Avoiding Unexpected Medical Bills

November 09, 2019

Dealing with health problems can be overwhelming physically, mentally, and emotionally. Between doctor’s exams, blood draws, imaging tests, and treatments, the journey to staying on top of our health can be stressful. Later, when you find huge unexpected bills in the mailbox months after your doctor’s visits, that just contributes to even more stress. Fortunately, there are ways to avoid some of these unexpected health costs. Read below for a list of tips from medical insiders on how you can avoid unexpected health costs, while still enjoying the healthcare you need.

Common Unexpected Health Costs

When you visit your healthcare provider, you may expect to pay fees like co-pays. And once you reach your deductible for the year, you may expect to pay a certain percentage of health fees until you reach your out-of-pocket maximum for the year. However, sometimes you incur fees outside of these costs, which can be confusing and frustrating.

A 2018 report by NORC at the University of Chicago reveals that 57% of Americans have experienced a surprise medical bill. The top reasons for such surprise bills included:

  • Physician services
  • Lab tests
  • Healthcare facility charges
  • Imaging
  • Prescription drugs

According to a June 11, 2019 article by the Center on Budget and Policy Priorities, surprise bills typically occur when a person receives out-of-network services (meaning outside the list of providers covered by your insurance provider). Often the surprise comes when the primary service is at an in-network facility but an out-of-network provider assists. For example, a complication during a procedure could lead to a consult with an out-of-network providers.

Other Surprise Bill Sources

A 2018 report by the American Hospital Association lists a few other common surprise medical bills. They report that if your health insurance pays less than what the provider charges for a service, you will receive a balance bill. Besides dealing with out-of-network providers, such bills can also be a result of out-of-network facility fees.

According to a July 2, 2019 article by Consumer Reports, some of the biggest surprise bills come from transportation services, such as ambulance rides or emergency helicopter rides to hospitals or other medical facilities. Often you need pre-approval, or pre-authorization for such services, except in the case of emergency. 

A September 12, 2019 article by Allways Health Partners also mentions that sometimes diagnostic tests can cause surprise bills. Diagnostic tests are those your doctor orders in order to diagnose a health condition you are showing symptoms for. Preventative tests, on the other hand, are performed to make sure you don’t have a condition that you are not showing symptoms for. Preventative tests may include blood sugar levels to test for diabetes risk, for example, and your insurance usually covers such tests. 

Questions To Ask Your Healthcare Provider Before Receiving Service

The major way to avoid unexpected healthcare costs is to make sure you ask plenty of questions any time you make an appointment with a provider. Call your provider, facility, and insurance company to gather information before going in for an appointment, procedure, or test.

Informational articles from Aetna Insurance, the American Association of Retired Persons (AARP), and Medical Daily recommend asking the following questions to avoid unexpected medical costs.

  • What is my coverage? Read your insurance company’s benefits brochure each year to understand what your deductible, co-insurance, and out-of-pocket maximums are. Also, read to see what types of care your insurance covers: what preventative appointments, tests, etc. If you don’t understand something, call your insurance company’s customer service to clarify.
  • Are you in-network? Ask this question of any provider, transportation service (ambulance or helicopter, for example), or facility you may need to use in a medical situation. If you’re not sure, call your insurance company to find in-network providers so you can plan ahead.
  • Do I need pre-authorization? Some types of procedures or tests require pre-approval from the insurance company, or a referral from your primary care provider. Asking this question can help you avoid any surprise bills related to a lack of prior approval for a treatment.
  • What hospitals and urgent care facilities are in-network? It’s important to know the answer to this so you can plan ahead in case of an emergency. The last thing you want when you must face an unplanned urgent situation is to end up in an urgent care or hospital that is out-of-network. Bills for emergencies, that typically include IV fluids, medications, imaging, tests, etc. could be end up costing thousands of dollars if out-of-network.
  • What code did you use? Before a procedure, call your provider’s office to find out which CPT code they are going to use. Then, call the insurance company to find out what the price is for that CPT code. This can give you an idea of what costs you will incur before your procedure or appointment, and eliminate confusion.

It’s also important to keep copies of claims, invoices, procedure/testing summaries, bills, and your explanation of benefits. Records of charges and codes can be used for reference later if you need to dispute a surprise bill. Finally, look online at your local hospital’s website or sites like Clear Health Costs to find price estimates of procedures or tests at various facilities around the nation.

Bottom Line

You don’t have to be another victim of unexpected health care costs. Doing the legwork can be tedious, but it’s worth it in the long run. Ask the right questions and know what your coverage is. This knowledge can prepare you for your next healthcare appointment, so you know what upfront costs to expect, and hopefully avoid unpleasant surprises down the road.

Never be afraid to be persistent and make sure the billing department of your doctor’s office submits your claims correctly. If they don’t, be sure to call your insurance company right away to notify them of any problems. Being a proactive patient can help you save lots of money and stress after your next healthcare visit!

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