Surprising medical bills: what can you do?


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In February 2020, Steve Morrow took his wife Kris to get Eye The procedure for a degenerative eye condition is called keratoconus.

They weren’t sure how much the procedure would cost – Chris’ doctor said it would depend on how bad her condition was Eye What and how the procedure will be involved. But since it was done in a doctor’s office, they were only responsible for $50 Participation. they PPO The insurance plan covers the rest.

“We paid a Participation “Three months later, we received a $3,550 bill from the provider,” says Morrow, who runs the online kayaking website, Paddle About in Gilbert, Arizona.

It didn’t stop there. Even after repeated phone calls to them insurance The company and the provider, billing continued to come.

Surprise bills are common

Morrows are not alone when it comes to surprise bills – when you get billed for medical services much higher than you expected.

“Sudden medical bills are at an all-time high,” says Gil Traocco, an oncology nurse and patient advocate who founded Medical Bell 911 to help people deal with these unexpected charges.

It says about 20% of hospital bills have a surprise charge, even for people who are fully insured. According to the Kaiser Family Foundation, there are millions of surprise bills every year.

Costs accumulate. If your plan doesn’t cover out-of-network care, you insurance The company may decline coverage entirely. Or you may be liable to pay the difference between what is covered by insurance and what is charged to you (a practice known as balance billing). You could end up with hundreds or thousands of dollars in debt.

What causes surprise bills

Surprise billing happens because part of your treatment isn’t covered by insurance plan.

It is common in emergency situations. An ambulance can take you to an out-of-network hospital, where your care is not fully covered. Or you may need things that aren’t fully covered, like an ambulance, a flight, or an emergency surgery.

You may also get sudden bills when it is not an emergency. Even if you go to a hospital or in-network facility, you may be charged for providers you can’t choose, such as anesthesiologists, radiologists, and pathologists.

“Many providers may be out of network, which leads to astronomical billing fees,” Trauco says. You may also be charged for unplanned imaging, lab work, or surgery.

Inaccurate billing errors and errors are another source of surprise billing. “Medical bills have a 30% error rate,” she says.

This is what happened to the Moreau family. Although their insurance company covered Eye action, the provider kept billing them incorrectly. “It was a mess,” Moreau says. “But after several phone calls with our provider and insurance company, we got everything away.”

what you can do

“You should never pay an elevated medical bill, or any medical bill, when it first arrives in your mailbox,” Trauco says. If you look at an invoice and it doesn’t look quite right, chances are the number you’re seeing is wrong.

Before you pay a questionable medical bill, get the facts. Ask your provider for a copy of your medical records with an itemized fee.

Ensure that records include:

  • Billing Codes
  • Consulting
  • Medicine
  • Procedures
  • surgeries

When you get your records, says Trauco, review them in detail and ask yourself these questions:

  • Is the diagnosis of admission and diagnosis of exit correct?
  • Are the admission dates correct?
  • Are the surgeries correct?
  • Were you given every medication?

You may find errors and charges that you can dispute. Many bills contain fees or recurring charges for things you didn’t receive, such as tests, procedures, or medications.

How to negotiate

Just because you get an invoice doesn’t mean you are responsible for paying it in full. “All medical bills are negotiable,” Traocco says.

First, contact your insurance company. Ask for a one-time exception. They may agree to cover the bill at an in-network rate. If they say no, you can file an appeal.

Then, contact the provider. “Tell your story and mention that you are cash-strapped. Ask who you want to talk to, and get them on the phone,” Trauco says. “Polite perseverance is a powerful tool.”

Try asking your provider to lower their fee to an in-network rate. This may save you about 30% of the total cost. You can also request a Pay Now Discount, which reduces the amount you have to pay if you pay right away.

You can also get help from Patient Advocate at patientadvocate.org.

Take your time researching and be patient as you negotiate.

new law

Congress recently passed a new law called the No Surprises Act to protect consumers from sudden bills for unexpected off-grid care. It will cover most privacy health plans It will become effective on January 1, 2022.

The new law will:

  • Ban balance billing (the difference between the service provider’s fee and the amount allowed for your insurance company)
  • End sudden bills for off-grid emergency room
  • End sudden air ambulance bills
  • Request your consent for planned actions
  • Ask insurers and service providers to negotiate the rate of payment, rather than having to negotiate

The new law does not cover ground ambulance services. It also does not anticipate surprise billing laws in your state.

How to prevent surprise bills

Since the new law doesn’t take effect until 2022, you should still pay close attention to your medical care and bills. “Be pro yourself and do your homework. Know what you owe before you go,” Trauco says.

If you’re going to have a scheduled surgery or procedure, get the facts about what’s covered beforehand. Contact the facility, even if it is in-network, and ask for a list of every caregiver who will be involved in your care. Be sure to include providers that you don’t choose yourself, such as anesthesiologists or radiologists.

Next, contact your insurance company. Make sure that each provider is connected to the network. Do not rely on the insurance company’s website. It may be old.

In the event of an emergency, request to be taken to a hospital within the network.

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