How to Protect Yourself from Surprise Medical BillsAugust 7, 2018
Surprise medical bills are bills you receive from out-of-network health care providers. Commonly, these bills arrive unexpectedly, in situations where patients were not aware that a doctor or facility was out of network.
To help you avoid these bills, below are some useful tips for protecting yourself against surprise medical bills.
6 Ways to Avoid Surprise Medical Bills
The best way to prevent surprise medical bills is to take the following steps before receiving medical care. Consequently, these steps tend to be most effective for planned procedures, rather than emergency care:
- Research medical professionals to find out if they are in your plan’s network – Not all medical professionals at an in-network facility may be in your network. For instance, an in-network hospital may employ an out-of-network anesthesiologist. So, do your homework to make sure that your treatment will be provided by in-network facilities and professionals.
- Contact your health insurance provider to determine whether the care or services are covered – You will be billed for services that aren’t covered by your plan.
- Get cost estimates – Some health care providers may be transparent with costs, featuring them on their websites. If that’s not the case for your chosen provider, ask for an estimate. Texas law requires health care providers to provide cost estimates within 10 days of a request.
- Make sure the price is right – Compare the estimate(s) you receive to the average cost of the procedure for your region. The Texas Department of Insurance (TDI) has put together this Consumer Information Guide & Search Tool to help people understand the costs of various procedures so they can make informed decisions.
- Ask about payment options – If you must go to an out-of-network health care provider and you want to avoid surprise medical bills, inquire about up-front payments, payment plans and possible discounts (like cash discounts).
- Know where to turn for emergency care – Figure out which nearby emergency rooms and urgent care centers are in network. This can prevent you from going to an out-of-network facility when emergencies arise and there’s no time to figure out where the nearest in-network provider is.
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What to Do If You Have Already Received Surprise Medical Bills
- Contact the provider who sent you the bill – Explain your concerns and request an itemized bill so you can look at the individual charges more carefully.
- Contact your health insurance provider to find out if you were wrongly billed – If you’ve met your deductible, you go to an in-network provider and the services you received were covered, there should be no reason for surprise medical bills. Sometimes, insurers may deny payment for portions of bills associated with medically unnecessary services. When that occurs, patients may be able to appeal the denial – and they may have a fraudulent billing claim against the provider.
- Compare the prices with the average market prices – Use the TDI’s Consumer Search Tool to see if the prices that you were charged are around the average price point for your region.
- Try to negotiate a lower payment – Some providers may accept partial payment (instead of no payment), so it’s worth asking about reduced prices.
- Contact the TDI about mediating the bill – The TDI boasts a 90-percent success rate at reducing consumers’ medical bills in the first stage of mediation.
A Texas Medical Billing Fraud Lawyer at the Amaro Law Firm Is Ready to Help You: Contact Us
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