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7 Tips For Avoiding Medical Bill Surprises

The cost of healthcare is often more than families can bear when they are dealing with limited finances and the burden of an unusually high medical bill. Many Americans leave the doctor’s office without a full understanding of what they are paying for and the reasons for each cost. People are often met with unexpected medical bills that struggle to pay and end up in serious debt.

The cost of health care can often vary greatly even within the same network and plenty of services are given a much higher price than they should. Those receiving medical care need to be more informed about health care costs so that they can avoid unnecessarily high bills. These are some of the best ways to avoid a surprise medical bill.

1. Know Your Health Insurance

If you have a solid understanding of the rules and features of your personal health care plan then you will have a better idea of what you should be paying for certain services. Do research and find out the answers to issues like co-pay for an emergency room visit, your ability to go out of network for services and the need for approval for certain tests and procedures.

2. Stay in Network if Possible

When you go out-of-network, your health insurance may not pay a percentage what an out-of-network provider is charging but rather a percentage of a pre-determined amount that could be significantly higher than what the provider bills you. The best option is to stay in-network whenever possible to avoid this kind of surprise.

3. Compare Prices with Other Networks

The cost of certain procedures can vary greatly but most often you can find this information online or call your provider to get a cost estimate. This can be helpful for big procedures which can vary by thousands of dollars.

4. Don’t Pay Right Away

When you get a bill from a hospital and there are a lot of unexpected and high charges don’t pay it immediately. The charge could be higher than the network prices you actually owe so you can wait until you get the explanation of benefit forms from your provider.

5. Fight Out-of-Network Bills

A big procedure from a non-network doctor can lead to a surprise bill. If you fight hard enough, though you can get the bill reduced by going to the doctor, the hospital’s patient advocate or by complaining to your insurer.

6. Negotiate Ahead of Time

You can look for the fair price in your area for a certain test or procedure and also what your reimbursement would be if your plan pays a percentage. When you know the fair price you can negotiate with an out-of-network provider in advance and know what the total cost will be.

7. Prepare for Complex Procedures

If you can’t find the fair price for a big out-of-network procedure online then you can ask the provider for the standard medical billing codes for whatever services you need. With this information you can find out prices and prepare for your procedure so that you are not hit with a surprise bill that you can’t pay.

Kenneth Gray has spent years working in the medical billing field and specializes in behavioral health billing at A-Fordable Billing Solution.