Of all the types of mail you could receive, a surprise medical bill is probably one of the least welcome. Unfortunately, it’s all too common an experience. Nearly a third of privately insured Americans have reported receiving a surprise medical bill—one that reveals their health insurance covered less than expected—in the past two years.
While surprise medical bills are sometimes a result of patients not understanding their insurance coverage, they’re more often a product of patients seeing an out-of-network doctor without realizing it. In fact, a recent review of 2.2 million emergency room visits revealed that one in five patients are treated by an out-of-network physician. While a patient may visit a hospital that’s in their health plan’s network, they may have a pathologist, radiologist, ER doctor, or anesthesiologist on their care team who isn’t in that network. Those health providers can set their own prices for their services, which can result in unexpectedly large medical bills.
How to Handle a Surprise Medical Bill
Whenever possible, you should talk to your doctor before any procedure and find out if the members of your care team are in-network. However, it’s not always possible to perform this due diligence, especially if you find yourself in the hospital unexpectedly, or a complication of a routine procedure requires another doctor to assist you.
If you do find yourself with a medical bill that’s larger than expected, there are a few things you can do to try to save on a surprise medical bill.
- Call your insurance company. Ask for detailed information about each charge to make sure there wasn’t an insurance billing error.
- Contact the out-of-network doctor. Although it’s not a sure thing, negotiating your medical bill with your insurance company and doctor may help with reducing your medical bill.
- Find out if your state has any protections against surprise medical bills. ConsumersUnion has an interactive map that shows you which states have legislation related to surprise medical bills.
- Educate yourself about healthcare costs. FAIR Health has extensive online resources to help consumers navigate healthcare coverage and payment. Reviewing some of these resources may help with negotiating medical bills with your doctor or insurance provider.
By familiarizing yourself with your health plan’s coverage and your state’s protections against surprise medical bills, you’ll be armed with the tools you need to dispute a financially burdensome medical bill from an out-of-network provider.
