Tips and Strategies To Avoid Surprise Medical Bills

Surprise medical bills are unexpected expenses that patients face after getting medical treatment. These bills can come from being treated by a doctor or in a facility not covered by your insurance. They can also occur when you receive a bill that is much higher than what you expected to pay. Even with good insurance, you may still have to pay unexpected costs.


Nowadays, surprise medical bills are common. Patients receive the necessary medical services but incur much higher bills than anticipated, sometimes even tens of thousands of dollars. To help you avoid these unexpected payments, here are some useful tips to protect yourself from surprise medical bills.

What is a surprise medical bill?


A surprise medical bill occurs when you unexpectedly receive a bill for medical services after unintentionally visiting a Primary Care Clinic or any specialist who is not part of your insurance network.


If a provider is out-of-network, they need an agreement with your health insurance plan. This lack of understanding means that the provider and your insurance company have yet to agree on a price for the medical services, so you might have to pay the difference.


Certain medical specialties are more likely to be out-of-network than others. In 2016, the Healthcare Cost Institute studied over 600,000 admissions to in-network providers and the associated out-of-network claims. The study found that some specialties, like anesthesiology and emergency care, had the highest out-of-network claims.


How Does It Affect Practice Revenue?


Surprise billing can have a significant impact on healthcare practice Revenue Cycle Management. It can result in delayed or denied payments, disputes with insurance companies, increased administrative costs, and patient dissatisfaction. Resolving surprise billing issues requires additional resources and can disrupt the smooth flow of revenue within the practice.

How much do surprise medical bills cost?
Surprise medical bills can be expensive and hard to afford. Around one-third of people who received a surprise medical bill said it was $1,000 or more. About half had a bill under $500, while only 2% had one under $100. However, the actual cost of surprise medical bills can be even higher.


A New York Department of Financial Services study discovered that the average cost of an out-of-network emergency bill was approximately $7,000. Furthermore, they found that insurance companies typically covered less than half of these emergency bills, leaving individuals with nearly $4,000 to pay out of their pockets. According to KFF, almost half of insured adults reported being unable to pay a $500 surprise medical bill.


8 tips to help you avoid unexpected medical bills
It’s best to take these precautions before you get medical treatment. These tips work better for planned operations rather than emergencies. You can also learn more about the No Surprise Act.


Understand Your Plan’s Coverage

Take your time to read and understand the benefits included in your package. Make notes to remember them. Knowing what your contract covers will help you avoid unexpected medical costs. Always contact your insurance company to confirm if a specific medical procedure is relevant to the insurance plan.


Confirm In-network Providers

The network of healthcare providers can change, so it’s a good idea to check with your insurer before your appointment to make sure your doctor is still part of the network. This information will be useful if you receive an unexpected bill.

Estimate Costs

Many insurance companies offer a cost estimator tool to give you an idea of the expenses for different treatments. Third-party apps are available online that can help you get cost estimates. Once you receive an estimated cost, ask your healthcare organization for their estimate. Compare it with your own research to see if there are any significant differences. Knowing the expected cost from your provider will help you avoid surprises when you receive the bill.

Ask the State for Help


Some states have rules to protect patients from unexpected medical bills, even though there aren’t any federal regulations for it. For example, in certain states, patients don’t have to pay for emergency room visits with network doctors. It’s a good idea to contact the state department and see if any laws can help you avoid surprise bills.

Check Your Bills


Hospital billing departments handle a lot of information daily, so mistakes in the bills are common. They might have used the wrong insurance information, charged you for services you didn’t receive, or got the dates wrong. Always look closely at your medical bills and see if there are any discrepancies.

Appeal the Bill


When you receive medical bills, they usually come with instructions on how to appeal if you think something is wrong. It’s a good idea to formally complain to your insurance provider if you believe you’re receiving extra bills. Before contesting a medical bill with your insurance, inform your doctor about the situation and ask them not to send it to collections. They don’t have to comply with this request, but it will give you more time to resolve the issue with your insurer.

Confirm the Payment Plan

If you can’t solve the problem and must pay the bill, ask about a payment plan. 

Know when to Change the Emergency Care Plan

It’s important to know where to go for medical care during emergencies. Medical procedures can be overwhelming, and unexpected bills can worsen things. While there’s no specific date for the government to eliminate surprise bills, you can prevent them by following the basic steps we mentioned earlier.

Final Thoughts

No Surprises Act aims to safeguard you from unexpected medical bills. This law will make providers charge you the rates your insurance company would pay for emergency and in-network hospital services. To avoid surprise charges, selecting healthcare providers within your insurance network is advisable.

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