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8 Ways on How to Avoid Surprise Medical Bills (Plus How to Dispute It)

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In this article, you’ll discover 8 effective ways on how to avoid surprise medical bills?

One of the biggest financial concerns that Americans have about their health care is a surprise bill. No one wants to experience it.

Although insurance and drug costs are concerns too, an unexpected bill leaves a person worried and lost in thought as to why it happened.

According to a 2018 Kaiser Family Foundation poll, 67% of people worry that they may not be able to clear a surprise medical bill — this fear surpasses not being able to pay for food, mortgage, rent, health insurance plans, and prescription drugs.

Not too many people can understand their medical bills — most are filled with jargon, confusing numerical codes, and acronyms the average person can’t place their minds on. In a survey, roughly 70% of respondents rated their medical bills as confusing.

How to Read Your Medical Bill

Sometimes, being able to read your medical bill can reveal hidden messages that will serve as your evidence when trying to fight it. Because there’s a way to fight it, we’ll discuss that in this post as well.

To help you read and interpret your medical bill, here are some effective tips:

1). Get an Itemized Invoice

Perhaps the first thing you can do is ensure that your medical bill has a detailed list of charges. If there’s no itemized invoice, don’t hesitate to call the hospital’s billing office or speak with the doctor in person.

There are so many ways to avoid getting charged for the services you never received.

One way is when there’s no clarity in the invoice, says Pat Palmer, CEO of Beacon HCI, an organization that helps employers identify reduce costs by first pinpointing where potential errors may be.

Since you’re going to get medical statements from surgeons or medical specialists (depending on what you were treated on) who may not be employees (in most cases) of a different hospital where you were treated, it’s always ideal if you request an itemized invoice or bill from these providers.

2). Look Out For the Obvious

Don’t accept a medical bill that doesn’t bear your full name, address, and other personal information. These must be correct on the invoice. Don’t forget to verify your health insurance details as well.

A piece of wrong information will always pose a huge problem when you’re making a claim. It can be denied because there’s no authentication.

When you see that your bill covers “adjustment” or commonly referred to as a “plan discount,” then you know it’s the difference between the total fee you should pay a facility or doctor for the service negotiated by your insurance company.

The ‘plan discount’ is an indication that a portion of the charges has been paid by your insurance company. When there are no payment details in this section of the bill, it’s also a sign that your plan is still owing the full charges — call your insurer and ask questions before paying the charge.

3). Read the Codes

In this case, always remember that most if not all medical procedures include a corresponding five-digital code. On one hand, this numerical concept is often referred to as Current Procedural Terminology (CPT) for the insurance field.

On the other hand, it’s called Common Procedure Coding System (HCPCS) for Medicare. No matter what you call it, know it’s useful for determining what your provider will be paid.

There exist “thousands of billing codes, and they’re very complicated to understand, too,” says Teresa Brown of Hospital accounts at Medliminal. There can be too many obvious mistakes such as a misrepresentation of doctor’s notes, typos, and so on.

4). Cross-check the EOB or MSN

When you receive the unexpected distress bill, it’s recommended that you compare it with your MSN or EOB.

Either an Explanation of Benefits (EOB) which your insurer issues or a Medicare Summary Notice (MSN).

These documents will show the services you received when you last visited, what the medical professionals charged, the exact amount your insurance company paid, and the outstanding amount of money you’re expected to pay.

As a rule, read through the Notice to confirm the dates and codes match the medical bills the providers sent you — everything must match!

Effective Ways to Avoid Unexpected Health Bills

As The Coalition Against Surprise Medical Billing continues to wax stronger and garner more support in several U.S. states, you can be assured that you’re not alone in the fight against unhealthy medical bills.

So how do you prevent it?

The truth is that there are so many ways to go about it. If you’re ready, let’s show you some of the 8 proven and legitimate ways to avoid surprise medical bills.

Note: These helpful tips (ways) to curb surprise health bills were extracted from a report by the Healthcare Financial Management Association (hfma), America’s Health Insurance Plan (AHIP), and the American Health Association (AHA).

Let’s dive right in.

1. Ask the Right Questions

One of the best things you can do to avoid a surprise medical bill is to consult with an in-network doctor or facility. Then you need to be open-minded and ask a lot of questions about coverage.

“It’s important that you ask a doctor or physician if your insurance company covers some treats or not,” says Shawn Plummer, an insurance marketer.

You should also ask the medical partner about the procedure or test, find out how much the doctor charges, what’s covered, and the like.

You want to be aware from the beginning — so that you can proceed with your claims with a good understanding of your medical bill.

The medical partner may not be certain or confident to give you answers to these questions, if that’s the case, you can request for the Current Procedural Terminology (CPT) code.

With this information, it’s a lot easier to call in your insurer to know if the procedure is covered or not.

Some insurance companies will cover one form of a mammogram. It’s easier to track down the coverage details if you have access to the CPT code.

If your doctor orders a procedure for you, it’s a smart move to find out what they charge beforehand. Even if you don’t get a direct answer, you’ll be referred to the billing office. You’ll always need the five-digit code to get accurate pricing information.

2. Prepare for an Emergency

It’s called an ‘emergency’ because you didn’t expect it. It’s more or less a ‘surprise’ just like your medical bill. That being the case, it’s always great to plan and be ready.

You’ll be in control if anything goes wrong and you don’t have enough time to check your insurance company’s website or call them to ask questions.

Some good ways to prepare for an emergency is to “check nearby hospitals that your health insurance covers,” says Talente.

What is your coverage like when you do need help? Are there ambulance services, and so on.

In a study published in JAMA Internal Medicine revealed that 85% of ambulance services usage led to an out-of-network bill. What matters is that you get the care you need when there’s an emergency. You can deal with the ‘surprises’ later.

Ideally, request for an ambulance service that your health insurer covers, especially when the situation is not life-threatening.

3. Utilize the In-network

Understand how insurance companies work can help you avoid unexpected medical bills from medical partners. In a nutshell, insurers create a network consisting of healthcare providers, hospitals, clinics, laboratories, and other medical organizations.

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These medical organizations are covered by the insurance company. When you use a hospital that’s outside this carefully designed network, you’ll be paying higher charges on your medical bills. Why is this so?

It essentially because the insurance partner has negotiated good rates with in-network medical facilities and doctors.

Using health care providers outside your insurance means you’re not covered, because the insurance company has no agreement with them.

The insurance will only pay the agreed amount they’ve negotiated with in-network health providers, which means you’ll be paying reduced charges overall. You only have to pay the difference but your insurer must first do their part.

Asking your insurance company if a hospital, doctor or physician is covered before booking an appointment is always the best approach.

To play it safe and be in control, Talente recommends capturing a screenshot of the insurance company to show the exact listing of the health care provider. You need to document this screenshot — it’ll come handy when there’s a dispute in the future.

4. Know What You’re Paying Beforehand 

The American healthcare system is full of surprises. It’s not just about the medical bills, but everything.

That’s why you must be upfront and know what percentage of the medical charges you’ll be paying. Ask questions about the terms guiding the share of payment.

Don’t just rely on your insurance company to settle what the in-network doctor or physician charges, get to know what you’re paying.

Are you paying in full, for example, for some medical services pending when you top the health plan’s deductible for the year in question?

Have it at the back of your mind that the agreement may not cover all the medical charges, for example, routine preventive services that include blood pressure screenings, immunizations, and the like are not included in the deductible.

Your insurance company is supposed to pay them, aside from any copay. When it comes to other services, though, you’ll be expected to pay as soon as you’ve met the deductible.

According to a Kaiser Family Foundation study, the average deductible amount for an individual, mostly for a workplace health plan in 2018 was $1,573. This year, though, the amount is still within the same average, so keep it in mind.

5. Ask Your Doctor to In-network Laboratories for Tests

There are several routine tests you may be involved in, such as blood-work, MRIs, and other related medical tests.

You’re already aware of the high cost of using out-of-network healthcare providers — you don’t even want to experiment with it. But you can do better by asking your doctor to stay in-network. If you don’t ask the doctor to do it, I’m sure you know they won’t.

That’s why your health insurance company is there. They can show you a nearby lab that you can use. You can use free tools online to search nearby in-network labs for MRI and radiology centers, flu shot providers, and other emergency care providers.

6. Be Mindful of Facility Fees

Facility fees exist and if you’re not careful, you might end up paying extra fees for that. In every state, studies show there are health facilities that include a charge for using their space and even equipment.

Surprise facility fees are costing medicare billions already, says Terrie Morgan-Besecker, Investigative Reporter.

A quick story to help you understand how far this has gone. In 2018, my aunt took her daughter to a medical facility after she fell from the balcony.

It was that serious but his treatment included a bandage and some antibiotic treatment. When the health invoice was sent, the cost of using the facility was included.

You should know this before visiting a physician or medical facility — you could be charged a facility fee. Make sure you ask if there’s a facility fee first, especially if the situation isn’t an emergency.

You can always find another location that doesn’t charge a facility fee. Often, fighting facility fee is somewhat more difficult than the bill itself, so keep that in mind.

7. Compare Costs Before Choosing a Particular Provider  

To avoid surprise health bills, comparing two or more providers might be very helpful. If you have several pharmacies nearby or you can access multiple labs in your city, you should check in on their costs first.

You may find a more cost-effective laboratory or health facility. For older people, it’s always good to save some money, after all, studies show that individuals over 65 years of age struggle to pay their medical bills.

Furthermore, 6 in every 32 people skip health care as a result of surprise out-of-pocket costs.

You can trust your insurance company to guide you in this respect and show you their preferred pharmacies and health care facilities, based on their in-network providers.

As you know, this would save you some money. Don’t hesitate to call in your insurance provider to ask for different prices or recommendations.

Aside from saving money outright, you’ll be in better hands to file claims in the event of an unexpected bill and you’ll have an insurance company behind you.

8. Prepayment Can Earn You a Discount

When you consult with a healthcare facility or doctors that reward their patients and clients, you can get a discount for prepaying your share of the medical bill — mostly for common procedures or solutions such as mammograms and CT scans.

Asking questions can help you take control of this situation, as most doctors don’t advertise this opportunity.

In the end, it’s still your insurer who will determine what your share of the bill should be. If there’s a specific process for getting a refund, you need to know how it works so you can follow it properly. The medical team should provide this guideline.

You might need a refund if the prepayment you agreed is higher than the amount in the bill.

Before you pay in advance, always ask your insurance company for advice. This is crucial since prepayment could impact the general health plan you adopted.

How to Dispute Surprise Medical Bill

The right word is “fight.” Because that’s exactly what you should do when you’re presented with a surprise medical bill. We’re all aware that the process can be frustrating and boring — but it’s your right to do so.

It’s also a huge waste of time (and other resources). “It takes our expert case managers on average 22 calls to resolve a case,” says Caitlin Donovan.

The good news is you have a chance of smiling in the end if you follow the right approach.

Follow these tips to increase your chances of getting either an insurance denial reversed or an overcharge medical bill lifted:

a). Request for an itemized bill

Don’t settle for just a summarized version of the services you received while at a hospital or healthcare facility. You’ll likely see one lump sum for you to pay — don’t do that even if you’ve got the money — first, ask for an itemized invoice.

“You want to see every bit of what you’re charged, says Teresa Brown, senior director of hospital accounts at Medliminal.

Teresa has been spearheading a team that reveals medical bills and support individuals who wish to lower their bills.

b). Speak to your doctor or physician

You should talk to your doctor or any medical professional who cares for you. If you don’t understand some charges, you can ask for clarifications, be sure to point out any errors and request for a review of the bill.

If you’re disputing an overcharge or even a charge, the doctor can hold off sending the medical bill to collections, while you try all you could to fix the issue, a phone call could just be all you need to resolve the problem.

c). Talk to your insurance provider

You may even be surprised to know that your health plan is lagging in important information you would want to be there. If that’s the case, call your insurance company and speak to them directly. They’ll likely keep mute unless you ask.

A simple question such as, “What should happen for this to be covered?” will suffice, said Donovan.

If your insurance didn’t include a key medical record that shows service was important, or maybe it’s covered by an out-of-network medical professional.

d). Collect evidence 

Get all the documents you need to make the case of incorrect billing.

You can use online tools to find the five-digit codes that correspond to all the charges and ensure they reflect perfectly the implemented procedures.

Armed with all the documents you need to make the claim, the last piece of the puzzle would be to file an insurance appeal. This appeal up to 180 days after you’re denied by your insurance company.

You can download this guide from The Patient Advocate Foundation to find out how to go about the whole process.

Conclusion

There you have it, the ‘surprise medical bill’ saga and how to go about avoiding it. Understanding your medical bills and being able to interpret it is one of the best skills you can learn.

All in all, nothing beats asking timely and relevant questions about an error on your medical bill.

Even if you aren’t overcharged and everything is good between you and your insurance company, asking questions will help you deal with medicare issues that may arise in the foreseeable future. Check out our Men’s Health Blog for more information.

Richard Tibbetts

Richard R. Tibbetts is a oral surgeon by day and a wellness enthusiasts by night. Richard is very active in the health and wellness community. He donates his free time to help teach locals about nutrition and wellness. Richard continues to study better ways to live a healthier life. Richard runs his own nutrition and wellness coaching program as well. In his Free Time Richard loves to go fishing, camping, and being in the outdoors. He has a real love for nature almost the same way he does for health and wellness. Follow Me on Social Media Twitter: @RichardTibbett6 Facebook: https://www.facebook.com/richard.tibbetts.7140

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