Patients receiving medical care increasingly also receive something unexpected and troubling: a bill they thought would be paid by their health insurance plan.
Without their knowledge, patients may be treated by physicians or providers outside their health insurance network who are paid at a lower rate than an in-network physician. Patients are then expected to pay the difference between the actual charge for the medical service and the lower amount their insurance companies agree to pay. These out-of-network payment issues are caused by gaps in insurance coverage.
“Health insurance plans are extremely complicated, and even savvy consumers face uncertainty about what is covered by their health insurance,” said Jeffrey S. Plagenhoef, MD, president of the American Society of Anesthesiologists.
Following are three ways to help you avoid these surprise medical bills.
- Before having a medical procedure, ask who will be involved in your care and whether they’re in your plan’s network. Also, call your insurance company to verify that the hospital or medical center and your physicians and other providers are in-network.
- Realize that low premiums don’t necessarily mean affordable care. Before choosing a health insurance plan, always ask for details about what the plan covers and doesn’t cover to protect against high co-pays, deductibles, and a plan with a small network of physicians.
- Understand that surprise medical bills can occur when the insurance plan offers a low premium but limits the number of physicians available to patients. Insurance plans with small networks remove or reduce patient choice. These inadequate networks limit insurance companies’ costs and shift them to patients and other stakeholders.