Having good health insurance might seem like all you need to cover your medical bills. However, you might actually be required to make out-of-pocket payments for various reasons. Research shows that in the last two years, one-fifth of U.S. adults received surprise medical bills — and even if you have coverage, you could be stuck with a huge invoice.
Surprise bills arise when your health service provider is out of network, meaning you’re responsible for paying these costs out-of-pocket. Although it can be a tough endeavor, there are a few steps you can take to make these payments more manageable.
Understanding the Problem
In many cases, surprise medical billing can leave patients on the hook for hundreds of thousands of dollars. Records show that 8.5% of Americans, or 27.5 million people, had no health insurance at any point in 2018. In addition, there are about 3 million non-fatal injuries and illnesses reported annually by private employers. But while worker’s compensation is there to protect you in such cases, that protection doesn’t extend to medical emergencies that occur outside of the workplace.
Surprise medical bills are unexpected, as the name suggests, primarily because patients often assume that their health insurance will cover the majority of the cost. Even if you visit a hospital that’s in your network, the physician or specialist you see might actually be outside your insurance network. When that occurs, you could be hit with a bill that your insurance company won’t touch.
The Eradication of Surprise Bills in 2021
The COVID relief and omnibus spending bill will prevent out-of-network medical staff who work in in-network facilities from asking for any money from the patients. This is both for emergency and non-emergency situations. In emergency cases, patients are supposed to pay for in-network cost-sharing, which includes the deductible, coinsurance, and co-payment for out-of-network care. For non-emergency scenarios, the patient needs to be informed to make balance billing possible. But even though this legislation may provide relief in many cases, you might still face an unexpected cost after receiving medical care. As a result, you may need to take additional steps to eradicate some of the burden. Here are a few tips to keep in mind when receiving any kind of unexpected healthcare bill.
Check for Errors
Undoubtedly, hospitals handle a lot of data on a daily basis. As such, errors can certainly occur. Getting bills for a service you did not receive, having wrong dates on your invoice, or incorrect insurance information might appear on bills you receive. Check the billing thoroughly to ensure no item or service was overpriced by the hospital billing department and don’t be afraid to contact the relevant party to discuss any mistakes you feel are present. Confirm that you were not charged for items covered under the facility fee, such as gloves and blankets. Finally, keep a record of all the information you received from the hospital, including recording phone calls.
Talk with your Care Providers
At this stage, you can try to negotiate the amount you are required to pay or discuss a payment plan with your providers. You have the option of asking your insurer to negotiate with the doctor or healthcare provider on your behalf for less stringent payment terms. Research the market price for the service or procedure you were billed for and request if your healthcare provider is willing to charge the typical market. This is in instances where the charges seem too high and exaggerated.
Contact your Insurance Provider
Filing an appeal with the insurance company could also help. If that appeal is rejected, you can go to your state insurance regulator and file an appeal or a complaint. However, things might not always go in your favor. When a personal injury suit is filed, the defendant has approximately three weeks to answer the claim. Filing a complaint against your insurer follows a different process. Still, you may want to gather any written notices or any documentation to back you up, such as records from the doctor’s office, to strengthen your case when disputing a bill or insurance coverage.
As the pandemic pushes people to the limit financially, the last thing you want to receive is a surprise medical bill for a service or procedure. It can be both depressing and daunting as you try figuring out where to get the required money. The above information is adequate to educate you on what surprise medical bills are and how you can make them manageable.
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