Cost & Quality

Preventing Debt From Surprise Medical Bills

The cost of healthcare has become a hot topic in American politics in recent years, and with good reason. A recent Bankrate survey found that 22 percent of Americans are losing sleep over healthcare or insurance costs, up from 13 percent just one year ago.
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The cost of healthcare has become a hot topic in American politics in recent years, and with good reason. A recent Bankrate survey found that 22 percent of Americans are losing sleep over healthcare or insurance costs, up from 13 percent just one year ago.

One aspect, in particular, has even gained attention from both Congress and President Donald Trump within the past two months: surprise medical bills.

Congress has proposed bipartisan legislation that sets up consumer protections against surprise billing in certain situations. Trump also issued an executive order in June that calls for hospitals to be more upfront about prices for common tests and procedures, a measure that should go into effect later this year.

The cause of surprise billing

Unexpected medical bills, often outrageously expensive, can catch patients by surprise if they see a doctor who is not within their insurance network. It’s a common issue, with The Wall Street Journal reporting that an estimated 51 percent of ambulance rides, 22 percent of ER visits and nine percent of elective cases lead to surprise medical costs.

What often happens is that while the hospital or clinic might be considered in-network, a specific doctor might not be in-network (or vice versa). The legislation proposed by the Senate includes cost protections for situations such as these, plus scenarios where patients receive emergency care or follow-up care at an out-of-network facility due to travel restrictions.

While the new legislation and executive action may help patients and their families, surprise billing will persist in situations outside the purview of these new protections.

Preventing surprise healthcare bills

The best way to combat surprise billing is to prevent it whenever possible. Here are some tips on how to do so: 

  • Know insurance policy details: The first step is understanding the specific insurance policy. Check with the provider for a list of in-network hospitals, specialists and primary care physicians in the area. If it’s for an upcoming appointment, it’s worth calling the provider to double-check whether the facility and doctor are in-network and covered.
  • Ask about costs upfront: Whether it’s visiting a new primary care physician or seeing a specialist, patients should call ahead about out-of-pocket costs. For planned visits, ask about the billing codes for the tests or procedures to confirm that the insurer will cover them. While many standard preventative procedures like a basic cardiac stress test or mammogram are covered by insurance policies, more advanced screenings such as a 3D mammogram may be billed under a different code that is not covered by all insurance plans.
  • Make an emergency plan: While it’s impossible to predict when emergencies will happen, it’s important to plan, including determining if specific emergency care providers are covered by insurance. That requires some research on the front-end, but it may save some stress and a lot of money in the long-run.
  • Understand patients’ rights: In addition to new federal protections, many states have additional regulations regarding “balance billing,” when patients are billed for out-of-network providers at an in-network facility. Knowing specific state protections can help fees to be waived or lowered.

While it’s promising that both Congress and Trump are making strides towards eliminating surprise medical bills and helping lower overall healthcare costs, sometimes surprise billing is unavoidable. These tips can help prevent these charges or combat excessive debt that can often result from unplanned medical expenses.

Originally published on Bankrate.com

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Madison Blancaflor is a Bankrate.com contributor. Bankrate is a leading publisher, aggregator, and distributor of personal finance content on the Internet.

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