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Medical bills, expected or not, can be stressful. In 2012, 75 million people—41 percent of working adults—had trouble paying their medical bills or were paying off medical debt over time, according to The Commonwealth Fund 2012 Biennial Health Insurance Survey released in April 2013.1 This number increased from 58 million in 2005.2
Avoiding health care costs may be unrealistic, but you can do a few things to help contain them, including being aware of what they are, understanding charges for the care you receive and negotiating affordable rates.
Before receiving medical services, be sure they are covered by your health insurance benefits and know at what dollar amount or percentage they are covered. Also find out if you must meet your deductible before benefits kick in, if you will be responsible for a copay and what the coinsurance will be.
Make an effort to see in-network providers and go to in-network hospitals. They have contracted with your insurance company and are typically covered by your health insurance plan at a higher percentage. Depending on your plan, care from out-of-network providers may not be covered at all.
Check with your health insurance plan if you are not sure about providers and benefits.
It’s unlikely your doctor or nurse can tell you how much your care will cost; however, they can provide you with specific information about your health care services. Ask your health care provider what procedures you will be receiving and request the related billing codes.
Having this information will help you arrive at a more accurate estimate of medical bills related to the treatment you will receive.
Contact the billing department for the hospital or clinic from which you will receive care. Provide them with information about the services you will receive, including billing codes. Ask what other fees you can expect and be sure to provide them information about your health insurance plan or let them know you do not have health insurance and will be paying out of pocket.
Finding rate estimates for medical services can be difficult, but such information is becoming more readily available. Many websites provide local pricing data based on claims. Some options include, but are not limited to, the following:
A handful of state health insurance departments have created databases, and a growing number are establishing all-payer claims database systems.3 Visit apcdcouncil.org/state/map for an interactive state report. Researching the Medicare rate for health care services can also be a good starting point when it comes to negotiating; you can find Medicare fee schedules at cms.gov.
You may want to get billing estimates from multiple providers—even if they all take your health insurance, they may charge different rates.
Talk to the billing department for the provider you will use about your situation and ask how they can work with you. Bring the rate information you’ve gathered to the conversation and be sure to reference your findings. Again, the Medicare rate can be a helpful place to begin. If you do not have health insurance and are able to do so, offer to pay cash and see if you can receive a discounted rate. You may also ask for a payment plan.
This may be done over the phone or by scheduling an in-person appointment. Whatever decision you arrive at, be sure to get the agreement in writing. This process may also be followed after you’ve received the bill.
According to the Medical Billing Advocates of America, 80 percent of hospital bills contain errors such as duplicate charges, charges for a brand name drug when prescribed a generic one, and charges for a higher level of care than that which was received.4 Once you have received health care services and your bill arrives, look it over carefully. You may need to contact the billing department to ask for an itemized version.
If anything seems off or you do not understand a charge, contact the billing department to discuss it and verify its accuracy. Again, if you are concerned about being able to pay the charges, you can call and attempt to negotiate a lower price or payment plan. If you find charges that seem incorrect, you can ask for an explanation in writing, request that they be changed and/or begin an appeals process.
Also be sure to look over your health insurance company’s explanation of benefits. It is not a bill, but it will provide important billing and benefits details as well as insurer contact information for any questions you have. If your health insurance company denies your claim, find out why. You may then wish to go through the insurer’s appeals process to dispute it.
Medical billing advocates and claims assistance professionals work with patients to review their bills, ensure charges are accurate and help them reduce costs. You can search for these trained individuals at websites such as CoPatient.com, BillAdvocates.com, or Claims.org. Advocates work with the insured as well as the uninsured.
1S. R. Collins, R. Robertson, T. Garber, and M. M. Doty. (2013, April). "Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act."
2The Commonwealth Fund. (2013, April). "New Health Insurance Survey: 84 Million People Were Uninsured for a Time or Underinsured in 2012 [Press Release]."
3APCD Council. (2014, January). "The Basics of All-Payer Claims Databases: A Primer for States."
4Palmer, Pat. (2013, December 19). "Hospital Bill Audit Services: How to Obtain a Hospital Bill Audit." Medical Billing Advocates of America.