What do you do when you disagree with or can’t afford a medical bill?

Many Americans struggle to pay medical bills, avoid care because of cost worries or forgo other needs due to health care cost burdens.

It can be hard to understand what you’re being charged for on a medical bill. I’m a health policy and economics researcher who studies insurance and out-of-pocket health care expenses, and even I sit at my kitchen table trying to wrap my head around bills and explanations of benefits.

In my newly published research, I surveyed a nationally representative sample of 1,135 American adults – a subset of participants from the University of Southern California’s Understanding America Study – to find out how they handle troubling medical bills. I learned that advocating for yourself can pay off when it comes to medical bills, and you may be missing out on financial relief when you don’t pick up the phone.

Squeaky wheel gets the grease

My team and I found that 1 in 5 patients had received a health care bill in the prior year that they disagreed with or couldn’t afford. Nearly 35% of the bills came from doctor’s offices, nearly 20% from emergency rooms or urgent care and over 15% from hospitals. Other sources of bills included labs, imaging centers and dental offices.

A little over 61% of respondents contacted the billing office about a troubling bill, but 2 in 5 did not. Why not? About 86% of patients said they did not think it would make a difference.

But reaching out got results. Nearly 76% of patients who reached out got financial relief for an unaffordable bill. Nearly 74% who spoke up about a potential billing mistake received bill corrections. For those who negotiated their bills, nearly 62% saw a price drop.

Additionally, 18% of patients who reached out got a better understanding of their bill, 16% set up payment plans and a little over 7% got the bill canceled altogether. Nearly 22% said their issue was unresolved, and 24% reported no change.

The majority of people who reached out about their medical bills reported that it took less than one hour to handle their issue.

Picking up the phone

We found that people with a more extroverted and less agreeable personality – based on the Big Five Personality Test – were more likely to reach out about a medical bill. People without a college degree, with lower financial literacy or with no health insurance were less likely to reach out to a billing office.

Differences in who does and doesn’t call about a medical bill may be exacerbating inequalities in how much people end up paying for health care and who has medical debt.

Many Americans are in health plans with high out-of-pocket cost sharing, including high-deductible plans. This so-called consumer-directed health care paradigm is intended to motivate consumers to be more cost-conscious when seeking care and navigating their bills. But by design, it puts the burden on patients to deal with billing issues.

Another recent study my team and I conducted found that 87% of U.S. hospitals offer their own payment plans, but only 22% of these put plan details on their websites. You have to call for more information.

In another recent study, my team called hospitals as “secret shoppers” planning an elective knee surgery. We sought information critical to assessing affordability: financial assistance, payment plans and payment timing options. While the information was often available, it was hard to access. We couldn’t reach a representative with information at about 18% of hospitals, even after calling on three different days. We were typically directed to three different offices to get all the information we wanted.

Policymakers have made strides in price transparency in recent years. For example, hospitals are required to post prices for their products and services. Practices and policies that further reduce the administrative burden of accessing aid and navigating troubling bills.

Pro tip: Make the call

Patients who make the call are benefiting when it comes to medical bills.

A colleague who knew I was working on this study asked me for advice about a $425 bill her household had received for a lab test at an urgent care center. The bill seemed inflated and unfair, forcing an unexpected stretch to her budget.

I told her it was worth a call to the billing office to express her feelings about the bill and see whether any adjustments could be made to the amount owed or the timing of payment.

It was worth the call. The billing office representative offered three options on the spot: a.) a payment plan, b.) a prompt payment of $126 paid immediately over the phone to settle the account, or c.) financial assistance if eligible based on income.

My colleague chose option b and paid less than one-third of the original bill amount.

The next time you get a medical bill that troubles you, pick up the phone or ask a disagreeable extrovert to make the call for you.

Erin Duffy, Research Scientist and Director of Research Training in Health Policy and Economics, University of Southern California

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our Sun drives a constant outward flow of plasma, or ionized gas, called the solar wind, which envelops our solar system. Outside of Earth’s protective magnetosphere, the fastest solar wind rushes by at speeds of over 310 miles (500 kilometers) per second. But researchers haven’t been able to figure out how the wind gets enough energy to achieve that speed – until now.

Our team of heliophysicists published a paper in August 2024 that points to a new source of energy propelling the solar wind.

Solar wind discovery

Physicist Eugene Parker predicted the solar wind’s existence in 1958. The Mariner spacecraft, headed to Venus, would confirm its existence in 1962.

Since the 1940s, studies had shown that the Sun’s corona, or solar atmosphere, could heat up to very high temperatures – over 2 million degrees Fahrenheit (or more than 1 million degrees Celsius).

Parker’s work suggested that this extreme temperature could create an outward thermal pressure strong enough to overcome gravity and cause the outer layer of the Sun’s atmosphere to escape.

Gaps in solar wind science quickly arose, however, as researchers took more and more detailed measurements of the solar wind near Earth. In particular, they found two problems with the fastest portion of the solar wind.

For one, the solar wind continued to heat up after leaving the hot corona without explanation. And even with this added heat, the fastest wind still didn’t have enough energy for scientists to explain how it was able to accelerate to such high speeds.

Both these observations meant that some extra energy source had to exist beyond Parker’s models.

Alfvén waves

The Sun and its solar wind are plasmas. Plasmas are like gases, but all the particles in plasmas have a charge and respond to magnetic fields.

Similar to how sound waves travel through the air and transport energy on Earth, plasmas have what are called Alfvén waves moving through them. For decades, Alfvén waves had been predicted to affect the solar wind’s dynamics and play an important role in transporting energy in the solar wind.

However, scientists couldn’t tell whether these waves were actually interacting with the solar wind directly or if they generated enough energy to power it. To answer these questions, they’d have to measure the solar wind very close to the Sun.

In 2018 and 2020, NASA and the European Space Agency launched their respective flagship missions: the Parker Solar Probe and the Solar Orbiter. Both missions carried the right instruments to measure Alfvén waves near the Sun.

The Solar Orbiter ventures between 1 astronomical unit, where the Earth is, and 0.3 astronomical units, a little closer to the Sun than Mercury. The Parker Solar Probe dives much deeper. It gets as close as five solar diameters from the Sun, within the outer edges of the corona. Each solar diameter is about 865,000 miles (1,400,000 kilometers).

With both these missions operating together, not only can researchers like us examine the solar wind close to the Sun, but we can also study how it changes between the point where Parker sees it and the point where the Solar Orbiter sees it.

Magnetic switchbacks

In Parker’s first close approach to the Sun, it observed that the solar wind near the Sun was indeed abundant with Alfvén waves.

Scientists used Parker to measure the solar wind’s magnetic field. At some points they noticed the field lines – or lines of magnetic force – waved at such high amplitudes that they briefly reversed direction. Scientists called these phenomena magnetic switchbacks. With Parker, they observed these energy-containing plasma fluctuations everywhere in the near-Sun solar wind.

Our research team wanted to figure out whether these switchbacks contained enough power to accelerate and heat the solar wind as it traveled away from the Sun. We also wanted to examine how the solar wind changed as these switchbacks gave up their energy. That would help us determine whether the switchbacks’ energy was going into heating the wind, accelerating it or both.

To answer these questions, we identified a unique spacecraft configuration where both spacecraft crossed the same portion of solar wind, but at different distances from the Sun.

The switchbacks’ secret

Parker, close to the Sun, observed that about 10% of the solar wind energy was residing in magnetic switchbacks, while Solar Orbiter measured it as less than 1%. This difference means that between Parker and the Solar Orbiter, this wave energy was transferred to other energy forms.

We performed some modeling, much like Eugene Parker had. We built off modern implementations of Parker’s original models and incorporated the influence of the observed wave energy to these original equations.

By comparing both datasets and the models, we could see specifically that this energy contributed to both acceleration and heating. We knew it contributed to acceleration because the wind was faster at Solar Orbiter than Parker. And we knew it contributed to heating, as the wind was hotter at Solar Orbiter than it would have been if the waves weren’t present.

These measurements told us that the energy from the switchbacks was both necessary and sufficient to explain the solar wind’s evolution as it travels away from the Sun.

Not only does our measurement tell scientists about the physics of the solar wind and how the Sun can affect the Earth, but it also may have implications throughout the universe.

Many other stars have stellar winds that carry their material out into space. Understanding the physics of our local star’s solar wind also helps us understand stellar wind in other systems. Learning about stellar wind could tell researchers more about the habitability of exoplanets.

Yeimy J. Rivera, Researcher in Astrophysics, Smithsonian Institution; Michael L. Stevens, Researcher in Astrophysics, Smithsonian Institution, and Samuel Badman, Researcher in Astrophysics, Smithsonian Institution

This article is republished from The Conversation under a Creative Commons license. Read the original article.