If you have ever had a serious illness or have cared for a person with the illness, you know how quickly medical bills can accumulate: from laboratories, radiologists, pharmacies, doctors, from different departments of the same hospital, from some of your insurance networks. health, others do not.
Determining the bills to pay can be very confusing, no matter how smart you are. If you’re sick or have technological, cultural, or language barriers, not to mention financial difficulties, navigating this maze can be especially daunting.
California law, signed by Governor Gavin Newsom in October, can help you figure out the tangle of medication bills and understand what your health plan covers and when coverage begins.
SB 368 requires that most government-regulated private-sector health plans send members updates for each month they receive treatment and show how much they have spent on their annual deductible — the amount a person owes. your pocket before insurance will start paying for most of your care – and how close you have reached the self-sufficiency limit, after which the insurer will pay 100% of the care.
The law, which will come into force in July, should help people suffering from expensive chronic illnesses who need to keep a better eye on their debts, as well as healthy people who rarely seek treatment but may suddenly face unexpected medical situations, such as a first aid visit.
The new law requires health plans to send their own updates by mail unless the insured wants to receive them electronically. The information should also be archived in a format that is available to customers at all times.
The new law should benefit more and more people, given the prevalence of ever-increasing self-responsible health plans.
As deductibles rise, members of the health plan will see the financial protection of their insurance begin later this year. And in many cases, after fulfilling their deductible, they still have to spend a thousand or more before they reach their one-year cash limit.
Some people with costly illnesses, such as cancer or HIV, have to make drastic decisions – whether to seek treatment or pay rent, for example. In such cases, knowing when the financial bleeding will end can be critical, reducing the pressure on the family budget.
The new law may also be helpful if you need non-emergency surgery, such as hip arthroplasty or cataracts. The best time financially is when you are close to reaching your deductible and cash limits or if you have already reached them. So getting this information can be a lot of help.
The law could also help people avoid paying money they don’t actually owe if, for example, they’ve already paid their deductible, but the medical bill they receive doesn’t reflect it.
Although your insurer is not required to report your current pocket status before the law goes into effect in July, you can still call customer service and request an invoice for clarification. If you do not get the answer you are looking for, ask your health plan to tell you who is regulating it and call that agency. Typically, this is the Department of Managed Health Care at 888-466-2219 or HealthHelp.ca.gov or the California Department of Insurance at 800-927-4357.
To check if you are eligible for free help, try the Patient Advocate Foundation (www.patientadvocate.org or 800-532-5274), which helps people find out about health bills they can’t pay, and also offers financial help based on their specific medical needs.
This story has been produced by KHN (Kaiser Health News), which publishes California Healthline, editorially independent service California Health Foundation.
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