Medical Bills Can Get Ugly

A friend with Kennedy’s Disease experienced multiple strokes and was hospitalized for over a year. I can’t pretend to imagine everything he went through mentally, physically and emotionally. And, the medical bills just kept on mounting up. My wife’s mother was hospitalized recently and had several tests performed to determine the health issues facing her. The medical bills were astronomical. 

This month’s Costco Connection magazine had an interesting article on medical insurance. After reading it, several points were discussed that I often overlook. Because of that, I thought I would share a portion of the article by by David and Amanda Horowitz.

Medical-bill basics
Don’t let charges take you by surprise

… Here are some things you need to know to avoid surprise bills. 

Understand the terms of your policy.

• In-network provider: A doctor, hospital or health-care facility that has an agreement or contract with your insurance company and provides services to plan members for negotiated rates.
•  Out-of-network provider: A provider who is not affiliated with your insurance company. In many cases, an insurance company will pay less or not pay anything for services received from an out-of-net work provider.
• Deductible: The amount of money you have to pay out of pocket each calendar year before your insurance will start paying.
• Co-pay or co-payment: A flat fee you pay to a health-service provider.
• Co-insurance: The percentage of charges you pay to the medical provider after your deductible has been met and your insurance has started paying claims.

Before you have a procedure.

• Ask your surgeon for a complete list of doctors and facilities that will be used.
• Call your insurance company to discuss your plan and determine if those doctors and facilities are in-network.
• If it is not possible to do your procedure completely in-network, contact the out-of-network providers and clarify the balance you will be responsible for…
•  If you get an unexpected bill, talk to your insurance company and the provider. Some providers may accept the insurance payment as payment in full, or the insurer and the out-of-network provider may negotiate a fee and decrease the balance you owe. 
•  If you have a plan that you bought through a state or federal marketplace, contact your state health insurance department. Some states have rules limiting how much you have to pay for out-of-network care.

Prescription sticker shock.

• Anytime a doctor writes you a prescription, find out the medication costs, if it is covered by your insurance and if there is a low-cost generic alternative.
• Ask your doctor if you can take a generic or a similar drug covered by your plan. If not, ask for an exception from your insurer.
• Check out the prices at pharmacies in your area or ask for a coupon from the medicine’s manufacturer.
•  If you have a chronic condition that requires medication, before you sign up with an insurance plan check if any of the drugs you take are covered.
• You will get the lowest out-of-pocket costs when you buy the coverage plan’s “preferred” generic, or Tier 1, drugs…

Emergency treatment. 

• Your emergency room treatment may not be treated as in-network, even if the ER is at an in-network hospital.  
•  Call your insurer to discuss your plan and find out which in-network hospitals in your area employ in-network emergency room providers.
•  If you get a surprise bill from an emergency room visit, contact your insurer and the provider and explain that since it was an emergency you did not have a choice of providers. The provider may accept the insurance payment or negotiate a reasonable fee with your insurance company.
• “Balance billing” occurs when an out-of-network provider bills a patient for the difference between the amount they charge and the amount insurance pays. Find out if your state’s insurance department has a law that prevents emergency room balance billing. If it has, you may file a complaint…
•  If you spot discrepancies in the bills, address them right away. You can find contact information for your state on the National Association of Insurance Commissioners website, naic.org.
•  For non-life-threatening situations, going to urgent care may be an option. Ask your insurance provider for information about co-pays and potential out-of-pocket costs at a
  clinic before you visit.

Appeals. 

• If your health insurance refuses to pay a claim, you can appeal the decision. Medical billing advocates may be able to help you navigate a difficult billing situation. …Organizations like the National Association of Healthcare Advocacy Consultants (nahac.memberlodge.com) or Alliance of Claims Assistance Professionals (claims.org). Be aware, however, fees for medical billing advocates vary. 

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