Avoiding Unwanted Bills

Healthcare can be expensive; take steps to keep your costs down. 

Avoid surprises in your medical bills

  • Understanding your health insurance, specifically your plan, can lessen your chances of a surprise bill. Here are a few terms you need to know.
  • In-Network providers: Doctors/providers/hospitals that your health plan has a contract to pay for services.  Your health insurance pays these providers directly.
  • Out-of-Network providers: Doctors/providers/hospitals that your health plan does NOT have a contract to pay for services. You may have to pay more for their services.
  • Balance Bill: If a doctor or providers bill for services is more that what your health plan agrees to pay, you will be charged the difference or “balance.”This is called a balance bill.
  • Out of pocket maximum: One you have reached the out-of-pocket maximum spend on things like deductibles and copayments, you don’t have to pay for care anymore. But if you use an out-of-network provider you will have to pay their bills, even if you have reached your out-of-pocket maximum. 

What to know about hospital and healthcare facility coverage

Just because your hospital is in-network doesn’t mean all of their staff is! There may be doctors or professionals that are NOT in network at your hospital, and this could mean an unexpected bill for you. 

Below are tips to avoid this from happening based on your procedure.

For scheduled hospital/facility procedures

  1. Before you receive care, check with your doctor/provider and the health plan to make sure they are in the network. Agreements often change.
  2. If you need to have a procedure, ask where it will take place to be sure that facility is in the network.
  3. Ask who else might be involved in your procedure and if they are in-network; for example, an anesthesiologist or pathologist. 
  4. Keep a record of the providers, the date you spoke with them, and the information you received.
  5. If you think you received an incorrect medical bill ask your health plan to help you resolve the issue.

In an emergency

If you or someone in your family had an emergency, where would you go? Instead of risking a large balance bill, do your research in advance. 

  1. Check with your health plan to see which local emergency departments are in network. 
  2. Ask your hospital if they employ their ER doctors. If they do not, check with your health plan to make that physician group is in network or your ER visit could end with a hospital and physician bill.
  3. Ask your health plan if emergency medical transportation is included in your network. In an emergency, you can ask to be taken to an in-network emergency, but the final decision is with the emergency response team. 
  4. If the healthcare need is not an emergency, find an urgent care center or walk-in clinic that is in-network.

During pregnancy and childbirth

Healthcare services for pregnancy and childbirth are unique. You’ll have new expenses, including those associated with your care during pregnancy and childbirth.

  • Step one! Choose an obstetrician keeping in mind where you want to deliver your baby. Make sure your doctor, their partners and the facility are in-network. Check with your health plan, the obstetrician and the facility where you plan to give birth. 
  • Step two! During your pregnancy, you will have regular visits and routine tests will be performed. If you need a referral to a specialist, confirm their in-network status before your appointment.
  • Step three! Before you reach your due date, select a pediatrician and confirm that he or she is in-network. Also ask if the other providers in the practice are in network.
  • Labor and Delivery: During childbirth, other healthcare professionals may be involved. For example, an epidural is given by an anesthesiologist. If you require a C-section an anesthesiologist will also be involved. If your baby requires specialized care, a consulting pediatrician or neonatologist may be needed. Check to ensure all possible providers are in-network.

When having a colonoscopy

  1. Contact both your health plan and the gastroenterology center to confirm that both the gastroenterologist and the facility where the procedure will be performed are in network.
  2. You will likely need anesthesiologist or nurse anesthetist. Ask if they will bill you separately for their services. If so, check to see if they are also in network.
  3. If any polyps or tissue samples are taken, they will be sent to a pathologist. Ask who provides the pathology services, if they will bill you separately and confirm their network status as well.

Important to note:  A routine or screening colonoscopy is preventative care, and is usually covered with little or no charge to you. For a diagnostic colonoscopy you may have to pay regular deductibles, copayments, or coinsurance amounts.