Navigating your Medical Bills: Be Your Own Advocate

Navigating your Medical Bills: Be Your Own Advocate

Nov 20 2017

The world of health insurance is complex and sometimes confusing, especially when it comes to understanding and navigating medical bills.

Whether it’s from a routine office visit or a serious medical procedure, there’s a level of anxiety and confusion for many Americans when they open up a medical bill. According to a 2016 Copatient State of Medical Bill Confusion survey, 72 percent of consumers have received a medical bill they didn’t understand.

Being an informed health care consumer can keep you healthy, while saving you time and money.

In order to prevent this stress and better manage your health and financial well-being, it’s important for you to be a proactive, informed and engaged patient and consumer.

Here are six ways to become your own health advocate.

  1. Know your health plan

What kind of coverage do you have? Is it an HMO or PPO? Do you have coverage through Medicare or Medicaid? Your health plan not only determines the amount you pay for a doctor visit, but it also controls what medical services – tests, screenings and treatments – are covered as benefits, as well as the amount you pay out of pocket and where you’re able to receive those services.

In addition to knowing your health plan, it’s also vital to have a basic understanding of how health insurance works. For example, a Kaiser Family Foundation survey found that 41 percent of Americans are aware doctors providing care at an in-network hospital may not necessarily be in-network providers but 58 percent incorrectly believe that all care received at an in-network hospital will be from an in-network provider or said they don’t know.

Don’t hesitate to reach out to your health insurer to ask questions about your health plan or any planned procedures so you can advocate for yourself and be prepared for any potential costs.   

  1. Research your costs

As health care costs continue to rise, health insurers are also developing tools to help increase cost transparency for members.

Leverage these tools to research your potential costs before receiving the care. Priority Health’s Cost Estimator, for example, allows members to search the costs of various procedures and tests at different facilities. The tool then estimates out-of-pocket costs based on the member’s unique plan benefits

Once you receive the bill, cross reference the research you conducted ahead of time to ensure the costs are in line with what you expected.

  1. Lookout for errors

Mistakes can happen from time to time, which is why you need to pay close attention to each medical bill to make sure there are no accidental charges or fees. Some of the most common errors include:

  • Upcoding – when a medical billing code is mistakenly entered as a similar, but more serious treatment or diagnosis
  • Unbundling – charges that should normally be entered under one code, but are listed separately
  • Duplicate billing – when you receive multiple bills for the same treatment or service
  1. Keep track of your records

Just as you would with your annual tax returns, it’s a good rule of thumb to keep a file of your medical records and bills. You can save hard copies the old fashioned way or digitally thanks to the rise of electronic billing systems. This will save you from going through the hassle of getting them transferred if you switch doctors, jobs or health providers.

  1. Make use of free preventative care

Many health plans provide members with access to free preventive care services such as well-child visits, flu shots and physicals to help prevent illness, find diseases or medical problems before symptoms occur. These services are covered at 100 percent when performed for preventive purposes by an in-network provider, which means that even if you haven’t met your deductible, there’s no out-of-pocket cost for you.

Recent surveys found that the majority of Americans are unaware of these preventive health benefits or are avoiding them out of cost concerns, so make sure to check with your insurance provider to see what’s covered under your health plan.

  1. When in doubt, ask questions

Any visit to a doctor or hospital can be unnerving or overwhelming, but don’t be afraid to ask questions about a medical condition or concern. Be prepared with a list of questions and take the opportunity to get clarification or more information while you have your provider’s undivided attention.

Being an informed health care consumer can keep you healthy, while saving you time and money.

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