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Seven Ways To Avoid Surprise Medical Expenses

You probably visit the doctor knowing that it will be a pricey transaction, but you still want to keep the expense at a minimum.  If you have health insurance, you have already cut your bill by a large percentage, but just having a good health plan isn’t enough—you should know the details of your policy so that you aren’t caught by surprise by unexpected charges.

Health care is likely one of the most expensive services that you will purchase in your lifetime. According to the Agency for Healthcare Research and Quality, if you are aged 18 to 44, your next hospital stay should cost you, on average, $7,400, and if you are aged 45 to 84, it will cost you, on average, $12,500.

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If you suffer from chronic conditions like high blood pressure or diabetes, you may expect a lifetime of treatment costs that can quickly burgeon into something unmanageable unless you prepare properly. Here are some suggestions to limit your medical costs:

  1. Know your plan: Whether you get your health coverage through your employer, one of the Obamacare exchanges or a private insurer, it is in your best interest to know exactly the details of your health plan. Take the time to read what benefits your policy provides, the extent of your network and your financial responsibilities.  Although your insurer should have provided all of the documentation pertaining to your policy, that paperwork may be difficult to understand.  If you need assistance deciphering the plan details, feel free to ask your insurance agent or an independent third party like one of the insurance brokers at Boost Health Insurance. Be sure to learn what your plan covers before you need medical services; if you ask questions after you’ve seen a physician, it is probably too late to change any charges.
  2. Learn if your caregivers are in your network: One of the most frustrating aspects of obtaining medical care is finding out that the new doctor you are seeing is not in your plan coverage network. If your doctor is not in-network, you may have to pay extravagant surcharges like coinsurance, forcing you to make a painful decision about continuing to see a physician you may particularly like. This also applies to emergency situations in which a host of professionals like physician’s assistants, radiologists and anesthesiologists may be asked to care for you.  It is in your best interest to ask their names and check if they are in your network; even in an emergency situation, you still have the right to request professionals who are covered by your plan.
  3. Discuss costs beforehand: Many physicians are more than happy to discuss how much certain products and services may cost you, if you take the initiative to bring up the topic. Unfortunately, many medical providers do not keep up to date on how much certain services cost, and the price you pay may vary depending on what type of health insurance you have.  Therefore, it is important to talk to the billing administrator and ask for at least an estimate—it may not be completely accurate, but it should provide a rough guess of about how much you will owe. There are also a number of pricing tools available through insurers, consumer advocacy groups and government agencies that may also provide some advance warning of a service’s cost.
  4. Remain up to date on your plan: Your insurer will update your plan on a regular basis, but it is your responsibility to keep apprised of any policy changes.  Although your insurer is required to notify you if your policy is altered, you must still take the time to learn how those plan changes may affect your bottom line.  If you have read all of the paperwork, but you are still confused, be proactive and consult with your insurer before you start a new treatment. Write down all of the names of people you speak with and what they tell you.  If you still get a bill that is significantly larger than you expected, ask your insurer to talk to the medical provider; in some cases, an insurer may assist you in negotiating a smaller bill.
  5. Learn about state regulations: Although the federal government does not offer protections from surprise medical expenses, many states do. These legal protections vary from state to state, but at least some include remedies for out-of-network billing during ER visits.  If you do get an unexpected bill from a medical provider, you should call your state department of insurance to learn if you have any available alternatives to paying.
  6. Double check the itemized list: When you do receive a bill from a hospital or clinic, you should carefully go through the list of charges.  If you don’t remember receiving such a service or, even, if you have lingering doubts, contact the hospital’s patient advocate or claims consultant and ask for a clarification. If you are sure you are being overcharged, ask them to remove the item.  If you feel you are getting stonewalled, you may find help from organizations like the Patient Advocate Foundation.
  7. Make sure a service is properly coded: Many preventive services under the Affordable Care Act like vaccinations, annual checkups and health screenings are free. However, sometimes a provider may assign the wrong code to the preventive service, and consequently, your insurer may actually charge you for what should be a free service.  Sometimes this is because your doctor ordered additional services, so it is important to stipulate at the outset of the visit that this should only be a checkup or include only free testing.  If you think you are being unfairly charged, contact your insurer and ask for a senior claims examiner to go over the bill, especially the billing codes.
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If you would like to learn more about how to save money on your medical bills, please visit Boost Health Insurance to speak with a health insurance specialist.

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