And The Unexpected Cost of Health

Avoiding The High-Cost of Healthcare

Many patients these days believe that if they have health insurance, most or all of their medical expenses will be covered by their health insurance plan. But, in today’s sophisticated health insurance plans, patients are finding out-of-pocket costs are really beginning to add up, whether it be a co-pay or a portion of a medical bill that is not covered by insurance.

Consumers should begin reviewing medical bills closely…extra or incorrect charges are becoming more commonplace. In fact, Consumer Reports noted that one-third of privately insured patients have received these types of bills. And 53 percent said the situation was not resolved to their satisfaction

Calling your doctor’s office to ask if he or she is covered under your insurance is not enough. A doctor might participate with your insurance for some things (products), but not others,” Additionally, some doctor/dentists may suggest that they “Participate” with your insurance company, but this does not always mean they are an “In-network” provider!

Never rely on physician/dentist website when checking whether a doctor is in or out of network. Websites are frequently out of date…some websites are better than others. There is no national standard of what each should look like.

In an effort to conserve time and save money, patients should feel free to pepper doctors with a list of questions before starting any treatment…“Is this procedure or test really necessary?” “What are the alternatives?” “Can we wait and see?” “Are there other ways to treat this?”

To really collaborate with your physician/dentist, you should state your preference and express your feelings. Don’t be intimidated by the white coat!

One out of three consumers has received a “surprise medical bill” from a doctor or dentist -- and it happens more frequently than you think. Unfortunately, the health care system isn’t so transparent as to who is or is not in your network!

One of the most common surprise medical bills that patients receive is from the emergency room. You may visit a hospital that you are told is in network, but the radiologist doesn’t participate with your insurance.

There are other examples; when having surgery, the anesthesiologist is often out of network and patients routinely receive a huge bill for their surgery. Being treated for sleep apnea? Majority of dentists treating the disease are not in-network with medical insurance companies and patients are often shocked when receiving a bill approaching $6-7,000! You have to be diligent.

This all happens to a lot of people, often under the worst circumstances!

Some states, such as New York and California, have protections in place against unexpected medical bills. But others states have yet to follow suit. There are numerous horror stories about huge medical bills after routine medical procedures where the costs were never disclosed to the (patient).

Some of this is a result of cumbersome diagnostic codes and confusing paperwork. Some doctors/dentists simply don’t know ahead of time whether a specific kind of blood test is covered under a certain diagnostic code. This often leads to rejection by the insurance company, AFTER the procedure, and a surprise bill for the patient.

There are so many more regulations to meet these days, and it’s often frustrating for doctors. They often spend a considerable amount of time on administrative work when they really want…need to care for patients.

It’s becoming a problem that is leaving people frustrated with the medical system. If you have questions (on a bill), call the insurance company or your provider to find out what went wrong. Know what your deductible and your co-pay is. Many people don’t know this. If you have co-insurance, know what portion you are responsible for.

If you call the physician or dentist, ask for the billing department and make sure to get a clear understanding of why you received the charge, ask for an estimate and any insurance requirements IN WRITING. Also, double check with the insurance company and see if the billing department’s answers line up.

If your medical or dental practice has experienced the patient with an unexpected bill #weshouldtalk