It is almost inevitable that your medical bill will be more than you expect.  Partially, this is due to the skyrocketing prices that hospitals and doctors are charging, but it may also be related to unforeseen out-of-network fees and insurance coverage gaps.  If you do get a surprise medical bill, you are not the only one; of those who had a hospital stay, almost 60 percent of Americans on self-insured health plans and 18 percent of Americans on large employer health plans received at least one surprise out-of-network bill in 2016.

Watch Out for Balance Bills

It is becoming increasingly more common that patients receive a bill for uncovered services that are in-network, followed by another bill that charges you for out-of-network services.  This second bill is called a balance bill and is usually much larger. Even if you visit a hospital that is in your insurance network, you may receive treatment from doctors who are not covered by your health plan.

If you stay at a hospital outside of your network, you are likely to see considerably higher bills because those fees aren’t pre-negotiated with your insurer. Unfortunately, more providers in the health care industry are using balance billing to overcharge patients because there is no cap on the size of those fees.

If you get a balance bill that may be in the tens or hundreds of thousands of dollars, you may think that it is illegal.  The bad news is that there is no federal law prohibiting balance billing. Although almost half of the states have some legal protections for consumers, these laws don’t apply to self-funded health plans.

Self-funded health plans are insurance plans offered through companies or unions that pay claims out of their own funds.  These self-funded health plans may be administered by a major insurer, but they don’t afford the same legal protections that conventional health plans do. Many companies use self-funded health plans as a way to save money on employee insurance, but these programs often provide less coverage of services, making you more vulnerable to out-of-network fees.

Know What Is Covered by Your Plan

In many cases, you may have fully read your policy and understood all of the stipulations—or at least, assumed you did—but may not have realized that your insurer may have different definitions

If the doctor bills it as something other than preventive care, you may be on the hook for hundreds or thousands of dollars.  On the other hand, you may also be charged full price if the service is not considered preventive care.

How to Accurately Estimate Costs

There are many steps you can take to precisely predict the size of your medical bills. First of all, make sure that all of your medical service providers are in your network.  This should include the primary provider as well as any supplementary ones that might provide additional services.  Discuss all of the procedures that might be involved during the visit.

Don’t assume that your medical provider or your insurance is fully up to date on their current contract.  These insurance bargains are constantly being updated, so double check with both sides to confirm their coverage details.

Once you know what your doctor’s visit or hospital stay will include, then call your insurer. Ask if all of the potential treatment providers are covered under your health plan; if not, then ask your physician to only use those that are. Ask your insurer how much any involved procedures are likely to cost and how much of that will be your responsibility.

If you are unhappy with how much you are going to pay, then do some additional research. Ask your insurer if there are covered providers in the area that are cheaper. Also, check directly with the providers themselves.  Some hospitals offer serious discounts to patients who are willing to pay with cash, so it might make financial sense to cut out insurers in some cases. If you want care from an out-of-network expert, discuss your payment arrangements ahead of time; many will allow you to make monthly installments.

How to Respond to Gigantic Bills

If you do receive a large, surprise bill, you do have some available options so there is no need to panic. It is important to take action as soon as possible; ignoring it, won’t make it go away.  Unresolved medical debt could lead to damaged credit or legal action.

Examine your bill closely. Make sure that all of the services are ones that you received. If you think there is a mistake, call the provider and ask for an explanation.  In most cases, billing administrators are happy to double check the bill with you and remove any erroneous charges.  Keep the bill and notes on any discussions—including who and when you talked to them—in your records; they may come in handy if you wish to contest any charges.

If the bill appears accurate, contact your doctor’s office to see if they are willing to negotiate a smaller fee.  If they say no at first, or if you are not experienced at bargaining, you may be able to hire a patient advocate who can represent you. You can find a patient advocate at local hospitals or community centers.

Finally, if you can’t get the provider to negotiate, you may want to try a legal remedy. Some states like New Jersey have a patient arbitration procedure that allows you to contest overly large medical bills.  If your state doesn’t have a similar system, you should discuss your case with an attorney.  There are many cases where patients have successfully sued based on an “unfair price.” Many hospitals will happily settle rather than go through a costly court battle.

To learn more about avoiding surprise medical bills, please visit Boost Health Insurance.