How To Avoid Unexpected Medical Bills

Facing a large, unexpected medical bill can be incredibly stressful, often leading to significant financial hardship, growing debt, and even causing people to avoid essential medical procedures due to cost concerns. The anxiety of dealing with such bills can impact your overall well-being and disrupt your financial stability. I've helped countless individuals navigate these challenges, and I understand how overwhelming and disheartening this situation can be. Fortunately, you can learn from the experiences of my clients! By following these three practical tips, you can effectively prevent unexpected expenses, gain a clearer understanding of your financial obligations, and manage your healthcare costs more efficiently. Implementing these strategies will not only help you stay informed but also enable you to handle medical expenses with greater confidence and ease.

1. Have an Upcoming Procedure?

Knowing your financial responsibility ahead of time is crucial in preventing unexpected bills. Here’s how to get ahead of potential costs:

• Ask for a Pre-Treatment Estimate: Before undergoing any procedure, it’s essential to request a pre-treatment estimate from your doctor's office. This estimate will give you a detailed overview of the costs associated with the treatment and help you anticipate what you might owe.

• Include Insurance Coverage in the Estimate: Some medical offices provide estimates that include details of your insurance coverage. This will give you a clearer picture of how much you’ll actually pay out-of-pocket after your insurance benefits are applied. If the office doesn’t provide this information, you can request the pre-treatment estimate and then contact your insurance provider to review the details.

• Shop Around: Prices for medical procedures can vary significantly between different facilities. For procedures like scans, imaging, and bloodwork, costs can differ between hospitals and stand-alone imaging centers. Stand-alone facilities often have lower prices compared to hospitals. By comparing prices from various providers, you can identify a more cost-effective option that fits your budget.

2. Experienced an Accident or Sudden Illness?

If you face an unexpected emergency, it’s important to know your rights under the No Surprises Act (NSA), which went into effect on January 1, 2022. This act provides protection from surprise billing in several ways:

• Emergency Services: The NSA prohibits surprise bills for emergency services provided by out-of-network providers or facilities without prior authorization. This ensures that you won’t face unexpected charges for necessary emergency care.

• Out-of-Network Cost-Sharing: The act also bans out-of-network cost-sharing, such as out-of-network coinsurance or copayments, for both emergency and certain non-emergency services. This means you won't be required to pay higher out-of-network rates for covered services.

• Supplemental Care: Additionally, the NSA protects you from being billed at out-of-network rates for supplemental care, such as radiology or anesthesiology, provided by out-of-network professionals working in an in-network facility. This provision helps prevent balance billing for essential supplementary services.

3. Be Prepared

Although you cannot predict when an accident or illness will occur, being prepared can significantly alleviate potential financial stress. Take the time to review your health insurance plan details, focusing on your deductible and out-of-pocket maximums. This critical information is typically found in your Summary of Benefits or can be accessed by registering for a secure online account with your insurance carrier.

By taking these proactive steps, you can significantly reduce the risk of encountering unexpected medical bills. It’s important to remember that if you do receive a bill that seems incorrect or unexpected, you shouldn’t hesitate to challenge it with your provider or insurance company. Mistakes can happen, and billing errors are not uncommon. Be proactive in reviewing your statements and questioning any discrepancies or charges that seem inconsistent with what you were told or what was outlined in your insurance coverage. After all, you are your own best advocate!