I Had a $10,000 Deductible—Here’s How I Paid $0 of It
The Deductible That Disappeared
My health insurance card felt like a cruel joke. I had a “good” plan through work, but it came with a $10,000 deductible I had to pay before my insurance covered anything. When I needed surgery, that meant a $10,000 bill was coming my way. Instead of draining my savings, I applied for financial assistance at the non-profit hospital. I argued that I was “underinsured”—my policy was inadequate for a major event. The hospital agreed that the deductible was a financial hardship and used their charity care program to forgive the entire amount.
How to Prove You’re “Underinsured” and Qualify for Charity Care
My Insurance Card Wasn’t a Shield, It Was Evidence
The hospital billing office initially told me I couldn’t get help because I “had insurance.” I knew I had to prove I was “underinsured.” For my application, I didn’t just send pay stubs. I sent a copy of my insurance plan’s summary of benefits, highlighting the massive deductible and the 30% coinsurance. I showed them that even with my insurance paying its share, my remaining portion of the bill was more than half my annual income. This evidence proved that my insurance card wasn’t a shield; it was proof of my impending financial disaster.
My Insurance Denied My Claim—Here’s How Charity Care Saved Me
The Denial Letter That Became My Golden Ticket
I was devastated when my insurance company sent a letter denying the claim for my hospital stay. I was now on the hook for the entire $60,000 bill. I felt hopeless. Then I realized the denial letter itself was a powerful tool. I immediately applied for the non-profit hospital’s charity care program. I attached the insurance denial as the very first page of my application. It was undeniable proof that, for this specific hospital stay, I was effectively uninsured. The hospital treated me as such and forgave the entire bill.
The “Catastrophic” Health Plan Holder’s Guide to Financial Aid
My Bare-Bones Plan Led to Full Forgiveness
I had a “catastrophic” health plan, which was cheap per month but covered almost nothing until I hit a massive deductible. It was basically “bankruptcy protection,” not real insurance. When I needed a procedure, I knew I couldn’t afford the out-of-pocket costs. At the non-profit hospital, I applied for financial aid. I argued that I was “functionally uninsured.” I showed them my plan documents and explained that a catastrophic plan provides no real coverage for routine hospital care. They agreed and granted me a 100% discount, just as if I had no insurance at all.
How I Used My High Premiums to Argue for Financial Hardship
The Premiums That Paved My Path to Forgiveness
My income was just a little too high to qualify for charity care based on the hospital’s simple chart. But the chart didn’t account for the fact that I was paying over $800 a month in health insurance premiums. In my appeal letter, I created a simple worksheet. I took my gross income, then subtracted my annual insurance premiums. The result was a much lower “net” income. I argued they should consider my income after this necessary medical expense. They accepted my logic and approved me for the aid I needed.
My Insurance Said It Was “Out of Network”—The Hospital Forgave It Anyway
When Charity Care Is Better Than Insurance
The ambulance took me to the closest hospital, which turned out to be out-of-network for my insurance. My insurance company paid a tiny fraction of the bill, leaving me with a crushing balance. I knew my insurer wouldn’t budge. So I ignored them and focused on the non-profit hospital. I applied for their charity care program. Since my insurance had paid so little, the hospital essentially treated me as an uninsured patient. They forgave the entire massive balance that my “out-of-network” plan had left behind.
How to Get Charity Care to Cover Your Co-pays and Coinsurance
The 20% That Felt Like 100%
My insurance covered 80% of my major surgery bill. I was responsible for the other 20%. The problem was, 20% of a very big number is still a very big number. My coinsurance responsibility was over $25,000. I was grateful for my insurance, but I couldn’t pay my share. I applied to the hospital’s financial assistance program. I showed them my Explanation of Benefits, which detailed my coinsurance amount. The hospital’s charity care program covered my entire 20% portion, taking my bill from $25,000 down to zero.
The Secret to Using Charity Care When You Have a Health Sharing Ministry
The Two-Step That Erased My Bill
I belong to a Health Sharing Ministry, which isn’t traditional insurance. When I needed surgery, I knew the ministry might not cover the full cost. My secret was a two-step process. First, because I was technically “uninsured,” I applied for financial aid at the non-profit hospital as a self-pay patient. They granted me a 70% discount. Then, I submitted the remaining 30% of the bill to my Health Sharing Ministry. My fellow members shared the funds to pay that smaller balance. The combination of both resulted in a zero bill for me.
I Hit My Out-of-Pocket Max, But Still Got Bills—Here’s How I Fought Them
The “Max” That Wasn’t Really the Max
I thought hitting my insurance’s out-of-pocket maximum meant I was done paying for the year. I was wrong. I was still getting bills from out-of-network providers that my insurer said didn’t count toward my maximum. I was stuck. My strategy was to take these denied, out-of-network bills and submit them to the non-profit hospital’s charity care program. Even though I had “good” insurance and had hit my max, the charity care program was able to wipe out the surprise bills that fell outside my insurance plan’s rules.
The “Gap” Patient: How to Get Help When You Don’t Qualify for Medicaid but Can’t Afford Insurance
Too Rich for Medicaid, Too Poor for Everything Else
I was stuck in the “Medicaid Gap.” My income was just high enough that I didn’t qualify for Medicaid in my state, but it was so low that I couldn’t possibly afford a marketplace health plan. When I ended up in the hospital, I had no coverage at all. The hospital social worker understood my situation perfectly. She helped me fill out the charity care application. Because I was uninsured and had a documented low income, I was a prime candidate. The hospital forgave my entire bill. Their program was the safety net I desperately needed.
My Short-Term Health Plan Was a Joke—Charity Care Was the Punchline
The Plan That Covered Nothing
I was between jobs and bought a “short-term” health insurance plan to tide me over. It was cheap for a reason. When I had to go to the hospital, I discovered the plan covered almost nothing. It was full of loopholes and exclusions. I was left with a massive bill. I applied for the non-profit hospital’s charity care program. I showed them the denial letters from my useless short-term plan. They essentially treated me as an uninsured patient, and their financial assistance covered what my junk plan wouldn’t.
How to Appeal Your Insurance Company and the Hospital at the Same Time
My Two-Front War Against Medical Debt
My insurer denied a claim, leaving me with a huge hospital bill. I knew I had to fight back on two fronts simultaneously. On Monday, I filed a formal appeal with my insurance company, arguing they should cover the bill. On Tuesday, I filed a financial assistance application with the non-profit hospital, arguing that if the insurer won’t pay, I can’t afford the bill. This two-pronged strategy created a pincer movement. In the end, the insurance appeal failed, but my proactive charity care application was approved, saving me from the debt.
The Argument That Your Insurance Plan is “Non-Compliant” with the ACA
The Junk Plan That Broke the Law
The short-term insurance plan I had purchased didn’t cover basic things like preventative care, which I knew was a requirement for plans under the Affordable Care Act (ACA). When they denied my hospital claim, I argued that they were not a legitimate, ACA-compliant plan. In my charity care application to the hospital, I made the case that I should be treated as uninsured because my “insurance” didn’t meet the minimum legal standards of coverage. The hospital agreed with my reasoning and approved my application for full forgiveness.
How to Get the Hospital to Accept Your “In-Network” Rate, Then Forgive It
A Two-Step Path to a Zero Balance
I had to use an out-of-network hospital for a specialized surgery. The bill was astronomical. My first step was not to ask for forgiveness, but to negotiate the price. I called the hospital and asked them to accept my insurance’s “in-network” rate as a gesture of goodwill. They agreed, which cut the bill in half. Then, I took that new, lower bill and applied for the hospital’s financial assistance program. Because the balance was still a hardship, they forgave the rest. I negotiated the price down, then got the lower price forgiven.
I Was Balance Billed Illegally—Here’s How I Used Charity Care to Fight It
My Bill Was Illegal, But I Had a Backup Plan
I received a “balance bill” from an out-of-network ER doctor, which I knew was illegal under the No Surprises Act. While I was fighting that bill with the doctor’s office, I simultaneously applied for charity care at the hospital where I was treated. My thinking was, even if my fight with the doctor failed, I would have a backup plan. In the end, the doctor canceled the illegal bill, but having the charity care application in process gave me peace of mind and a second way to win.
My Insurance Company Went Bankrupt—Here’s How I Got My Bills Covered
My Coverage Vanished Overnight
I had insurance through a small, new company. Halfway through my cancer treatment, the company suddenly went bankrupt and my coverage disappeared overnight. I was left with active treatment and no way to pay for it. I immediately sat down with the hospital’s financial counselor. I showed her the notice from the state insurance commissioner about the company’s bankruptcy. The hospital treated me as a newly uninsured patient. They approved me for retroactive and ongoing charity care, allowing me to complete my treatment without interruption and without debt.
How to Use Your Insurance Company’s Denial Letter as Evidence for Charity Care
Their “No” Was My “Yes”
The letter from my insurance company was blunt: “This claim has been denied.” I was on the hook for the entire $40,000 hospital bill. I was devastated for a moment, and then I realized that the denial letter was actually a gift. It was the best possible evidence for my charity care application. I attached it as the cover page. It proved, in black and white, that for this specific medical event, I was 100% uninsured. The hospital’s financial aid office didn’t even have to question my status; the insurer did the work for them.
The “Pre-Authorization” Nightmare That Led to a Full Bill Forgiveness
The Paperwork They Forgot to File
My doctor scheduled me for surgery, but his office forgot to get “pre-authorization” from my insurance company. The insurer denied the claim, leaving me with a bill for the entire surgery. I was furious at my doctor’s office. But then I applied for charity care at the hospital. In my application, I explained the pre-authorization error. The hospital recognized that the billing issue was caused by the doctor’s office, not me. Out of fairness, they granted me a full financial hardship write-off and told me they would fight with the doctor’s office themselves.
Why Having Insurance Can Sometimes Make It Harder to Get Aid (And How to Overcome It)
The “You Have Insurance” Brick Wall
The first time I called the hospital billing office, the clerk said, “Sorry, we can’t help you, you have insurance.” It’s a common brick wall. They see you as the insurance company’s problem. To overcome this, I had to change my language. I stopped saying “I can’t afford my bill.” Instead, I started saying “I am applying for assistance as an underinsured patient.” Using the specific term “underinsured” is the key. It moves you from the “insured” category to a special category of people who have insurance that is not adequate to prevent financial hardship.
I Used My “Explanation of Benefits” (EOB) to Prove I Was Underinsured
The Document That Told My Whole Story
The “Explanation of Benefits” (EOB) from my insurance company looked like a bunch of confusing numbers. But I realized it was the perfect tool to prove I was underinsured. The EOB clearly showed the “Amount Billed” by the hospital, what the “Plan Paid,” and my “Patient Responsibility.” I circled my “Patient Responsibility”—which was thousands of dollars—and attached the EOB to my charity care application. It was an official document from a third party that proved exactly how much my “good” insurance was leaving me to pay.
How to Get the Hospital to Bill Your Insurance, Then Write Off the Rest
The One-Two Punch to My Bill
I had insurance, but I knew I couldn’t afford my large co-insurance payment. I spoke to the hospital financial counselor before my procedure. We made a plan. Step one: The hospital would bill my insurance company as usual. Step two: Once the insurance paid its portion, the hospital would automatically apply their financial assistance to the remaining balance. This ensured the hospital got paid as much as possible from my insurer, and I was only asking for help with the part I was truly responsible for. It was a fair and effective strategy.
My COBRA Premiums Were Insane—This Is How I Got Off of It and Got Free Care
I Chose Charity Care Over COBRA
After I lost my job, I was offered COBRA to continue my health insurance. The monthly premium was over $1,500—more than my rent. It was completely unaffordable. I made a strategic decision. I officially declined the COBRA coverage. This meant I was now legally uninsured. I took the letter declining COBRA coverage and submitted it with my application for financial assistance at the local non-profit hospital. Because I was now uninsured with no income, I qualified for 100% free care. I chose charity over the crippling cost of COBRA.
The “Medical Loss Ratio” Argument That Can Help Your Case
The Law My Insurer Was Breaking
My insurance company seemed to deny everything, and their profits were soaring. I learned about the “Medical Loss Ratio” (MLR) rule under the ACA. It requires insurance companies to spend at least 80% of the premiums they collect on actual medical care. My insurer’s MLR was much lower. In my appeal of a denied claim, I pointed out that their pattern of denials suggested they might not be meeting their legal MLR requirements. The mention of this specific federal regulation often encourages an insurer to take a second, more generous look at a claim.
How to Prove Your “Affordable” Health Plan is Anything But
The Plan I Couldn’t Afford to Use
My “affordable” marketplace health plan had such a high deductible that I avoided going to the doctor. When I finally had to have a hospital stay, the out-of-pocket cost was a nightmare. To prove my plan was unaffordable in practice, I attached a copy of my monthly budget to my charity care application. It showed my modest income and my essential expenses. It was clear proof that while I could afford the monthly premium, I had absolutely no room in my budget to pay the thousands of dollars required to actually use the plan.
I Had a Bronze Plan—Here’s How I Got Platinum-Level Forgiveness
My Low-Tier Plan Was My High-Value Argument
I had a “Bronze” level health plan from the marketplace, which meant low premiums but very high out-of-pocket costs. When I needed surgery, I knew I was in trouble. But my Bronze plan became my best argument. In my charity care application to the hospital, I highlighted that my insurance was the lowest possible tier of coverage. I argued this was clear evidence that I was a person of limited financial means. The hospital agreed that my choice of a Bronze plan reflected my financial reality and granted me their highest level of assistance.
The “Grace Period” Loophole for Marketplace Plans
The 90 Days That Saved Me
I had lost my job and was struggling to pay the premium for my marketplace insurance plan. I entered the 90-day “grace period,” during which the plan was still active. In that window, I had a medical emergency. The insurance company told the hospital they were holding the claim pending my premium payment. The hospital, seeing that the claim was likely to be denied, allowed me to apply for their own financial assistance program. I was approved for charity care just before my insurance was officially terminated. The grace period gave me the time I needed.
How to Handle a Hospital That Won’t Bill Your Insurance First
The Billing Standoff
The hospital was demanding I pay my full deductible upfront, before they would even bill my insurance company. I knew this was wrong. I politely refused. I told the billing manager, “You have a contract with my insurance company that requires you to submit a claim first. You cannot hold me responsible for the full, inflated charge. Please submit the claim as required, and I will be happy to discuss my portion after my insurance has paid.” Standing my ground and knowing their contractual obligation forced them to bill my insurance first.
My Employer-Sponsored Plan Had a “Coverage Gap”—Charity Care Filled It
The Donut Hole for Hospital Bills
My employer’s health plan was strange. It covered the first $1,000 of a hospital stay, and anything over $10,000, but there was a “coverage gap” or “donut hole” in between. I was responsible for everything from $1,000 to $10,000. It was a huge liability. When I had a surgery that fell into that gap, I applied for the non-profit hospital’s charity care. I showed them my unique plan documents. They understood the bizarre gap in my coverage and used their financial aid to cover the portion my weird insurance plan wouldn’t.
The ERISA Law You Need to Know If You Have Insurance Through Work
The Federal Law That Governs Your Work Insurance
I was having a dispute with my employer-sponsored health plan. I learned that these plans are governed by a federal law called ERISA. This was important because it meant my appeal rights were determined by federal law, not state law. Knowing about ERISA helped me understand the strict deadlines and procedures for filing an appeal with my health plan. It’s a complex law, but simply knowing its name and that it controlled my appeal process helped me find the right resources to fight the denial.
How to Get Charity Care When Your Insurance Requires a “Step Therapy” You Failed
The Steps I Had to Take to Get Forgiveness
My insurance required me to try and fail on two cheaper drugs before they would approve the expensive one my doctor wanted. This is called “step therapy.” While I was going through this process, the bills were piling up. I applied for charity care at the hospital. In my application, I included the documentation of the “step therapy” denial from my insurer. This was proof that I was currently being denied the most effective treatment due to my insurance policy’s rules, which strengthened my case for financial hardship and helped me get approved.
I Was Denied for an “Experimental” Treatment—Here’s How the Hospital Covered It
My Last Hope, and the Bill That Came With It
My insurance company refused to pay for a treatment my doctor recommended, calling it “experimental.” It was my only option left. I was being treated at a major university hospital, and I applied for their financial assistance. My doctor wrote a powerful letter to the charity care committee, explaining that while the treatment was new, it was based on solid science and was my best hope for a cure. The hospital’s committee, made up of physicians, decided to overrule the insurance company and cover the treatment themselves under their charitable mission.
The State Insurance Mandate My Plan Violated (And How It Helped Me)
The Law My Insurer Ignored
My insurance plan refused to cover a specific type of therapy. I was angry. I did some research and discovered my state had a law that mandated all state-regulated insurance plans to cover that exact therapy. My plan was in direct violation of state law. I filed an appeal with my insurer and also filed a complaint with my state’s Department of Insurance, citing the specific mandate. Faced with a clear legal violation, my insurance company quickly reversed its denial and paid the hospital bill.
How to Fight a “Coordination of Benefits” Issue Between Two Insurances
The Blame Game
I was covered under my own insurance and my husband’s. When I had a hospital stay, the two insurance companies started fighting over who was “primary” and who was “secondary.” Both were refusing to pay, and I was stuck with the bill. I finally got the hospital’s patient advocate involved. She initiated a three-way call with me and representatives from both insurance companies. She acted as the mediator and forced them to resolve their “coordination of benefits” dispute. She got them to stop the blame game and pay the bill.
My HSA Plan Was Drained by One Bill—Charity Care Covered the Rest
My Health Savings Account Ran Dry
I had been diligently saving money in my Health Savings Account (HSA) for years. But one major surgery wiped out the entire account, and I still owed the hospital thousands more. I applied for charity care. I submitted my HSA statements as part of my application. The statements were powerful proof of my financial hardship. They showed that I had been saving responsibly for medical costs, but that this one catastrophic event had overwhelmed all my preparations. They saw my good-faith effort and forgave the remaining balance.
The “Formulary Exception” That Got My Expensive Meds Covered
The Drug That Wasn’t on the List
The prescription my doctor wrote wasn’t on my insurance’s “formulary,” or list of covered drugs. They wanted me to take a different, less effective medication. My doctor helped me file for a “formulary exception.” He wrote a letter to the insurance company explaining why, for me specifically, the non-formulary drug was medically necessary and the alternatives were not appropriate. It took some time, but the insurer granted the exception and agreed to cover the medication. This prevented a huge out-of-pocket pharmacy bill.
How to Argue That Your Plan’s Network is “Inadequate”
A Network So Small, I Couldn’t Find a Doctor
My insurance plan had a very narrow network of doctors. The only in-network specialist for my condition was 100 miles away and wasn’t accepting new patients. I had no choice but to see an out-of-network doctor. My insurer denied the claim. I appealed, arguing that their provider network was “inadequate” to meet my medical needs. I showed proof that I had tried to find an in-network doctor. Because they failed to provide reasonable access to care, they were forced to cover my out-of-network visit at the in-network rate.
I Was Denied Because My Doctor Was “Tier 2″—Here’s How I Won
The Tier Trap
My insurance plan had different “tiers” of doctors. My doctor was a “Tier 2” provider, which meant my co-pay was much higher. I was struggling to afford the visits. In my appeal to the insurer, I argued that my doctor was the only provider in their network with expertise in my specific rare condition. Even though there were other “Tier 1” doctors, they were not appropriate for my care. I made the case that for me, my doctor was a medical necessity. They granted me a “tiering exception,” lowering my co-pay.
The “Timely Filing” Error by the Hospital That Became My Victory
Their Mistake, My Freedom
My insurance company denied a huge claim from the hospital. The reason? The hospital had waited too long and missed the “timely filing” deadline. The hospital’s contract with the insurer gave them 90 days to submit the bill, and they had submitted it on day 95. The hospital then tried to bill me for the full amount. I refused to pay. I wrote a letter stating that their failure to meet their contractual timely filing deadline was their error, not mine, and that they were prohibited from billing me for their mistake.
How to Get Your Deductible Paid for by a Foundation
The Grant That Covered My Share
I was ready for my surgery, but I had no way to pay the $5,000 hospital deductible required by my insurance. The hospital social worker told me about the HealthWell Foundation. I went on their website, found my specific medical condition on their list of covered diseases, and applied for a grant. I was approved. The foundation paid the $5,000 directly to the hospital on my behalf. My deductible was met, my insurance kicked in to cover the rest, and I was able to have my surgery without any out-of-pocket costs.
My Insurance Company Was Sued for Bad Faith—I Used It in My Appeal
Their Bad Reputation Was My Good Evidence
My insurance company was being difficult and denying a claim that should have been covered. I was frustrated. I did a quick Google search of the company’s name and “lawsuit.” I found several news articles about a recent class-action lawsuit they had lost for “bad faith” insurance practices. In my appeal letter, I mentioned that I was aware of their recent legal history regarding claim denials. It was a subtle way of letting them know that I was paying attention and that I knew they had a reputation for acting in bad faith.
How to Navigate “Reference-Based Pricing” Plans and Get Aid
The Plan With No Network
My employer switched us to a strange “reference-based pricing” plan. It had no network of doctors. Instead, it promised to pay a “reasonable” amount for any service, which was usually a lowball offer. The hospital billed me for the huge difference. I was stuck in the middle. My strategy was to apply for the non-profit hospital’s charity care program. Since I had no “in-network” benefits, they treated me as underinsured. The charity care covered the large portion that my weird insurance plan refused to pay.
The “Subrogation” Clause and How it Affects Your Bills After an Accident
The Car Crash and the Insurance Clawback
I was injured in a car accident that wasn’t my fault. My health insurance paid my hospital bills. Then, I received a settlement from the other driver’s auto insurance. My health insurance company then sent me a letter demanding to be paid back out of my settlement. This is called “subrogation.” It was a nightmare. I learned that this is a standard clause in most health plans. It’s a crucial thing to be aware of: if someone else is at fault for your injury, your health insurer will want their money back.
I Used My High Prescription Co-pays to Prove Hardship
My Pills Were Proof
When I applied for hospital charity care, my income was a little bit too high to qualify. But the application didn’t ask about my prescription drug costs, which were over $400 a month. In my appeal, I included a printout from my pharmacy showing my out-of-pocket prescription costs for the entire year. I argued that these costs were a mandatory medical expense and should be deducted from my income. They agreed, and this new, lower “medical income” made me eligible for a 100% write-off of my hospital bill.
The Student Health Insurance Plan Holder’s Guide to Hospital Bills
My Campus Plan Had Its Limits
My university’s student health insurance plan was great for visits to the campus clinic, but when I had to be hospitalized off-campus, I discovered it had major coverage gaps and a high deductible. I was a full-time student with a tiny part-time job. I applied for financial assistance at the non-profit hospital. I provided my student insurance information, but I also provided my tuition bill and my FAFSA form. This proved my status as a student with limited resources. The hospital’s charity care covered what my student plan wouldn’t.
How to Get a “Retroactive” Insurance Denial Overturned
The Denial I Didn’t Know About
Months after my hospital stay, I got a huge bill. I called my insurance company, and they said they had retroactively terminated my coverage for the month of the surgery due to a paperwork error. I was now uninsured for a bill that was months old. I immediately filed an appeal with the insurer. I also contacted my state’s Department of Insurance. The pressure from the state regulator, combined with my appeal, forced the insurer to admit their error and retroactively reinstate my coverage. The hospital bill disappeared.
My Insurance Paid a Tiny Fraction of the Bill—Charity Care Handled the Rest
The 10% Solution
My insurance plan had a terrible reimbursement rate. For my $80,000 hospital bill, they only paid $8,000. I was left with a balance of $72,000. It was an impossible, life-ruining amount. I applied for the non-profit hospital’s charity care program. In my application, I showed them the Explanation of Benefits from my insurer. It was clear proof that my plan offered completely inadequate coverage. The hospital saw the massive remaining balance and my modest income, and they wrote off the entire $72,000.
The “Peer-to-Peer” Review I Used to Win My Insurance Appeal
My Doctor vs. Their Doctor
My insurance company denied a procedure, saying it wasn’t medically necessary. Their decision was made by a nurse reviewer. My first appeal was also denied. For the final level of appeal, I demanded a “peer-to-peer” review. This meant my doctor got on the phone and had a direct conversation with a doctor from the insurance company who was a specialist in the same field. My doctor was able to present the clinical case for why the procedure was necessary. His expert opinion convinced the insurance doctor to overturn the denial.
How to Get the Hospital to Fight Your Insurance Company For You
My Advocate With a Billing Department
I was locked in a frustrating appeal process with my insurance company. They were refusing to pay for a service the hospital said was essential. I finally went to the hospital’s own financial counselor and explained the situation. She was frustrated on my behalf. She said, “Let me handle this.” The hospital’s own billing and appeals department took over the fight for me. They knew who to call and what to say. After all, it was in their financial interest for the insurer to pay. They fought and won the battle for me.
The “Self-Funded” vs. “Fully-Insured” Distinction You Need to Understand
Who Really Holds the Money?
I was fighting my employer’s health plan over a denied claim. I learned I needed to know if the plan was “self-funded” or “fully-insured.” In a fully-insured plan, my employer pays a premium to an insurance company like Blue Cross, who pays the bills. In a self-funded plan, my employer pays the bills directly, and just uses an insurer to process the claims. This was key. Since my plan was self-funded, my final appeal went to my own HR department, not the insurance company. My employer had the final say.
I Had “Bad” Insurance But Walked Away With a $0 Bill—You Can Too
The Insurance That Was Worse Than Nothing
My insurance plan was so bad, with such a high deductible and so many exclusions, that I was actually in a better position than if I had no insurance at all. Here’s why: having the “bad” insurance made me a perfect candidate for my non-profit hospital’s charity care program for the “underinsured.” I used my terrible insurance plan as evidence of my financial hardship. The hospital ended up forgiving my entire out-of-pocket responsibility. My bad insurance became my golden ticket to a zero-dollar bill.