Strategies to help you avoid surprise high medical bills

If you’ve ever received an unexpected high medical bill you’re not alone. Maybe your primary care doctor or a specialist referred you for diagnostic tests or imaging and you assumed that since your doctor was in your insurance network, he or she would refer you to an in-network facility, which is often not the case. Perhaps you needed emergency care, only to find out later that the anesthesiologist and the emergency room physician weren’t in-network even though the hospital was. And then there are errors on medical bills, which can increase your bill.

There are a number of strategies you can use to help lower the risk you’ll face an unexpected high medical bill, as well as ways to manage any big bills you do receive.

• Know your insurance plan inside and out. It’s important to understand how your health plan works. That includes knowing how to find out which doctors, labs, testing facilities, pharmacies, care facilities, and hospitals are in-network. You’ll also need to know if you need pre-authorization or pre-certification for certain types of care and how to get it, as well as what your deductible is and what co-pays or co-insurance you have for both in- and out-of-network care. In some types of plans, there is no coverage for out-of-network care, which can significantly increase your costs if you see a non-network healthcare provider.
• Get a second opinion. If you’re diagnosed with a serious, complex, or rare health problem or receive a recommendation for surgery, it’s wise to seek a second opinion from a physician who has experience treating patients with your condition. Not only can a second opinion lower your risk of misdiagnosis, it can also help you make sure you’re receiving the most appropriate care, which lowers the risk of paying for often costly, inappropriate care.
• Use your FSA or HSA account. If you do receive a large medical bill, the money you’ve saved in a flexible savings account or health savings account can be used to pay for covered costs.
• Manage the cost of medications. If you’re prescribed high cost medications, such as cancer immunotherapies and biologics or medications to treat hepatitis C, nerve pain, and HIV, specialty pharmacy services can provide advice and guidance to ensure that the medications prescribed are the most appropriate ones. Specialty pharmacy plans also help make sure you’re receiving medications that need to be administered by infusion or injection in the most appropriate and cost-effective setting, for example at a physician’s office rather than a hospital outpatient clinic, where the cost can be five times higher. Check with your employer (if you have an employer-sponsored health plan) or contact your insurer to find out if your health insurance includes these services. If not, an insurer’s nurse advice line or a health advisor may also be able to help you get the information you need.
• Contact a medical billing advocate. According to some estimates, between 30% and 80% of medical bills in the U.S. contain at least one error. In nearly a third of those cases, the error represents a significant amount of money. If you receive an unexpected large bill or if you think there may be errors on your bill, a medical billing advocate can help. A billing advocate can not only review bills for accuracy and dispute incorrect charges with hospitals and providers, an advocate can also help negotiate a cost reduction in cases where you were unaware that an ER physician, anesthesiologist, or radiologist was not in your health insurance network, for example.