Medical expenses can take a significant toll on your finances, especially when they catch you off guard. To maintain your financial stability and peace of mind, it's crucial to take proactive steps to prevent unexpected medical costs. In this blog, we will discuss various strategies and tips to help you avoid those unexpected medical bills.
1. Understand common health insurance terms
The first step in avoiding unexpected medical bills is to thoroughly understand your health insurance coverage. Review your policy, paying close attention to:
- Premiums: The amount you pay for your insurance plan.
- Deductibles: The amount you must pay out-of-pocket before your insurance starts covering costs. The amount a plan participant pays for covered health care services before his or her insurance plan starts to pay.
- Out of Pocket Maximum: The most a plan participant can be required to pay for covered services in a plan year. The out-of-pocket limit does not include monthly premium amounts or spending for services the plan does not cover. An out-of-pocket limit is also called an "out-of-pocket maximum."
- Coinsurance: The percentage of costs of a covered health care service the participant pays after having paid his or her deductible.
- Copay (also known as copayment): A fixed amount the participant pays for covered health care services.
- In-network providers: Knowing which doctors and hospitals are in-network can save you money. The facilities, providers, and suppliers a health insurer or plan has contracted with to provide health care services. The insured person typically pays a lower price for using services within the network.
- Out-of-network costs: Understand the higher costs associated with using out-of-network providers. Services received outside an insurer's network. These services typically carry a higher cost to the insured person.
- Coverage limits: Be aware of annual and lifetime limits on certain treatments or services.
2. Advocate for yourself
Don’t be afraid to have a cost conversation with your provider. It can be intimidating to ask questions during your doctor visit, not only about your personal symptoms but about price. Most providers now can provide a Good Faith Estimate prior to receiving treatment. We encourage you to ask questions and don’t be afraid to dig deeper before saying yes to the next suggested step.
Here are some specific examples on when it pays to ask “what’s the cost, or what will be covered?”
During your preventative care visit – During preventative visits, you can make sure to reiterate any questions or concerns you will be billed as preventive. If you have back pain or bring up an old knee injury it can sometimes result in the Doctor billing as non-preventative.
After a referral– If your doctor suggests you get an MRI, meet with a certain specialist or physical therapist, or complete other specialty care, ask your provider what the expected cost is. They can get you in touch with the providers billing department to ensure what you need is covered, or give you an estimate on costs.
Before a major procedure - Before undergoing any medical procedure or treatment, discuss the potential costs with your healthcare provider. Ask about alternative treatments and whether they are covered by your insurance. If you're facing a non-emergency medical procedure or treatment, contact your insurance company to ensure its covered and to obtain prior authorization if necessary. This step helps you avoid unexpected denials of coverage after the fact.
When it doubt, ask for a Good Faith Estimate and a Prior Authorization of services.
3. Consider an independent practitioner or specialist
You don’t have to use the doctor’s recommendation for a specialist. Oftentimes an independent practitioner like a Physical Therapist or Chiropractor is cheaper going direct versus using the providers choice.
You don’t have to use the doctor’s recommendation for a specialist. Oftentimes an independent practitioner like a Physical Therapist or Chiropractor is cheaper going direct versus using the providers choice.
4. Choose in-network providers
Whenever possible, seek medical care from in-network healthcare providers. In-network providers have pre-negotiated rates with your insurance company, which can significantly reduce your out-of-pocket expenses. You can typically find a list of in-network providers on your insurer's website or by calling their customer service.
5. Understand your care options when sick
For non-life-threatening medical issues, consider visiting an urgent care clinic instead of the emergency room. Emergency room visits are often much more expensive, and your insurance may have higher copayments or deductibles for ER visits.
6. Make sure your EOB & bill match before making ANY payments
If you do get a bill its important to match to your Explanation of Benefits (EOB).
If you do get a bill its important to match to your Explanation of Benefits (EOB).
7. Stay Informed about plan changes
Stay informed about changes to your health insurance policy. Policies can change annually, so make sure you understand any updates or modifications that may impact your coverage and costs.
Being an informed patient can help you make cost-effective decisions about your healthcare.
While you can't predict every medical expense, you can take steps to minimize the risk of unexpected costs. Understanding your health insurance, choosing in-network providers, and advocating for yourself are essential steps to safeguard your financial well-being in the face of healthcare costs.