Even if you’ve got health insurance, there’s no guarantee against getting a medical bill full of unexpected charges. In a 2018 survey on health care billing by NORC, a research organization at the University of Chicago, 57 percent of respondents said they had been surprised by a bill they thought would be covered by their health plan.
Communication, or the lack of it, is part of the problem, according to Richard Gundling, senior vice president of health care financial practices at the Healthcare Finance Management Association. “We’ve learned that sometimes health care providers are reluctant to talk about money because they don’t want patients to feel like money will affect their care,” he says. “But consumers absolutely want to know. It can be empowering.”
In a medical emergency, you may have little say in who treats you or how. But in the course of routine or planned care, patients can take the initiative.
“It is your right and responsibility to ask questions about what you will be charged for health care,” says Teresa Brown, senior director of hospital accounts at Medliminal, a company that helps businesses and consumers reduce medical costs by ferreting out billing errors. “I would do that for my plumber, I would do that for my car, and you need to do it for your health care bills.”
Here are some steps you can take to avoid getting hit with unexpected medical bills.
Stay in network
Before planned treatment, call both your insurer and the medical office to verify that the service or procedure is covered by your health plan and that the doctor or facility is in your plan’s network. Give the doctor’s office the exact name of your plan as well as your group number and member ID, as your doctor might accept only some of an insurance company’s plans.
Do the same for any facilities and specialists that will be involved in your care. Tell your primary care physician you want to remain in network for all services. If your regular doctor orders a test, call the lab or imaging center to verify your coverage. If you are referred to a specialist, call his or her office to check whether the specialist is in network.
If the lab or specialist is out of network, there’s nothing wrong with going back to your primary doctor to get an in-network referral. “Most doctors will be happy to honor this request because they know many good physicians in a given specialty,” Gundling says. “They don’t want you to get a surprise bill, either.”