{"id":18084,"date":"2019-02-22T14:34:59","date_gmt":"2019-02-22T19:34:59","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18084"},"modified":"2023-03-03T15:46:52","modified_gmt":"2023-03-03T20:46:52","slug":"how-to-protect-yourself-against-surprise-medical-bills","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/how-to-protect-yourself-against-surprise-medical-bills\/","title":{"rendered":"How to Protect Yourself Against Surprise Medical Bills"},"content":{"rendered":"

Story updated in January 2020.<\/em><\/p>\n

\n

In 2012, Leslie Becker threw caution to the wind and scheduled ankle surgery without knowing the cost.<\/span><\/p>\n

She was 23, fresh out of college and covered by her employer\u2019s high-deductible insurance plan. She did her best to anticipate how much she\u2019d have to pay for the procedure. When she asked about the cost during a pre-surgery visit, a nurse told her it could be anywhere from $5,000 to $25,000.<\/span><\/p>\n

\u201cI pressed her for more information but didn\u2019t really get any,\u201d says Becker, now 31 and working as an art director in Milwaukee. \u201cJust that they wouldn\u2019t know the final cost until all the paperwork shook out.\u201d<\/span><\/p>\n

Becker was lucky: Her insurance picked up the balance of the $28,000 bill after she met her $2,500 deductible. But she was still confused after the bill was settled. \u201cThe cost of surgery didn\u2019t seem to be based on anything logical,\u201d she says. Why would such seemingly uncomplicated surgery for a common ankle injury be billed at the highest end of the range the nurse gave her?<\/span><\/p>\n

Becker\u2019s story highlights how patients can be thrust into a\u00a0<\/span>stressful new position as consumers<\/span><\/a>\u00a0\u2014 required to shoulder more of their health expenses than ever before,\u00a0and\u00a0without a clear idea of what their care will cost.<\/span><\/p>\n

The days of handing over a modest co-pay and letting the insurance company pick up the rest of the tab are a distant memory for\u00a0<\/span>a growing number of patients<\/span><\/a>\u00a0with high-deductible health plans. For these consumers, it\u2019s up to the individual to keep an eagle eye on the cost of office visits and lab tests, and to sift through billing statements and find time for lengthy phone calls with insurance providers and hospital billing departments.<\/span><\/p>\n

\u201cSay right off the bat, \u2018I\u2019m worried about finances. Can you talk to me about how we can lower costs?\u2019\u201d<\/span><\/p><\/blockquote>\n

\u201cIn the past, oftentimes consumers knew very little about their health insurance,\u201d says Robin Gelburd, founding president of\u00a0<\/span>FAIR Health<\/span><\/a>. \u201cThe consumer was almost in the chorus line in the back, while the employer and the insurer were stars of the play. Now consumers [are] the stars of their own insurance play, and there\u2019s no script. They\u2019ve been asked to ad lib really important decisions.\u201d<\/span><\/p>\n

The lack of price transparency in healthcare can leave patients feeling powerless, at the mercy of a frustratingly opaque system. Unlike with other types of purchases, it\u2019s\u00a0<\/span>not easy<\/span><\/a>\u00a0to shop around, compare prices and make informed decisions about healthcare. Even if a patient visits an in-network hospital, they could end up seeing an out-of-network doctor and receiving a massive bill; Congress has attempted to curb this kind of surprise billing, but <\/span>lawmakers reached an impasse<\/span><\/a> as of late 2019.<\/span> \u00a0<\/span><\/p>\n

Despite these challenges, there are steps you can take to rein in costs and\u00a0navigate the messy world of medical\u00a0billing. We talked to experts about what patients can do before, during and after a visit to advocate for themselves and keep their healthcare costs in check.<\/span><\/p>\n

Before your visit<\/h2>\n

The most important thing you can do before an appointment is confirm that your provider is part of your insurance network. Most insurance companies offer tools that patients can use to search online for in-network providers by name, location or specialty. (Third-party websites, including Zocdoc, can offer these services too.) Sometimes\u00a0<\/span>insurers\u2019 provider databases are out of date<\/span><\/a>, though, so it\u2019s wise to double check with the doctor\u2019s office.\u00a0<\/span><\/p>\n

\u201cWhen we work with patients who receive a big bill, it\u2019s almost always due to something being out of network,\u201d says Caitlin Donovan, director of outreach and public affairs at\u00a0the\u00a0<\/span>National Patient Advocate Foundation<\/span><\/a>.<\/span><\/p>\n

Even if you visit an in-network facility, there\u2019s no guarantee that every provider you see will actually be in your network.\u00a0\u201cIf you\u2019re going for surgery at a hospital, that will include not just your surgeon but your anesthesiologist or your radiologist,\u201d Donovan says. Your surgeon might be in-network, but your anesthesiologist might not be. To cover your bases, note on your intake forms that you only want to see in-network providers. Doing this can help you build a case to present to your insurance company if you need to\u00a0<\/span>appeal a claim<\/span><\/a>\u00a0later.<\/span><\/p>\n

\u201cThere are some unsung heroes in billing offices,\u201d she says. \u201cThey can be very, very good at fighting for you.\u201d<\/span><\/p><\/blockquote>\n

But sometimes, you may want or need to visit an out-of-network provider. If you decide to take your care out of network, online cost estimate tools can give you a leg to stand on when negotiating prices with the hospital or doctor\u2019s office \u2014 a\u00a0<\/span>totally legitimate move<\/span><\/a> when you\u2019re facing an exorbitant bill, even though many patients don\u2019t realize they can negotiate, Donovan says.<\/span><\/p>\n

Tools like the\u00a0<\/span>FAIR Health cost estimator<\/span><\/a> aggregate data from billions of\u00a0insurance claims around the country, allowing patients to look up common procedures and find the average cost for in- and- out-of-network services in their area. If your doctor\u2019s office quotes $10,000 for an out-of-network procedure but FAIR Health data shows an average of only $6,000 for the same procedure, you can use that data to try to negotiate a lower price before you go in for the procedure, Gelburd says.<\/span><\/p>\n

When you\u2019re making an appointment, also be mindful of where you schedule it. There might be vast price differences, for example, between seeing your primary care provider for a sick visit (in person or via telehealth) versus going to the ER or urgent care when you don’t feel well. “There are so many different venues for care, and some venues may offer similar services,\u201d Gelburd says.<\/span><\/p>\n

During your visit<\/h2>\n

Research\u00a0shows that\u00a0<\/span>increasing price transparency doesn\u2019t affect a physician\u2019s decision to order (or not order) a procedure<\/span><\/a>, which means the onus is on the patient to ask questions about what their care will cost.<\/span><\/p>\n

Nervous to talk about money with your doctor? Don\u2019t be, Donovan says. And don\u2019t wait until your doctor is halfway out the exam room door to approach the subject: \u201cSay right off the bat, \u2018I\u2019m worried about finances. Can you talk to me about how we can lower costs?\u2019\u201d<\/span><\/p>\n

In many cases, your doctor can provide treatment that fits your budget without sacrificing your quality of care. For cancer patients, for example, it can be more affordable to receive IV chemotherapy at the doctor\u2019s office than to take a chemo pill at home.<\/span><\/p>\n

\u201cMany doctors would presume a patient would be more comfortable taking a pill at home, but not every type of insurance covers the pill at the same level as they cover chemo,\u201d Donovan says. In that case, it\u2019s important for a patient to tell their doctor that affordability is a bigger priority than convenience.<\/span><\/p>\n

If you\u2019re stunned by the total at the bottom of your bill, remember: This cost isn\u2019t necessarily set in stone.<\/span><\/p><\/blockquote>\n

Even if your doctor doesn\u2019t have the answers to all your questions, Donovan says, they can usually point you in the right direction toward a financial assistance department or billing office.\u00a0\u201cThere are some unsung heroes in billing offices,\u201d she says. \u201cThey can be very, very good at fighting for you.\u201d<\/span><\/p>\n

During your visit, also pay close attention to any referrals your doctor makes to other specialists. Ask them not to choose anyone outside your plan\u2019s network.<\/span><\/p>\n

\u201cProviders should care what patients\u2019 choices are,\u201d Gelburd says, \u201cand [help them] understand what their insurance may provide for.\u201d<\/span><\/p>\n

After your visit<\/h2>\n

Don\u2019t rush to pay your bill without giving it a second glance. NPAF estimates that about half of all medical bills have some type of error, Donovan says, and they\u2019re usually not errors that work in the patient\u2019s favor.<\/span><\/p>\n

Always request an itemized bill, and if you notice that something wasn\u2019t covered, ask your insurance company why; your next step may be to\u00a0<\/span>appeal the denied claim<\/span><\/a>. It\u2019s also\u00a0<\/span>not uncommon for patients to be billed for the wrong treatment<\/span><\/a>, or even for a treatment they never received.<\/span><\/p>\n

After Donovan gave birth to her daughter, a breastfeeding consultation that should have been covered by the Affordable Care Act was accidentally recorded as \u201claceration\u201d instead of \u201clactation.\u201d She was billed by her insurance company for the mistake, and it took more than a year \u2014 and countless phone calls \u2014 before it was resolved.<\/span><\/p>\n

\u201cBe persistent,\u201d she says. \u201cA lot of times, these places rely on people to give up.\u201d<\/span><\/p>\n

If you\u2019re stunned by the total at the bottom of your bill, remember: This cost isn\u2019t necessarily set in stone. You can attempt to negotiate with the billing department, especially if you\u2019re uninsured or received out-of-network care and your insurance company hasn\u2019t already negotiated the price down.<\/span><\/p>\n

\u201cUltimately, the hospital wants to get paid,\u201d Donovan says. \u201cSo by saying, \u2018I am working with you in good faith, I\u2019d like to pay. This is what I\u2019d consider a reasonable rate; what would you consider a reasonable rate?\u2019 These are conversations you can have with the billing department.\u201d<\/span><\/p>\n

Regardless of whether insurance covers your claim, if you notice a major difference between the amount your hospital billed and the average amount reported by the FAIR Health cost estimator or other sources, it\u2019s worth calling the billing department to ask if the price can be adjusted.<\/span><\/p>\n

\u201cThe worst they can say is no,\u201d Donovan says. \u201cIt\u2019s not like they can raise the price after you ask.\u201d<\/span><\/p>\n

The future of price transparency<\/h2>\n

There have been some moves toward demystifying the cost of care for patients, including\u00a0<\/span>a federal mandate requiring hospitals to post their prices online<\/span><\/a>\u00a0starting in 2019.<\/span><\/p>\n

But the mandate hasn\u2019t done much for patients in the short term. Even when hospitals post their sticker prices online, those numbers don\u2019t reflect what insured patients will owe after their insurance kicks in. The price lists also aren\u2019t standardized across hospitals, which makes it challenging for patients to compare prices for the same services at different hospitals.<\/span><\/p>\n

Still, Gelburd sees the move as a step in the right direction.<\/span><\/p>\n

\u201cImperfect and confusing as those lists may initially be, it really sends a signal,\u201d she says. \u201cAny step toward clarity is positive. We\u2019re at the beginning of the arc.\u201d<\/span><\/p>\n

Some<\/span><\/a>\u00a0<\/span>states<\/span><\/a> have also created laws to protect patients from\u00a0<\/span>surprise billing<\/span><\/a>, and there have been\u00a0<\/span>bipartisan efforts<\/span><\/a>\u00a0to implement similar protections at the federal level. Surprise billing, also known as balance billing, occurs when patients inadvertently receive out-of-network services. This can happen when a patient is sent to an out-of-network provider at an in-network facility, or when a patient is taken to an out-of-network emergency room while they\u2019re unconscious.<\/span><\/p>\n

In late 2019, Congress came close to making a deal that would provide federal protections against surprise billing. But <\/span>the deal fell apart<\/span><\/a> when lawmakers from the Ways and Means committee issued a counterproposal in December 2019 that effectively killed the deal.\u00a0<\/span><\/p>\n

Policymakers are at odds<\/span><\/a> over the best way to curb surprise billing: Some favor implementing set rates that insurers must pay providers for services; others want an arbitration approach that requires insurers and doctors negotiate each claim on a case-by-case basis. <\/span>Physicians have lobbied<\/span><\/a> in favor of arbitration<\/span><\/a>, but insurers say it’s arduous and expensive. Patient advocates believe setting flat rates for services will do more to curb surprise bills than arbitration, which would put more money in the hands of doctors and hospitals.<\/span><\/p>\n

Now, it\u2019s up to Congress to push legislation forward in 2020, but <\/span>some patient advocates worry that the effort to eliminate surprise\u00a0 billing will fall to the wayside<\/span><\/a> during a contentious presidential election year.<\/span><\/p>\n

Despite efforts to improve price transparency, it\u2019s ultimately up to patients to ask questions, comb through bills and be vigilant for errors or odd charges. For patients diagnosed with chronic, debilitating conditions, organizations like the\u00a0<\/span>Patient Advocate Foundation<\/span><\/a>\u00a0can provide case managers to work with hospital billing departments and insurance companies on a patient\u2019s behalf. You can also ask a family member, spouse or friend to contact the billing department or insurance company on your behalf if you\u2019re struggling to do it alone, Donovan says.<\/span><\/p>\n

It takes persistence, but it\u2019s possible for patients to regain some power and make more informed decisions about their care, even as price transparency reform is slow to progress. The key, Gelburd and Donovan agree, is to ask questions, speak up for yourself and refuse to shy away from talking money with your provider \u2014 taboo as it may seem.<\/span><\/p>\n

\u201cIt\u2019s not only permissible, but it\u2019s totally appropriate to enter a conversation about healthcare pricing with your provider,\u201d Gelburd says. \u201cPatients should feel empowered to raise these questions.\u201d<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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