Tag: health insurance

How to Understand, Manage, and Sometimes Fight Medical Bills

In this post I talk about my recent elective surgery and the shockingly high six-figure hospital bill. I offer a KFF Health News article detailing various patients’ exorbitant medical costs, emphasizing the importance of understanding medical bills, insurance coverage limitations, and potential avenues for reducing charges.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

Please do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with your physician or other qualified healthcare provider.

My Hospital Surgery Bill

Recently, I underwent an elective surgery to treat a painful but not life-threatening condition. It’s been a long time since I needed any type of surgery.

I received a message from the hospital about the projected cost of my procedure and one-night hospital stay. My husband has been in the hospital a few times over the past few years, so I knew to expect a large number. But I still gasped when I saw the 6-figure number following the dollar sign.

Now this is a non-life-saving, one-and-a-half-hour surgery, with a one-night stay in the hospital (sometimes a same-day surgery) that will “cost” my insurance companies and me over 100K! The only thought in my mind was “I’m so glad I have good insurance coverage.”

Of course, that astronomical number is nowhere close to what the insurance will actually pay, but that’s another issue. (see number 7 below) . But it caused me to notice this article from KFF Health News and pass it along to you.

Medical Bills Can Be Vexing and Perplexing. Here’s This Year’s Best Advice for Patients.

Emmarie Huetteman

A Texas boy’s second dose of the MMRV vaccine cost over $1,400. A Pennsylvania woman’s long-acting birth control cost more than $14,000.

Treatment for a Florida Medicaid enrollee’s heart attack cost nearly $78,000 — about as much as surgery for an uninsured Montana woman’s broken arm.

In 2025, these patients were among the hundreds who asked KFF Health News to investigate their medical bills as part of its “Bill of the Month” series.

Insured and uninsured. Job-based and government-funded. Comprehensive and short-term. Part of a sharing ministry. So many people with different health insurance situations asked the same questions:

Why do I owe so much? And how am I going to afford it?

As millions of Americans grapple with the rising cost of health insurance next year, the “Bill of the Month” series is approaching its eighth anniversary. Our nationwide team of health reporters has analyzed almost $7 million in medical charges, more than $350,000 of that this year.

Of this year’s 12 featured patients, five had their bills mostly or fully forgiven soon after we contacted the provider and insurer for comment.

(You can read the 12 patients’ stories on the KFF website.)

Our mission, though, is to empower every patient with the information needed to understand, manage, and — if push comes to shove — fight their own medical bills. Here are our 10 takeaways from 2025.

1. Most insurance coverage doesn’t start immediately. Many new plans come with waiting periods, so it’s important to maintain continuous coverage until the new plan kicks in.

One exception: If you lose your job-based coverage, you have 60 days to opt into a COBRA policy. Once you pay, the coverage applies retroactively, even for care received while you were temporarily uninsured.

Photo by Andrea Piacquadio on Pexels.com

2. Check out your coverage before you check in. Some plans come with unexpected restrictions, potentially affecting coverage for care ranging from contraception to immunizations and cancer screenings.

Call your insurer — or, for job-based insurance, your human resources department or retiree benefits office — and ask whether there are exclusions for the care you need. Ask specifically about per-day or per-policy-period caps, and what you can expect to owe out-of-pocket.

3. “Covered” does not mean insurance will pay, let alone at in-network rates. Carefully read the fine print on network gap exceptions, prior authorizations, and other insurance approvals. The terms may be limited to certain doctors, services, and dates.

4. Get a cost estimate in writing for nonemergency procedures. If you object to the price, negotiate before undergoing care. And if you’re uninsured and receive a bill that’s $400 or more than the estimate, the federal Centers for Medicare & Medicaid Services has a formal dispute process.

5. Location matters. Prices can vary depending on where a patient receives care and where tests are performed. If you need blood work, ask your doctor to send the requisition to an in-network lab. A doctor’s office connected to a health system, for instance, may send samples to a hospital lab, which can mean higher charges.

using a syringe to obtain blood specimen from an individual
Photo by Pranidchakan Boonrom on Pexels.com

6. When admitted, contact the billing office early. If possible, when you or a loved one has been hospitalized, it can help to speak to a billing representative. Ask whether the patient has been fully admitted or is being kept under observation status, as well as whether the care has been determined to be “medically necessary.”

And while there may be no choice about taking an ambulance, if a transfer to another facility is recommended, you can ask whether the ambulance service is in-network.

Photo by Mikhail Nilov on Pexels.com

7. Ask for a discount. Medical charges are almost always higher than what insurers would pay, because providers expect them to negotiate lower rates. You can, too. If you’re uninsured or underinsured, you may be eligible for a self-pay or charity care discount.

8. There’s help available for Medicaid patients. If you get a bill you don’t think you should owe, file a complaint with your state’s Medicaid program and, if you have one, your managed-care plan. Ask whether there is a caseworker who can advocate on your behalf. A legal aid clinic or consumer protection firm specializing in medical debt can also help file complaints and communicate with providers.

9. Your elected representatives can help, too. While a call from a state or federal lawmaker’s office may not get your bill forgiven, those officials often have an open line of communication with insurance companies, local hospitals, and other major providers — and advocating for you is their job.

10. When all else fails … you can write to “Bill of the Month”!

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House.

Do you have a confusing or outrageous medical bill you want to share? Tell us about it!KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Exploring the HEART of Health

By the way, my surgery and hospital stay went well, and I am recovering nicely.

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

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Dr. Aletha

Raymond and I on a recent vacation. My surgery should help me continue to enjoy traveling and fun with my family.

Navigating November Changes: Sleep, Insurance, and Elections

In November, significant changes will occur in the United States, impacting our health and daily routines. Daylight Saving Time ends on November 2, leading to shorter days. Health insurance enrollments for Medicare and Marketplace plans open, while state and local elections on November 4 will influence community health resources and services. Anticipating these changes helps us plan ahead and avoid feeling stressed.

Updated November 8, 2025

Change often seems to happen slowly, especially when we want something quickly. Sometimes change happens suddenly and dramatically, like when the world was plunged into a viral pandemic six years ago.

Some notable changes will happen in November, at least in the United States, and they can have a direct effect on our individual and collective health.

  • Time- from Daylight Saving to Standard
  • Healthcare-changing Medicare, ACA, or employer-sponsored health plans
  • Elections-Voters choose among candidates to fill multiple federal, state, and local offices

Daylight Saving Time ends on November 2

In most of the United States and Canada, we will resume standard time on Sunday, November 2 at 2 AM. Unless you’re awake at that time, you’ll probably want to change your clocks before going to bed Saturday night. (Although many clocks change automatically now.)

That means sunsets will come even earlier than they have been, and there will be fewer daylight hours until the first day of winter, December 21. If you live south of the equator, you welcome more sunshine instead.

Some people may not feel any different as far as sleep and sleepiness due to the change. For most people, “falling back” is less disruptive to sleep than “springing forward.”

Here are some tips to help you adjust to the new day-night schedule of light and dark.

Night before and morning of

  1. Keep your regular bedtime the night before — treat the clock change like a normal night of sleep so you preserve your circadian rhythm.
  2. Avoid a late bedtime because of the “extra” hour — going to bed much later undermines the benefit of the gained hour.
  3. Wake at your usual time on Monday even if you feel rested; consistent wake times anchor sleep timing and help adjust quickly.

Gradual schedule shift if you’re sensitive

  1. Shift sleep-wake by 15–30 minutes for 2–3 days before if you know you’re sensitive to schedule changes.
  2. Split the difference after the change by keeping the new clock time but nudging bedtime slightly earlier for a few nights.

Use light strategically

  1. Get bright morning light as soon as practical after waking to advance circadian timing and reduce morning grogginess.
  2. Dim evening light and avoid screens 60–90 minutes before bed to encourage melatonin production and earlier sleep onset.
Photo by Ketut Subiyanto on Pexels.com

Health Insurance Enrollment for 2025

Many people have a chance to change their health insurance in November.

Medicare is available to anyone at age 65 and certain other people. Enrollees can make changes from October 15 to December 7.

Medicare Advantage Plans (Part C), Medicare CostPlans,Demonstrations/Pilots, and Program of All-inclusive Care for the Elderly (PACE).

If you aren’t eligible for Medicare or an employer-sponsored insurance plan, you may get coverage through the Health Insurance Marketplace, with open enrollment starting November 1 through January 15.

If you are covered by an employer-sponsored health plan, you may be required to sign up for next year’s coverage, especially if you want to change coverage options. Otherwise, you may automatically be enrolled into the same plan.

Whatever plan you choose, you should carefully evaluate options, especially out-of-pocket costs. In a previous post, I reported on the problem of medical debt, due to unexpected expenses not covered by insurance.

Your out-of-pocket medical expenses may increase with a less expensive insurance plan if it requires higher deductibles and co-pays than a plan with higher premiums. You should consider the cost of anticipated health care as you choose coverage.

How to Pay for Medical Care: A Guide for Americans

In this post I review how people pay for their healthcare. In the U.S., medical care financing includes employer-provided insurance, Medicaid, Medicare, the Affordable Care Act, and COBRA. Eligibility for these programs varies based on income, age, and employment status. Additional financial assistance exists through Medicare Savings Programs and nonprofit organizations, helping manage medical bills…

Keep reading

November 4-United States Elections

You may think this is not an election year. That is correct as far as federal elections, as for President, Senators, and Representatives.

However, many state and local elections will be held on Tuesday November 4. These include elections of governors, state supreme court justices, attorneys general, and other state offices.

These elections cover a mix of executive, legislative, judicial, and local offices. Special elections may also be held to fill vacancies in Congress.

New York City, the most populous city in the United States, will elect a new mayor in 2025.
Photo by Dr. Aletha

Several major U.S. cities will elect mayors this year, including.

  • New York City
  • Charlotte
  • Seattle
  • Boston
  • Detroit
  • Albuquerque
  • Atlanta
  • Miami
  • Minneapolis
  • Cleveland
  • Cincinnati
  • Pittsburgh
  • Saint Paul
  • Greensboro
  • Jersey City
  • Durham
  • Buffalo
  • Toledo

(This list was compiled with the use of AI)

📌 Note: Election dates and contests can vary by locality. It’s always best to check with your local election office for the most accurate and up-to-date information.

You can also find election information at Ballotpedia.

Notable results–

On November 4, voters elected Mikie Sherrill as governor of New Jersey (the first woman Democrat to hold that office).

Abigail Spanberger is the first woman elected governor of Virginia.

Michelle Wu was reelected mayor of Boston, Massachusetts. She was the first woman elected to that office in 2021.

Zohran Mamdani, a relative newcomer to politics and self-described “democratic socialist”, was elected mayor of New York City, the largest city in the United States.

Boston Massachusetts elects a new mayor in 2025. photo by Dr. Aletha

How Voting Affects Your Health

State and local governments play a vital role in our communities by funding, organizing, and regulating essential health services. State health departments set public health policies, direct disease prevention programs, and manage emergency responses.

Some local governments operate health departments and clinics that provide direct care like vaccinations, maternal health services, and screenings. They also monitor water quality, food safety, and environmental hazards, keeping us safer. 

Since elected officials oversee these services, voting in local elections directly impacts the quality and availability of care. Local leaders decide budgets for hospitals, mental health programs, and emergency medical services, and they influence partnerships with schools, nonprofits, and first responders.

When we vote, we choose the decision-makers who determine how resources are allocated, which programs are prioritized, and how quickly communities can respond to crises. Thus, local elections shape the health systems that touch our lives every day—making participation vital for strong, resilient communities. 

Navigating Your Changes

  1. What changes do you anticipate this month, or before year-end?
  2. What will these changes mean for you?
  3. What do you need to know and do now to be ready?

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Dr. Aletha