Getting hit with an unexpected medical bill can be scary. It can happen to anyone; in fact, surprise medical bills have affected more than half of all Americans. Even if you have health insurance, there’s no guarantee that you will not get an unexpected bill from your healthcare provider. This is usually because your health insurance policy does not cover as much as you thought it did. There are ways that you can avoid receiving a surprise medical bill in the mail, and EZ has provided some helpful tips to keep you from being blindsided.
Stay In Network
If your primary care physician refers you to a specialist, check to see if they are in your policy’s network before making an appointment. Seeing a specialist who is not in your network will mean having to pay a hefty bill for any services you receive from them. To avoid a surprise medical bill from a specialist that is not covered under your plan, call your insurance company and ask them to find a provider that is in your network. Or you can ask how much you’ll have to pay for the services so you can be financially prepared.
Recent surveys show that people most often receive surprise medical bills after a visit to the emergency room. The next most common unexpected charges came from diagnostic tests and appointments with specialists. Why? Because these visits usually involve medical care that is more advanced than what is covered by your plan. While all ACA-approved health insurance plans cover 100% of preventive care, some services and tests are considered above and beyond preventive, and you could end up being billed for them. If possible, try to ask questions about any care and tests you are receiving at an emergency room or from a specialist.
For example, if you are scheduled for a mammogram, which should be covered by your plan, call your health insurance company and ask for the billing code that they use for mammograms. Then when you go to the doctor’s office for the test, make sure that they are using that billing code. If they use more advanced reading methods such as a 3D mammography, which you might have to pay for out-of-pocket.
When you plan to have any kind of tests or procedures done, such as lab work or surgery, see if you can get a cost estimate from the hospital or healthcare provider beforehand. It is important to keep records so that if you get a surprise bill later, you can use that paperwork to justify your appeal.
Beware Facility Fees
Large healthcare facilities, including hospitals, add a charge for the use of their space and equipment, called facility fees. You could be charged a facility fee, which could be a few hundred dollars, just for visiting a doctor that is in a hospital complex or an urgent care office. Ask your provider ahead of time if there will be a facility fee, especially if it’s not an emergency situation and you do not need to visit a hospital.
Be Prepared In Case Of Emergency
In the event of an emergency, you could need an ambulance ride to the hospital. These rides are very pricey, costing several thousand dollars for just a few miles. Be prepared for emergencies by calling the ambulance providers in your area and making sure they are in-network. In the worst case scenario, if you need an ambulance ride and receive a large bill because they were not in-network, you can try to negotiate with the ambulance service or your health insurance company to reduce the price. You can even ask them to create a monthly payment plan for you.
Avoid Balance Billing
Balance billing is when a provider bills you for the difference between the amount they charge and the amount that your insurance pays. For example, if the provider’s charge is $200 and your plan’s allowed amount is $150, the provider may bill you for the remaining $50. Balance billing often happens when people go to a hospital or emergency room that is in their network, but see an out-of-network provider while there. If this happens to you, you can negotiate with the hospital billing manager or the doctor who billed you, and ask them to either pay the cost themselves or lower the bill for you. You can also call your health insurance company and ask them to waive the fees because you were in a hospital that was in your network.
Finally, and most importantly, if your medical needs have changed due to an addition to your family or a new chronic condition that you are managing, for example, then it might be time to look for a better health insurance plan. EZ will compare all available plans in your area, and find you the plan that best fits your financial and medical needs. Instead of settling for a health insurance plan with surprise medical bills, allow us to find you a plan with more coverage and a lower price tag.
To compare plans for free in minutes, enter your zip code in the bar above, or to speak to a trained licensed agent in your area, call 888-350-1890.