Avoiding Unexpected Medical Bills

avoiding unexpected medical bills text overlaying image of past due billsIn general, bills of any kind are met with groans, but unexpected medical bills are undeniably the worst. They have a habit of coming at the worst time and weeks or even months after you’ve seen a doctor or had a procedure.  Despite the inconvenience they’re far more common than you would think even when you have health insurance. Unfortunately, not everything is covered by health insurance, which is a bitter pill to swallow considering how expensive it can be.

 

While we have no control over which services are covered (or how much we have to pay for them), we can understand exactly what the benefits and coverage are. As long as your deductible is met, you generally don’t have to worry about paying for routine exams, surgical procedures, or lab work. However, some procedures are excluded. These are primarily “elective” procedures, such as weight loss surgeries. Unless you are a special case, your chances of having them covered are slim. Below we’ll go over what insurance companies typically cover, what they won’t and how to avoid expected medical bills.

 

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What Most Health Insurance Plans Cover

Typically, depending on the type of plan you have, most health insurance plans cover:

 

  • Hospitalization
  • Maternity and newborn care
  • Emergency services
  • Electrocardiograms
  • X-rays
  • Preventative services such as:
    • Annual check ups
    • Routine blood work
    • Cancer screenings
    • Blood glucose tests
    • Vaccines
    • Blood pressure monitoring
    • Blood cholesterol monitoring

The primary differences in these coverages depend on your company and the plan tier you choose. For instance, some of these could require copays or coinsurance.

What Health Plans May Not Cover

Surprisingly, there are a lot of things that are either not covered or are only partially covered by most insurance companies. 

Travel vaccines

Typically, insurance companies will only cover routine vaccinations that are needed in the U.S. Tropical disease vaccines are not covered if you are traveling to other countries. Most health insurance companies see these as not medically necessary.

Acupuncture

Even though there are numerous studies that show acupuncture has real medical benefits, health insurance doesn’t agree, since it doesn’t fit into most concepts of western medicine. An acupuncture visit can cost anywhere from $100 and up, out-of-pocket.

IVF

Unfortunately, many state health insurance plans do not cover in vitro fertilization (IVF). Whether you’re having trouble getting pregnant or just simply want to go a different route to your pregnancy, the procedure can cost between $10,000 and $20,000. Currently there are only 15 states that have laws making IVF coverage mandatory for health insurance.

Cosmetic surgery

In general, health insurance does not cover elective surgeries. Meaning that if the surgery isn’t approved by your physician for medical needs rather than cosmetic reasons it won’t be covered. For instance, if you have large breasts, a breast reduction is only covered if your doctor provides sufficient evidence that your breasts are causing health problems. Make sure you talk to your health insurance provider and doctor to avoid unexpected cosmetic surgery bills.

Dental and vision

This one can be surprising, but most health plans will not cover dental or vision care. There are however add-ons that you can purchase that are basically extra coverage specifically for these types of care. Additionally, things like LASIK (laser eye surgery) are seen as elective and not medically necessary.

Weight-loss surgery

Just like with breast reductions, unless your weight is causing severe health conditions your health plan will most likely not cover it. There is no federal law requiring health plans anywhere to cover these at all. Even if your doctor deems it medically necessary it can be very difficult to get these procedures covered.

Hearing aids

This is another surprising one, you’d think that hearing aids would be automatically considered medically necessary. And many people agree with you, this has been an ongoing argument in the United States for years. But as it stands most plans won’t cover hearing aids even though they’ll cover hearing exams. Currently only 4 states require hearing aids to be covered.

Out-of-network doctors

If you are hurt outside of your plan’s coverage area you’re probably out of luck. Your health insurance will most likely not cover out-of-network doctors unless it’s an emergency. And even then it’s tricky. However, there are plan types that do have some out-of-network coverage such as Preferred Provider Organizations (PPOs). They cover these doctors much less than their network providers but there is still some coverage there.

 

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How To Avoid Unexpected Medical Bills

The good news is that you can avoid many unexpected medical bills by taking a few extra precautions before your appointments. Here are some simple strategies recommended by patient advocates and insurance professionals.

1.Read, Read, Read!

Every January, your health insurance company will mail or email you a packet containing all the information about your plan. Although the language can be a bit jargony and difficult to read, it’s in your best interest to read through this packet thoroughly. You can’t just assume specific procedures and services are covered. That is how you end up with unexpected costs. Instead you need to read the fine print to gain an understanding of what your plan’s specific benefits and limitations are.

 

We recommend highlighting important parts you think can or will pertain to you. Take note of your plan’s deductible, this is the amount you have to pay during your coverage period before your plan will begin paying for medical expenses. For example if you have a $500 deductible, you are responsible for paying for your medical costs until you reach that amount. After that your plan will pay for covered services in full for the remainder of the year.

 

You’ll also want to note which services are fully covered. For certain preventive services, such as a flu shot, annual physical, etc, you will only have to pay a copay with the remainder being covered by your plan. These things are essentially free so you’ll want to take advantage of them.

2.Stay In-Network

Insurance companies establish a network of covered healthcare providers, labs, and hospitals. Outside of the coverage area, you will face a huge financial burden. This is because your insurance company negotiates rates with their participating providers, giving you services for a cheaper rate. In general, health insurance plans do not have to cover care from out-of-network providers. However, there are a few exceptions. All plans legally have to cover out-of-network services if it’s an emergency. 

 

To stay on the safe side, always make sure your provider is in your network before your appointment or any procedure. Prior to something as major as surgery you will definitely want to double check what your plan will cover. Make sure the facility, anesthesiologist, and equipment are all covered under your plan. That way you don’t end up with any unexpected costs.

3.Ask Your Questions

Even if you know your doctor or facility is in-network, always ask about coverage. If your doctor wants to perform a blood test, an EKG, or any other procedure or test during your appointment, ask if it’s covered before you consent. If the doctor is unsure, you can request the procedure’s Current Procedural Terminology (CPT) code and then call your insurance company to find out if it’s covered. This is helpful because your insurance may cover one type of mammogram for instance, but not another. Having this CPT code will make it easy for you to get a direct answer quickly to avoid unexpected bills.

4.Compare Costs

Comparing costs is a must! If your doctor sends blood work out to multiple labs, or if you have several pharmacy options near your home check the costs. One lab or pharmacy may be cheaper than another.

5.Get Preauthorization

By now it’s obvious the best way to avoid unexpected medical bills is to do your homework ahead of time. This is especially true when it comes to procedures. Most health insurance plans will require you to have pre approval for surgical procedures. If you don’t get the approval ahead of time you’ll face penalties or having to foot the entire bill yourself.

6.Expect The Unexpected

In the best-case scenario, you won’t have any medical emergencies, but plan ahead just in case. At the moment you won’t have time to call your insurer and ask which hospitals are covered. So, in your spare time, look up which hospitals near you are covered. Spend some time looking over your ambulance coverage as well. According to a study published in JAMA Internal Medicine, 85% of ambulance services end in out-of-network charges. In an emergency the most important thing is making sure you get the necessary care. We know you might not be in a situation where you can stop and ask if the ambulance ride is covered. However, in a non-life-threatening situation take a moment and ask if there’s a way to get an ambulance service that your insurance company will cover.

7.Document Everything

A simple phone call can provide you with a lot of answers to important questions. Such as whether or not a procedure is covered, if the physician is in-network, and which lab is preferred. But even after you get your answers, take one more step and get it in writing. Always request any information you get to also be sent in writing, regardless if it is a conversation with an advocate, the billing department, or a patient representative. This way you have everything you need in case you need to dispute any questionable charges.

The Final Step Work With EZ

All of that homework is a lot right? Well, here at EZ we can minimize all of this for you. By working with one of our highly trained licensed agents you can get all the answers you need in one place. They can compare all of your plans to make sure you get the best coverage for you as well as translate all the legal jargon in your insurance information packet from step 1. And they do it all for free! No hassle, no obligations. Enter your zip code into the bar below for free instant quotes to get started or call one of our agents directly at 877-670-3557.

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Revive Your Sex Drive With Acupuncture

Acupuncture has been used as a form of alternative medicine in China for centuries. It has many benefits, and has been said to cure ailments in the body, including sexual ones. There are pressure points all over our bodies, which acupuncturists use needles on to break up blockage or imbalances, and allow a smoother flow of energy. About 43% of women are affected by a low sex drive, whether due to stress, anxiety, or other conditions. Acupuncture has been rumored to treat allergies, sleep disorders, and many other conditions. More importantly, it helps treat multiple sexual issues, helping you regain your sex drive, and have better sex. Yes, better sex from tiny needles.

African American arm getting acupuncture needles put in forearm.
Acupuncture helps restore flow to clogged pathways in our bodies, and can help with many sexual issues.

Pinpointing The Issue

Within the acupuncture scope, low libido is seen as an imbalance of energy (Qi) within the organ systems, specifically the kidney and heart. A series of needles will focus on pressure points associated with the sexual issue, and work to shift blood and energy to the genital area, increasing arousal, and Yang energy. Yang energy is the metabolism and spark that ignited your sexual drive. 

Healing Different Sexual Issues

Acupuncture can be used for more than just a lowered sexual libido. Once the issue is established and the cause, then acupuncture can help people dealing with:

  • Diminished Libido
  • Vaginal Dryness
  • Infertility
  • Menopause
  • Premature Ejaculation
  • Low Sperm Count
  • Diminished Sperm Motility
  • Impotence

The Study

A study published in 2013 in the Journal of Alternative and Complementary Medicine focused on 35 men and women with sexual dysfunction. The dysfunction was most likely caused by the antidepressants they were taking for anxiety or other mood disorders. About 50- 90% of people who take selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) experience sexual dysfunction.

The patients were treated with 9 sessions of acupuncture. Each session lasted 15 minutes. Some of the acupuncture points used in the study — called kidney 3, governing vessel 4, urinary bladder 23, heart 7, and pericardium 6.

These are the common points of traditional Chinese medicine (TCM) diagnoses for, “conditions which often include sexual dysfunction,” says Dr. Baljit Khamba, ND, an assistant professor of naturopathic medicine at Bastyr University California, a naturopathic doctor in San Diego, and one of the study’s co-authors.

By the end of the study, women reported improved libidos, while men experienced improvement in multiple sexual functions including erection, timing of ejaculation, and ability to orgasm.

Asian man and womans faces peeking through a white comforter in bed.
Acupuncture can help people towards experiencing better sex.

Sexual Health Benefits

Acupuncture has little to no reactions or side effects. When speaking with the acupuncturist, make sure to tell them exactly what the issue is, and they will work their magic. The pressure points associated with your sexual drive, once the flow opens up will:

  • Improve circulationEnhances senses, which helps you reach an orgasm. 
  • Balance hormones– Hormonal imbalance can affect your sex drive. 
  • Lower stress levels– Being stressed out affects your sex drive and life. Acupuncture helps you to relax, which boosts your sex drive.

Can you imagine that little tiny needles put onto specific pressure points could solve your health issues? As crazy as it may seem, many different studies backup acupuncture and its success, especially with sex and hormones. As stated by Dr. Khamba, acupuncture “is a particularly useful way of treating the root cause” of any sexual dysfunction. Your insurance plan may cover a limited number of acupuncture treatments. Find out if your health insurance covers them, and if so, great! You can start researching acupuncturists in your area. If not, a session can cost anywhere from an initial visit of $75-$95, followed by routine visits of $50-$70. Prices vary within your area. Acupuncture is holistic, efficient, and can enhance your sex life. Definitely worth giving it a “shot.”