment may be made for additional medical services until the condition is no longer clinically determined to be emergent in nature and the patient is stable for transfer to VA or discharge.”
If you have any additional questions about this unusual profession, please contact us.

On our website you may be able to locate a job in this profession:

Find a Prudent Lay job in your city
Find a Prudent Lay job in your state

Reasons to Go to the ER: Part 1

Why do we go to the ER? For a cold? A cough?

No: The ER is where true medical emergencies are presented by a patient and treated by a skillful emergency medical “pit crew”. Their job is not to be your primary care doctor, it is to save a limb, to treat people who have been in an accident, to save the life of a friend, brother, sister, father and mother. When we misuse the ER for coughs, to get a general health check up, we are using up the resources in our local area that could be used to treat a truly sick person faster. Even with the current process of triaging patients (prioritizing the severity of symptoms in patients and ordering who will get treated in which order), having nurses and other medical personnel tied up with registering non-emergencies makes little sense.

What if, while the ER fills up with non-emergencies, the nurses have to turn someone away who has a deadly and sudden condition? It’s time to pause and call the primary care physician, or locate another option like Urgent Care if it is available; most emergency room visits in the United States are NOT emergencies and a waste of this emergency resource.

The below conditions are considered true emergencies and if you exhibit these conditions, you SHOULD go to the ER.

Severe Headache. On a pain scale, it’s 10/10 – Headaches like this may come with vomiting, hematemesis and other conditions. If you feel it is the worst headache in your life, then you SHOULD go to the ER.
Exacerbation of a Chronic Condition: when a previously diagnosed condition becomes worse, or new symptoms arise. A person with chronic fibromyalgia who develops severe spasms and excruciating pain should go to the ER. A person with increasing numbness in their extremities while undergoing chemotherapy should go the ER. A person who had a mild allergic reaction to a food they ingested now develops increased swelling of the face and arms SHOULD go to the ER.
Severe Medication Side Effects such as shortness of breath, chest pain, loss of vision, hearing and any other side effect that results in bodily dysfunction or damage. A person takes a medication prescribed by their doctor and as their doctor indicated, they experienced one of the side effects which is very severe: chest pain. They SHOULD go to the ER for a side effect that suddenly develops and is severe.
Asthma Attack, Difficulty of Breathing, Shortness of breath. A person unable to breath is in grave danger of losing consciousness – if they are on the road, this can be doubly dangerous. This person SHOULD go to the ER.
Chest pain, pain in left arm or jaw, sudden weakness or dizziness lasting longer than two minutes. May indicate a heart attack or loss of consciousness.

Go to Part 2 of the Series: Reasons to Go to the ER

Photo by Tony Webber (CC)

What is an Urgent Care Center? Are they Okay to Go to?

What is an Urgent Care center?
UC careAn urgent care center is a business that provides non urgent health care services. Many urgent cares have differing operating hours – some may be open 24/7 and others only until 6PM on some days of the week. It is a good idea to call before you go to any nearby UC, as they may have limited operating hours – unlike the ER.

Urgent care offices may refer patients to the ER if the severity of the condition is beyond the available experience of the personnel, or the services provided by the particular urgent care office. Bill Fay of Debt.org writes, “Care at urgent care centers is paid for on a fee-for-service basis. They usually accept most private health insurance plans, with co-pays averaging between $25-$50.”

The Cons of urgent care offices:
– Urgent cares may close as early as 6PM (see above example), so may not be a reasonable option for medical care, late into the evening.
– Close times and opening times vary greatly as well as schedules. You should call or visit their website to make sure they’re open before you go to an Urgent Care.
– Still may be too expensive for low income patients. Cost per procedure varies by business.

– Cannot treat complex conditions or serious injuries, so they may refer you to the ER if you have a more serious condition than they are able to treat.

The Pros urgent care offices:
– Faster-than-ER wait times and some are open 24/7.

– Treat minor injuries and illnesses.

– Faster-than-PCP wait times(you are seen the same day as opposed to being seen 1-3 weeks later at a PCP).
– Less expensive than ER*.
– Some insurers cover certain Urgent Cares and encourage you to use them for non urgent reasons.

Suggestions on selecting an Urgent Care office for non-urgent health care needs:
To ensure you have the best experience do review the Yelp reviews available online to help make a determination; take into consideration that one bad review does not necessarily make an office unworthy of a visit – but three or twelve do make a difference when there are no positive reviews.
– One bad review does not make a bad Urgent care.
– Many bad reviews and no positive reviews may indicate a poor office for health care needs.
– Overly positive reviews may not all be genuine, if the office is particularly new.
– Exercise a bit of careful scrutiny and ask family and friends for suggestions on options.

*ER visits MAY be covered by your insurer so may not cost you anything. Please speak to your insurance provider regarding going to the ER and if it will cost you anything. On the other hand, Urgent Cares NOT covered by your insurer will cost you out of pocket or some other amount. Please speak to your insurance provider.

Image credits: Tom Woodward, CC

Nearly 70% of Americans are on at least one prescription drug

An article worth noticing — 10 Big Pharma Statistics That Will Make You Cringe, by Emedcert.com:

“It’s been called America’s New Mafia; it’s been blamed for killing thousands of people. In the 2015 Harris corporate reputation poll that measures the quality of an industry’s reputation, the pharmaceutical industry ranked 9th out of 14 industries, with only 37% of public mentions being positive.”

Further, the article shares these figures and citations:

“- Nearly 70% of Americans are on at least one prescription drug, over half of Americans take two prescription drugs, and 20% of Americans are on at least five prescription drugs – Mayo Clinic

– For every $1 pharmaceutical companies spend on R&D for a new drug, they spend $19 on advertising that drug – BMJ

– 51% of drugs prescribed to Americans are generics, but they only make up 8% of the country’s total amount spent on drugs. The other 49% are the drugs with exclusive marketing rights, which makes up 92% of the total drug spending – IVN

– The percent markup of the prescription drug Xanax is approximately 570,000%. That means that the consumer cost per 100 tablets is roughly $137.79, while the cost of the active ingredients is $0.024 – LiveStrong

– In 2013, the total amount spent on drugs topped $329.2 billion. That’s roughly $1,000 per person – Last Week Tonight”

Reasons to Go to the ER: Part 2

Do you visit the ER for primary care needs, like mild coughs, prescription refills and general health checkups?

If you are one of the millions of Americans using the ER because you have no other option, please read this article.

A spotlight on the tremendous cost of ER overutilization and misuse:

The Huge Cost of Misuse of the ER: “Misuse of EDs accounts for $4.4 billion in waste annually and contributes to the high cost of American health care.” Georgia Health News
ER Over-utilization & repeat usage: Of 53 Million ER visits between 2006 and 2010, about 8 percent of patients returned within three days, and 1 in 5 made a repeat visit over the next month; a third of revisits occurred within three days, and 28 percent over a month, occurred at a different ER. Press Herald
Post-Obamacare ER usage: “Doctors say emergency room visits have increased since the advent of Obamacare”. Washington Times
ER Prescription requests & abuse: “More than two million people went to the emergency department in 2010 because of misuse or abuse of drugs – that is well over 6,000 ER visits a day.” Drug Abuse Warning Network’s (DAWN) 2010 report
Emergency Room Staff: Their Job and The Cost of Misuse
The ER is where true medical emergencies are presented to be treated by a skillful emergency medical team of doctors, nurses and medical assistants, specially prepared to treat life or death health emergencies.

Ideally, people who truly need emergency care would go to the ER – but today’s Emergency Departments are frequently misused for relatively tame conditions, such as coughs and moderate fevers.

Sometimes people go to the ER for second opinions, a place to stay, prescription refills and — very inappropriately — for nothing at all!

It shouldn’t surprise the reader to hear that this type of misuse of the ED is a tremendous waste of state and local resources, and a burden on this much-needed emergency resource.

According to Georgia Health News, “Misuse of EDs accounts for $4.4 billion in waste annually and contributes to the high cost of American health care. Patients with insurance are often unaware of the actual costs of the medical care they receive at an ED, because they pay little or nothing out of pocket. ”

The following reasons are appropriate uses of the ER. After this list we will give you three options for health care that you should consider as good ways to get the non urgent care you need.

Examples of Appropriate Use of the ER
Although these are examples, they will serve to clearly separate in your mind what a life or death health care need is, versus a low urgency health care need.

Conditions that qualify as an emergency and are appropriate use of the ER:

In children:

If your child is turning blue or pale, has slow or labored breathing, is lethargic or hard to wake.

Why: Turning blue or pale is an abnormal state for a child, indicating suffocation and/or organ dysfunction. This child SHOULD go to the ER.

A fever of 101 or higher for babies under 3 months.

Why: In this early stage, babies can be vulnerable to all kinds of health conditions that may require medical attention immediately. This child SHOULD go to the ER.

Severe abdominal pain or possible appendicitis *
Why: Appendicitis can be deadly. Severe and sudden pain in the abdominal area can be/can become a very serious condition.

Ingested toxic chemical or medications – poisoning and drug overdose
Why: The faster a chemical or poison can be cleared out, the better. Organs may begin shutting down if an accidental overdose has occurred.

Head trauma with loss of consciousness
Why: A loss of consciousness is an uncertain condition which requires further study; and head trauma can result in further harm to you that may manifest much later.

Severe difficulty breathing or asthma attack
Why: shortness of breath, work of breathing and asthma attack are a dysfunction of the body which may lead to suffocation and death.

Broken bones
Why: broken bones along with bleeding or loss of consciousness and severe pain should be treated at an ER where the staff is specially prepared to treat this type of injury.

Pressure or tightness in the chest
Why: Pressure or tightness in the chest may indicate a more serious condition.

Why: Bleeding that doesn’t stop may lead to loss of consciousness and needs immediate attention for evaluation of severity and treatment.

Severe Burns
Why: Severe burns are significant injuries that require immediate attention, much like prolonged bleeding.

Severe falls, even without injuries
Why: A fall, whether very severe or minor, may not show symptomatically immediately after the fall. It is good to get checked out, even if it has been a day or two after the fall. Like car wreck injuries that aren’t visible on the patient, fall injuries can manifest a little bit after the accidental fall and may be severe.

Car or motorcycle wreck / bicycle accident / work accident
Why: Some injuries are internal and may go undetected by hospital staff during the initial evaluation immediately after a collision or workplace injury. Sometimes a patient will come in days after complaining of severe pain, though at their initial presentation in the ER they were able to leave ‘without injury’.

Assault / Domestic Abuse / Rape / Suspected Child Abuse
Why: If you have been assaulted, the police department or the emergency room are the proper places to go. Any assault warrants a visit to the ER and local police should be called on to investigate. Suspected child abuse should be reported to police for investigation.

Why: A stroke can be deadly and manifests in different ways. Some of the ways to identify a stroke is by looking for one of the below conditions or all three:
– Drooping on one side
– Weakness on one side
– Slurred or strange speech
Call 911 if you see any of these signs.

Three options for medical care that is effective and can be faster than the ER:

1. Go to Urgent Care!
Call a local urgent care, find out if they’re open, and ask them if they take your insurance.

Ask them if the symptoms you or your child/friend has are worth going to the ER for.

Then go and get your condition treated.

Urgent cares have varying operating hours so calling the office you are considering is best before heading out. If you regularly have moderate conditions that need care, you could jot down your favorite local urgent cares that you can go to. Since some insurers will cover urgent care visits (please call your insurer to confirm), it will be less expensive for you and less expensive for the state, alleviating the burden on the local ER(s).

2. Call your insurer to locate your PCP and schedule an appointment.
Doctors shouldn’t be hard to reach, but if you have trouble getting an appointment, face lots of delays in your care – then it’s time to speak to your health insurer and ask them to give you another PCP (primary care physician). Not all doctors do a good job of spending an appropriate amount of time with each patient – some are hurried, some don’t express the attention and care needed to treat a person and send them home with assurance and hope. It’s good to find one that listens to you, provides you more than 10 minutes of their time to answer your pressing needs, and will be happy to speak to you over the phone. A doctor shouldn’t avoid his patients, nor should he hold them in suspicion.

3. Learn to treat common illnesses such as coughs, colds and fevers at home. Some conditions simply require that you wait them out, like a cold. A child with a fever can seem like a disaster to parents that have never been instructed by grandparents or parents to treat it; it’s important that you be educated, so spend some time in the library, or on webMD studying how to treat common illnesses that don’t require a PCP or an ER visit. Some parents go to the ER today simply because no one taught them how babies behave in their first 12 months. This lack of education leads to worried, frightened parents; if you are a grandparent or an older generation of parent, instruct your children in the treatment of common health problems.

Image credits: Lee Cannon, CC

7 Ways to Avoid Going to the ER This Winter

#1 – Call to schedule a visit to your doctor.

Talk to them about your concerns.

Your PCP can speak to you about your minor and non urgent complaints, or chronic conditions.

Running out of diabetes, asthma or other medication?

Low to moderate back pain?

It’s time to follow up. If you’re elderly, speak to a family member about helping you schedule the appointment and the transportation. Did you know? Some insurers now provide free rides to see your doctor.

Primary care docs can get to know your individual medical history, how you respond to certain medications, and prescribe you a variety of treatment options, or give you their best medical advice. They cannot always see you the same day, but they can get to know you and your health concerns more thoroughly.


Schedule a doctor’s appointment for a routine check up.

Find out who your primary care physician is by calling your health plan.
No insurance or doctor? Find free clinics near you
It’s good to establish rapport and communicate by phone or email with your doctor, especially if you are frequently ill and will be needing prescriptions.

Some go to the Emergency Department for an opinion on multiple complaints of very minor urgency. Perhaps they need to find another primary care physician; their insurer may be able to assist in reassigning them.

If you don’t have a doctor yet, call your insurer. You can also find clinics that are free in some states and cities. Lastly, Urgent Care centers may be able to provide care much faster than the ER. If you call them, you can find out about their payment options, in case you aren’t covered.


#1b – Call your dentist or an emergency dentist to treat your teeth.

Many people go to the ER for dental pain, when a clinic specially made for emergency dental treatments may be open and available to help. Give them a call. If they absolutely cannot treat you, they will likely send you to the ER anyway.

Why not try them first for that toothache?

Q: What leads to dental damage?

  • Lack of daily brushing, flossing (the brushing action, not the fluoride)
  • Sugars, acidic drinks, coffee, citrus drinks, black teas, pop and smoking
  • Fluoride is harmful to dental health and humans.
  • REDUCE ACID AND SUGAR CONSUMPTION. Drinking fewer pop drinks and coffee.

REGULAR BRUSHING ACTION. Brushing once in the morning and in the evening or after meals can be helpful; brush gently for about 1-2 minutes, without pushing too hard, and slowly for a much thorough and pain free clean.

Q: What can help teeth?
Drinking water, brushing your teeth daily, eating more vegetables, and reduced pop, black tea, dark roast coffee consumption. Stop smoking cigarettes, marijuana and drug use as they harm the whole body.

Starting a little at a time may be the easiest way to develop better habits for your teeth health.

# 2 – Keep a map of urgent care centers.

Put it on the fridge, near your computer at home, or enter a few of the nearest Urgent Cares into your phone just in case.


#3 – Be prepared.

Ensure you have a supply of fever reducer, Tylenol or aspirin, cough drops, honey and chamomile tea, in case you develop illness.

Some of us frequent the ER for coughs and fevers that can simply be treated at home with a fever reducer, cough drops and patience. 1-2 days of a cold, cough or fever may resolve itself within a week, sometimes less without a visit to the ER.


#4 – Drive carefully.

Drive with caution in winter weather. Minimize driving during holidays.

Accidents happen in fog, rain, snow weather, from lack of sleep, drug use, and cell phone distracted drivers.

Exercise restraint or leave the phone behind, if it’s too difficult.
Watch for black ice.


# 5 – Moderation.

Drink in moderation during festivities. During holidays and encourage others to be responsible about recreation.


# 6 – Shop safely.

When shopping, be respectful, safe, patient in crowded malls and shops. If you wish to avoid crowded shopping areas, try online shopping.


# 7 – Watch for ice.

Dress warmly, as necessary for the weather and look below to prevent slips down icy stairs, sidewalks and walking paths.


Feature Photo Credit: Maria Michelle