If you’ve ever been billed alone, you didn’t expect aftercare. A study found most Americans faced surprise medical bills, often from out-of-network providers. This is called balance billing. Here it means and how to handle it:
When you choose in-network care, you usually expect lower costs. But sometimes, even with in-network providers, you can get a costly surprise medical bill. This happens when You get care at an in-network place but from an out-of-network provider (even in emergencies). An out-of-network provider gives emergency care.
If you receive a surprise medical bill or are concerned about medical billing issues, it’s essential to contact your healthcare provider, insurance company, or a qualified medical billing company in Downers Grove for assistance. They can help you understand your bill, appeal insurance denials, and explore options for resolving billing disputes.
What is surprise medical billing?
When you go for medical care, you usually pick a place covered by your insurance. It is cheaper. But sometimes, even if it’s in-network, you might get a big bill unexpectedly. This is called a surprise medical bill. It happens when:
- You get treatment from an out-of-network doctor at an in-network place.
- You get emergency care from an out-of-network doctor.
You still have to pay the part that insurance does not cover. Patients often did not know; they only knew the doctor was out of network once they got the bill.
How often does surprise medical billing happen?
The Kaiser Family Foundation says 24% of ER visits at in-network facilities are affected. Also, 18% of inpatient admissions and 15% at in-network facilities face these charges.
Services by certain specialists, ambulance rides, and post-procedure equipment often lead to balanced billing. Many patients need to learn their providers are not-network. 7 out of 10 individuals learn about costly surprise bills after receiving them. A Texas manscape, where he faced a $109,000 bill after a heart attack gained attention. Despite insurance covering part of the cost, the out-of-network hospital led to an expensive surprise bill. His story highlights a common issue, especially in emergencies with limited care choices.
Handling a Surprise Medical Bill
If you have been surprised by a medical bill, there are still steps you can take to manage it. First, review the medical bill and the Explanation of Benefits (EOB) provided by your
insurance company. The EOB will tell you what medical treatments or services your insurer paid for and how much you still owe. Ask your provider for an itemized bill to ensure that everything you are charged for is for a medical service you received.
With 70,000 to 71,000 medical procedure codes to work with when composing your initial medical bill, mistakes are inevitable. Reviewing the itemized bill will help you avoid paying for things you did not receive.
You can get an itemized bill from your provider by calling their billing department and, if necessary, asking to speak to a supervisor.
If you need clarification on what is on the itemized bill, trust your instincts. Check the CPT (Current Procedural Language) codes from your bill on the CPT / Medicare Payment tool the American Medical Association provides.
If you have reviewed your medical bills and found that you still owe some unexpected charges, it’s time to negotiate. Contact your provider’s billing department, talk to a supervisor, and try to agree.
You may have to schedule a face-to-face meeting or call multiple times. According to a Consumer Reports survey, 57% of people who negotiated payment for their medical bills successfully reduced the amount owed.
While you can not expect to get your bill to disappear, you can hope to find a compromise. For instance, you can ask your billing department supervisor to accept what your insurance company is willing to pay so the provider still pays for the services. Still, you are not. You need to pay a hefty amount out of pocket.
If you are uncomfortable negotiating with your billing department or having trouble striking a deal, you should hire a medical billing attorney to do it on your behalf.
If you can’t pay immediately, ask for a payment plan. Talk to the billing department about setting up monthly payments. They might help, but you have to ask to find out.
How To Avoid Surprise Medical Bills
Surprise medical bills don’t always happen, but being a good healthcare consumer can minimize the chances of them happening to you. Of course, you should always go to the nearest care center in an emergency or life-threatening situation
When it comes to planned medical services, it’s essential to research and find out what’s covered and whatnot.
Don’t assume that just because your health care provider is in-network, they’ll be in-network providers.
The same goes for the place where you’re getting treatment. Your provider may be in-network, but the facility where you’ll be receiving care may be out-of-network, which could mean facility charges.
It’s easy to feel overwhelmed by all the questions you’ll have to ask about the care you’re about to receive. But by being an informed consumer, you can make the best healthcare decisions for you and protect your wallet.
