How to Avoid Surprise Medical Bills

man taking cash out of wallet, signifying finding funds for surprise medical bills

Using a HealthShare membership can simplify the medical billing process. However, unexpected illnesses or injuries can lead to bills that may not be shareable. By implementing certain strategies, these surprises can be minimized. Here are some effective ways to avoid the unnecessary stress of surprise medical bills.

Check for provider network restrictions

Aetna provides the example of a woman who had a surgery, then was charged thousands in excess of the expected bill because the hospital-provided anesthesiologist was out of network. Many HealthShares no longer use provider networks, eliminating potential complications.

When networks are no longer an issue, patients only need to check that the providers and facility are properly licensed—and situations where that might even be in doubt are exceptionally rare.

Removing network considerations also removes some of the headaches involved with medical billing. However, members of HealthShares that still use provider networks should confirm that providers and facilities are contracted with the correct network. While HealthShares with networks almost all use PHCS/Multiplan, the largest provider network in the United States, regional variations may exist. A member should communicate network preferences with their provider in advance and verify network participation on the day of the appointment.

Consider facility contracts

Facilities, including surgery centers, emergency rooms, urgent cares, imaging centers, and lab centers also have networks. A member should not assume that their provider will refer them to an in-network facility. They may not know which networks a facility is contracted with. Confirm network participation before undergoing any services, such as bloodwork, to avoid unexpected costs.

Ask about facility fees

Facility fees can significantly impact the final bill. While these fees may be justifiable for complex facilities like hospitals, they can vary widely between providers. According to The Alliance, fees are often charged by clinics owned by hospitals, even for virtual appointments. Whenever feasible, members can inquire about facility fees in advance to choose a facility with the lowest possible fee.

Shop around

Shopping around for healthcare services is possible, thought it may require some extra effort, and can help HealthShare members find the most affordable care. HealthShares in particular have begun providing their members access to comparison tools such as Healthcare Bluebook, which estimates prices based on billing codes. Members should utilize these resources and work with their HealthShare or provider to obtain accurate results and locate cost-effective care in their area.

Laws concerning balance billing

Recent legislation expands protections against balance billing for people who have health insurance. Balance billing is when a provider bills a patient for the difference between their fee and the insurance’s allowed amount. While it may seem that this legislation may not apply to HealthShare members, this may not always be the case. The law makes a provision for people without insurance: providers must give a good-faith cost estimate before rendering care. Per, patients can file a dispute if they are charged more than $400 above that estimate.

Request itemized bills

To ensure transparency and accuracy, request itemized bills from providers for each visit. An itemized bill makes it easier for a member to see what they were charged for and to verify the medical codes used. Itemized bills help identify errors and potential issues such as upcoding. Few providers will offer itemized bills without a patient request, but once the request is made, providers are legally required to provide them.

In conclusion, adhering to these guidelines significantly reduces the likelihood of receiving large and unexpected bills. While it requires effort to research before seeking care, the money and headaches saved can make the endeavor worthwhile.

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