More than half of Americans have received surprise medical bills, even after believing that their costs would be covered by insurance. How does that happen? Well, a few ways. Even after confirming that doctors and procedures are covered by an insurance plan, some patients can be surprised. The more complicated the medical issue or procedure, the higher the likelihood that this could happen. One example is a woman who needed surgery to replace a hernia. Even after researching the surgeon and procedure to get an idea of what was covered, the woman ended up with a surprise, four-figure medical bill. It turns out, the anesthesiologist assigned to the surgery was out-of-network, leading her to rack up unknown costs associated with the surgery.
The good news is that there are ways to get ahead of these unanticipated costs and avoid them. It requires asking providers up-front questions and doing some research ahead of any visits or procedures. While there is no “silver bullet”, there are some things you can do to avoid surprise medical bills. Here are some tips.
While most health plans cover all preventive care, hidden surprise medical bills may surface. Emerging technologies and other advancements in healthcare may throw a wrench into how things are billed. If you have a medical visit or procedure scheduled, check with your insurer beforehand to ensure that all tests and other medical services are covered. Obtain the correct billing codes so you can confirm them with the provider during your visit. These billing codes help to determine how much a test or procedure will cost. Many provider offices will get preauthorization from your insurance company beforehand, but it doesn’t hurt to do your own homework and come prepared.
There’s no rule against shopping around for medical procedures or tests. If your having lab or blood work done, costs may vary. Call your insurance company to obtain the billing code for the procedure. Then reference online sites to compare costs within different Zip codes around you. Many people assume that medical services cost the same no matter where you go, but that is not always the case. Some tests or procedures may range from a few hundred dollars to several thousands of dollars, depending on where they are done. The wide spectrum of pricing may even occur in the same geographic location. Doing your homework can help you avoid surprise medical bills.
While no one wants to expect the worst, it doesn’t hurt to be prepared for it. It can be helpful to plan for emergencies and to know what to expect in terms of cost and procedures. Research the costs of ambulance rides and ER visits. If an emergency situation were to arise, no one wants to deny care because of costs; however, knowing what to expect ahead of time can avoid adding insult to injury in the form of surprise medical bills. Contact your local fire department to see which ambulance company or service is responsible for your area, then contact your health insurance company to see if that company is in-network. Even out-of-network services can sometimes be negotiated.
Not too long ago, one woman faced $28,000 in charges for a simple throat swab. Imagine getting a bill that size just for having a sore throat checked out by your primary care doctor. What happened? In addition to the doctor ordering a slew of unnecessary tests, many of the tests were out-of-network. Unfortunately, lab facilities that aren’t in-network can run up your medical bills quickly. If your doctor is ordering one or multiple tests, be clear that you would like the tests to remain in-network. When in doubt, consult your insurance company to find in-network labs.
If you live in the Austin, Texas area, let Decent help you avoid surprise medical bills. We offer three different health insurance plans specially designed for the self-employed. All three plans — the Pathfinder Bronze Plan, Lonestar Bronze Plan, and Trailblazer Silver Plan — offer free primary care and run below market rate when it comes to premiums. Each of these plans is considered ACA compliant, so pre-existing conditions are accepted. Premiums that run 20-40% cheaper than traditional plans make these an appealing option for those looking for an option that doesn’t break the bank. Get your free quote today.