Surprise medical bills can be the most unpleasant surprise a patient can receive after receiving the treatment. Some of the expenses that are included in these medical bills are not even covered by the insurance companies, leaving the patients or their families to cover this unprecedented cost.
Imagine this scenario - after experiencing persistent headaches and blurred vision, you decided to visit a specialist to address the concerns. You carefully selected a reputable neurologist in your network, assuming that your comprehensive insurance plan would cover his services. The doctor thoroughly checked you via a series of tests and consultations, and you were relieved when he assured me that your condition was treatable and not too serious.
However, two weeks after my visit, you were stunned to receive a medical bill totaling thousands of dollars, and turned out that the neurologist's office had billed for specific diagnostic tests and services not covered by your insurance, leaving you with an unexpected and burdensome financial burden. Now, while you are on your way to recovery, this surprise medical bill has created unnecessary stress and financial strain, making you question the transparency of medical billing practices and the adequacy of insurance coverage for future healthcare needs.
Receiving such surprise medical bills is not a very uncommon practice across the globe, especially in first-world countries like the USA. In this mini-guide, we will dive deep into the intricacies of surprise medical billing, shedding light on the factors that contribute to this issue and the profound effects it has on patients' lives. We will explore how Practice EHR systems, designed to streamline medical practices, can play a pivotal role in mitigating surprise medical billing and promoting transparency in healthcare billing processes. And by the end, you will know 7 guaranteed ways to avoid these bizarre medical bills.
What are Surprise Medical Bills?
Surprise medical billing is a distressing phenomenon that occurs when patients receive unexpected, exorbitant medical bills for services they assumed were covered by their insurance. It's a scenario that unfolds all too frequently, leaving individuals grappling with the shock of bills that reach thousands of dollars, often from out-of-network providers. Even diligent individuals who make every effort to seek in-network care can find themselves ensnared in this web of unexpected expenses.
Primary Cause Behind Receiving Surprise Medical Bills
Surprise medical bills are a common issue faced by patients who unwittingly receive treatment from healthcare providers outside their insurance network. These out-of-network providers often charge exorbitant rates, which are only disclosed when patients receive their medical bills. Such charges not only burden patients with unexpected expenses but also drive up healthcare costs for everyone. When insurers have to pay more for such higher charges, they pass on those costs to their customers by raising premiums. This unfair system puts an undue burden on patients and must be addressed to ensure a fair and just healthcare system for all. Usually, in the United States, the ER bill is up to $623-$3,087, but in these surprise bills, these bills can be up to tens of thousands of dollars.
7 Proven Tips to Protect Yourself From Surprise Medical Bills
These unexpected invoices can wreak havoc on your financial stability and peace of mind so here are seven invaluable tips to protect yourself from surprise medical bills.
1. Know Your Insurance Inside Out
The first and most crucial step in safeguarding yourself from surprise medical bills is to have a deep understanding of your insurance plan.
Familiarize yourself with the details of your coverage, including what services are included, which healthcare providers are in-network, and any out-of-pocket expenses you might be responsible for. Most importantly, stay informed about your plan's deductibles, co-pays, and co-insurance rates. By having a clear grasp of your insurance, you can make the right decisions about your healthcare providers and treatment options.
2. Verify Network Participation
Before seeking medical care, always double-check whether your chosen healthcare provider is in-network. In-network providers have predecided service charges with your insurance company, ensuring that you'll pay less out of pocket. Many surprise medical bills occur when patients unknowingly receive services from out-of-network providers, even during in-network hospital stays. To avoid this pitfall, inquire about the network status of every medical professional involved in your care.
3. Pre-authorization and Referrals
Some insurance plans require pre-authorization for specific medical procedures or referrals to specialists. Failure to obtain pre-authorization or a necessary referral can result in surprise medical bills. As your insurance may deny coverage for services deemed unauthorized.
Always consult your insurance company and healthcare provider to ensure that you have all the necessary approvals.
4. Understand Balance Billing Laws
Understanding your state's balance billing laws is crucial for protecting yourself from surprise medical bills. Balance billing occurs when an out-of-network provider charges you the difference between their fees and what your insurance covers. Some states have enacted laws that protect patients from excessive balance billing, limiting the amount that out-of-network providers. Familiarize yourself with your state's regulations to know your rights and limitations in such situations.
5. Keep Detailed Records
Maintaining meticulous records of your medical appointments, and procedures. Moreover, communication with healthcare providers and insurance companies is a powerful tool in preventing surprise medical bills. Note the names of everyone involved in your care, the services rendered, and the dates of your visits. Keep the receipts and copies of all bills, explanations of benefits (EOBs), and correspondence with your insurance company. Having a well-organized record can help you dispute incorrect charges and prove your case in the event of a dispute.
6. Leverage Practice EHR Systems
Practice EHR (Electronic Health Records) systems have become integral in modern healthcare, streamlining administrative processes.
Ask your healthcare provider if they use a Practice EHR system. These systems often help in submitting accurate claims to insurance companies. With detailed and error-free electronic records, the likelihood of receiving erroneous bills decreases significantly.
7. Open Communication
Clear and open communication is vital when it comes to protecting yourself from surprise medical bills. Talk to your healthcare provider about the costs associated with any recommended procedures and inquire about potential out-of-network services. Ask for written estimates when possible, and don't hesitate to discuss any concerns or billing questions with your healthcare team. Being proactive in communication can help you make informed decisions about your healthcare and avoid unpleasant surprises down the road.
With these seven tips, you can significantly reduce your vulnerability to surprise medical bills. Remember that knowledge is your greatest asset, understand your insurance, and verify network participation. Stay proactive in communication with your healthcare providers.
For easy medical billing and reduced administrative costs, leverage technology like Practice EHR. Practice EHR and its medical billing services will also ensure accurate billing, and keep detailed records of your medical journey. By taking these steps, you can protect yourself from the financial shock of surprise medical bills. Enjoy greater peace of mind in your healthcare decisions.