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Special Needs Planning Newsletter: What the Planner Never Planned –  A Lesson in Overcoming the Unexpected

Chambliss Law Firm Monthly Editorial - June 2016

NEW! Chambliss Law Firm Monthly Editorial

What the Planner Never Planned – 
A Lesson in Overcoming the Unexpected
by Amy Boulware, Elder Care Planning Manager, (LAP MSW)

My husband and I planned for our first daughter. We loved children and wanted to be parents.  I must admit I have always been a planner. My husband actually says that I was one of those people who puts everything into neat little boxes. I was organized to a fault and just knew that as long as I worked hard at something it would turn out exactly as I had planned. 

I say was because on December 8, 1991 our life changed forever, and it was nothing like what we had planned. Our daughter Amanda was born almost three months early and weighed two pounds and one and one-half ounces as a result of me having toxemia. This is a condition in pregnancy, also known as preeclampsia and characterized by an abrupt rise in blood pressure and swelling. It affects about 5 percent of pregnancies and usually happens in first pregnancies. Our daughter was so tiny that I could hold her in the palm of my hand, and my husband's wedding ring hung on her wrist like a bangle bracelet.

To say that we did not plan for this would be an understatement. Not only did we not plan for it, I almost died in the process. My blood pressure was so high before they delivered her by cesarean that the doctors told my husband and parents that they might not be able to save me or the baby. Thankfully they were wrong about both! 

It was a terrifying time in our lives, and I remember it as if it was yesterday. Before we had our daughter, we had not really used our medical insurance in any significant way. We went to the doctor when we had colds and had our yearly checkups. We had not gone to the hospital, used emergency services, or even been to see a specialist. We had an 80/20 insurance policy.  It seemed good to us. We paid our co-pays at the doctor's office and didn't think anything about it after that. That is until we had Amanda.

We learned very quickly that 20 percent of a lot of money is a lot of money! Our mailbox was so full of medical bills that there were times when all I could do was hold them in my hands and cry. Our portion of her hospitalization was over $184,000. That didn't even include the doctors she saw or the treatment she received. We found out that having a baby in December who was still in the hospital in January of the next year meant we were responsible for paying deductibles and out of pocket expenses for both years even though the insurance company paid for her time in the hospital as one visit.

Neither my husband nor I were very savvy at the complexities of navigating this situation. All we knew was that we were thankful to have had the hospital there to take care of our daughter when we needed it. We understood that insurance paid their part and that we were responsible for paying our part. We also knew that she would continue to require care and treatment for some time to come. 

The part we couldn’t get our arms around was how we could possibly come up with this money to pay these bills. It was daunting. I had no idea who to go to for help and didn't know if there was any out there. It is because of this experience that I became educated in how to help families navigate this often daunting task. Here are some important tips if you find yourself facing mounting medical bills:

1.  Realize everything is negotiable. You may be able to get a portion of the bill reduced. It is always okay to ask if they are willing to discount. Ask the billing office how much the bill would be if you paid cash today. 

2. Ask to make a payment plan that will work within your budget. When our daughter was born, we were asked to pay her entire bill by putting it on a credit card. This would have been a terrible idea. Most hospitals do not charge interest on the balance and are willing to accept reasonable payments.

3.  Ask about charity programs. Most hospitals, especially nonprofit hospitals, have charity programs that pick up all or part of the cost of care if you meet certain eligibility requirements.  Talk to a case manager or hospital social worker for resources.

4.  Explore disease or disability specific organizations to see if they have available scholarships or grant programs. Nobody ever suggested that we contact the March of Dimes or any other programs that assist people with premature babies.

5.  Explore local assistance programs from your state and local government to see if you might be eligible for help. Each program has different criteria. So don't assume that because you don't qualify for one you won't qualify for any. Always apply. 

6.  Contact nonprofits and faith-based communities for assistance. Often several agencies will combine their efforts to help you. The United Way is a great place to start.

7.  Become educated about your insurance policy. We didn't understand the difference between out of pocket, lifetime maximums, or what that 80/20 policy really meant.

8.  Know what it means to be in or out of network. There are times when insurance companies will cover services that are out of network because they can't be found in your area.  Don't always take no for an answer.

9.  Find an advocate who can help you. Research care managers who can help you navigate the system. 

10.  Don't let fear paralyze you. My desire to let those bills mount in a pile on my desk would not have been helpful. Be creative. I even offered to work off part of our bill by volunteering my time as a trained social worker in exchange for taking money off of our bill. The head of accounting at the hospital said he had never heard of bartering for a hospital bill. Sometimes thinking out of the box is the way to go!        

I am proud to report that by our daughter's 17th birthday we were finally finished paying off her medical bills. With a small bonfire burning in our backyard pit, we burned the last bill and popped the cork on a bottle of sparkling wine!