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If you have received a medical bill recently, you all but certainly know that health care costs are high. Unfortunately, that is not the end of the bad news for many people. Some people receive surprise medical bills that tack on hundreds, or even thousands easily. But what if said surprise medical bills come from an out-of-network provider? Simply put, the hundreds or thousands extra become even larger. In fact, out-of-network medical costs can be 118% to 1382% more than the same cost under medicare.
Some people may call that a mistake. According to the Reuters over 42% receive a bill from an out-of-network provider in 2016. This is not a mistake, this is a common systematic failing. In fact, I would even argue that preventing out-of-network bills would lower average medical costs in America to levels that are far more manageable. In this post, I will explain how to avoid out-of-network costs, even when being balance billed so you do not end up with surprise medical bills that could easily cost thousands.
Check Your In-Network Providers And Call Them
Your insurance should have a provider network listing the in-network providers. In-network providers have discounted rates to be covered by your insurance. This sounds like a straight forward system. Regretfully, the providers your insurance lists are not always accurate. Call the provider to ensure they are in-network.
Ask How Their Billing Works And What Services You Will Be Charged For
I don’t know how your insurance works, but mine does not tell me whether the providers outsource work to someone else. That messed me up. When I went to the doctor for a test, I was charged not only by the clinic, but by the lab they sent the test to. Not too surprisingly, this bill came almost a month after my first bill so there was not much I could contest. Luckily, the lab was an in-network provider so the bill was not excessive. Sadly though, luck had to be involved to avoid that disaster. Unfortunately, many were not lucky enough to prepare for a similar surprise medical bill.
I did try to make sure that the clinic billing was straight forward. In fact, they said I should only receive one bill from the clinic. I’m sure they worded that so they could not be sued because they said nothing about receiving a bill somewhere else. However, there are still attempts you can take to try to prevent surprise medical bills to out-of-network providers. You can ask them EXACTLY what their steps are in the procedure and if all of the work will be done on site or outsourced. If it will be outsourced at all, you need to see if the outsourced work will be in-network.
Check For Fees
I know that in an emergency the last thing you will do is to read the fine print to see if there are any fees. In fact, you may be in a condition where that is impossible. When it is not an emergency, read the fine print for these pesky fees. One of the most common fees is a facility fee and usually doctors and staff are straight forward about whether there are facility fees.
Inform Your Insurance About Travel To Prevent Surprise Medical Bills
Your insurance may be good in the country, but it may be worthless internationally. This is especially true with Medicare. You should stay informed about whether your insurance will cover your medical bills on a trip. If you are going internationally, you could receive a travelers health insurance, which is a supplemental insurance plan.
Even if you travelling within a country, it may be best to inform your health insurance. One of my insurance advisers informed me that the knowledge of travel can help the insurance company stay on top of any medical bills your could have in case of an accident.
The Government Is Trying To Control Surprise Medical Bills
If you feel overwhelmed by the tips I gave to avoid surprise medical bills, you should. Is it fair? No! These surprise medical bills are similar to going to a restaurant, making sure you do not have to pay extra for an out-of-network sous chef while the restaurant is in-network, and calling them to make sure that they do not have to outsource the prep or cook work to an out-of-network restaurant. Oh and let’s add the fact that the tip will be billed to you much later and it can range from 15% to over 100% of the initial bill.
That is why the government is taking steps to try to make medical costs more transparent. There are two things wrong with this. First, these steps will not be required until 2021. Second, increasing transparency to excessive costs will do nothing about the costs initially. However, over time, competition created by this transparency should help to lower costs from medical providers. Either way, don’t expect any major changes for a while, there are still many steps necessary to make healthcare more affordable.
Healthcare costs have risen exponentially. This can at least be partially because of balance billing and their potential to be from out-of-network providers. Unfortunately, you can only try to prevent these. There are no guarantees that you will avoid these excessive costs. The main reason balance billing is such an issue is because they were built on a system which does not pride themselves on keeping customers well-informed. Even if you follow each of these tips, you may not be fully informed.
Luckily, this may change in the future and you may never have to try to stay overly informed about your healthcare providers. But until that time, you are going to need a bit more than the hopes that your insurance will be straight forward about where you can go for healthcare.