Ways To Stay Away From Shocking, Unexpected Medical Bills — Just Life Trends

Groans are common in response to invoices of any kind, but unexpected medical costs are especially uncomfortable. They frequently arrive in your mailbox weeks, if not months, after your doctor appointment or operation date. While these costs may come as a shock, they are not unusual. According to a 2018 survey conducted by NORC at the University of Chicago, 57 % had received a bill that they assumed would be paid by their insurance carrier. But there’s good news: by taking a few extra measures before your check-ups, you may save a lot of surprise medical expenditures. Patient activists and insurance professionals offer the following easy solutions.

1. Do your homework!

Every January, your health insurance sends you a large package including all of the specifics of your plan. Although the type is small and the language is thick, experts agree that reading and absorbing this information is essential.

“It’s up to you to understand your coverage,” Tamara Sieger, patient advocacy director for the Alliance in Reconstructive Surgery Foundation, says. “Don’t assume that specific operations will or should be covered by insurance,” she advises. Instead, read the fine language to get a good understanding of your plan’s benefits and restrictions, according to Sieger.

It may be beneficial to underline key points as you read through everything. Take notice of the plan’s deductible-this is the amount you must pay over the course of a coverage period (typically a year) before your insurer will cover charges. If your deductible is $500, for example, you’ll be responsible for paying claims until you reach that amount; after that, your insurance will cover claims for the remainder of the coverage period.

You’ll also want to understand which services are fully covered. Only have to pay a co-pay for some preventative or critical services (like the flu vaccine or your annual physical), and your insurance will cover the rest. Definitely want to take advantage of these offers.

2. Stay in touch with your colleagues.

The following is how insurance works: Insurance companies construct a network of covered healthcare providers, labs, hospitals, and other facilities. If you leave that coverage network, Sieger warns, you’ll pay a higher price. Because the insurer has negotiated pricing with in-network providers, this is the case.

Because the insurance company has no agreement with out-of-network providers, if the health care provider charges a higher rate, the insurance will only cover the amount agreed upon with in-network physicians, leaving you to pay the difference. (Womp, womp, womp!)

Always check if a provider is covered before going to an appointment to be safe. Take a snapshot of the insurance website where the provider is mentioned for proof in case there is a future disagreement, according to Talente.

You’ll need to check what’s covered much more extensively before a surgery. Although the surgeon may be in-network, you should also check to see if the facility, anesthesiologist, and equipment are covered by your plan, according to Teri Dreher, RN, iRNPA, the owner and CEO of NShore Patient Advocates. If your doctors wish to employ robotic surgical technology, for example, your insurance company may deem it unnecessary for the treatment and refuse to pay for it.

3. Be curious and ask a lot of questions.

Continue to inquire about coverage even if you visit an in-network doctor or facility. According to Shawn Plummer, an insurance marketer at Unkefer & Associates, “asking a doctor or physician if your insurance covers specific therapies is a necessary.” If your doctor wants to administer a blood test, an EKG, or any other procedure or test during your session, find out if it’s covered-and how much the doctor costs.

If the doctor is unclear, ask for the CPT code and call your insurance company to see if the operation is covered. For example, your insurance may cover one type of mammogram but not another. You’ll be able to find down the definitive coverage specifics if you have the specific CPT code.

4. Examine prices.

Is your doctor sending your blood test to several labs? Do you have a number of pharmacies in your immediate vicinity? One may be more cost-effective than the other at times.

“Your insurance carrier can recommend preferred laboratories, pharmacies, and providers who can help you save money,” Sieger explains. A simple phone call to your insurance carrier to check prices or enquire about preferred facilities might save you a lot of money-and prevent an unnecessarily hefty payment.

You can also get an estimate of prices for a procedure and compare what’s available in your ZIP code by using a pricing comparison tool like Clear Health Costs or FAIR Health Consumer.

5. Obtain preapproval.

It should be obvious by now: the best approach to avoid unexpected medical expenditures is to do the legwork ahead of time. When it comes to processes, this is especially true.

Most insurance companies need preauthorization for surgery, according to Dreher, who recommends requesting formal confirmation of coverage from your doctor. “Failure to have procedures preauthorized with insurance may result in penalties and procedures that are not covered,” Sieger warns.

6. Make a contingency plan in case of an emergency.

The best-case scenario is that you do not experience any medical issues. But, just in case, plan beforehand. If something goes wrong, you won’t have time to browse online or call your insurer to find out which hospitals are covered.

Look into which nearby hospitals are covered by your health insurance when you have some free time, suggests Talente. Take a few moments to look through your ambulance coverage as well. According to a recent study published in the journal JAMA Internal Medicine, 85 percent of ambulance use resulted in an out-of-network bill.

The most crucial thing in an emergency is to seek the help you require. However, if the issue isn’t life threatening (for example, if you need transportation from one hospital to another), you can see if an ambulance service is available that is covered by your insurance.

7. Documents.

Many crucial questions can be answered with a simple phone call: Is this a covered procedure? Is this doctor a part of your health-care network? What is the preferred lab for your insurance plan? Even after you’ve received replies and confirmation, experts advocate taking one more step: Put everything down on paper.

Always ask for the information to be given over in writing, whether it’s a conversation with a patient advocate, the doctor’s billing department, or a patient representative, advises Dreher. This manner, you can contest any charge that doesn’t appear to be correct.

Photo by Marek Studzinski on Unsplash

Originally published at https://justlifetrends.com on February 27, 2022.