Talk to anyone and you can elicit myriads of sob stories relating to medical bills and insurance denials. Everyone from providers to hospitals to patients gets frustrated with the medical cost and billing. Issues such as delayed insurance claim processing, coverage denials, high deductibles are just few of seemingly endless causes of high medical bills and debts.
There are a lot of things school doesn’t teach you and this is one of them: how to avoid and manage medical costs and expenses. I want to create a serie of blogs to talk about simple strategies that anyone can use to help avoid this type of situation.
These are things I hope my patients would be aware. It would make my life and patient’s life a lot easier.
Call insurance to verify coverage for each service/procedure you are undergoing. Find out if you have deductables for inpatient vs. outpatient expenses, medications, etc.
One of the biggest headache in medicine is dealing with health insurance companies. I see a lot of people naively believe that they will be covered because they have health insurance. Then they get a big shock when they realize that they have a $5000 deductable, or their insurance doesn’t cover their procedures or medications
Many people assume that if the procedure or medication is medically necessary, the insurance will cover it. Don’t confuse SHOULD with WOULD.
Ask your insurance if you have: 1. Deductable, 2. Benefit gap 3. Max out of pocket expense 4. Benefit cap. Note that these are annual so every year (either based on calendar year or anniversary year) you restart.
Realize that your copay varies depending on service and products
Ask for out of pocket pricing.
When it comes to many outpatient procedures, and expensive medication therapy, many insurance will not cover the cost of treatment. If this happens, or you know your deductable will be too high to make a dent in your annual medical cost, ask the clinic/pharmacy for the price for if you want to pay out of pocket. Many clinics and pharmacies have self-pay pricing versus insurance pricing. No one likes to deal with insurance claims, and many places will offer a discounted price if they don’t have to bill the insurance
If you receive a large medical bill, call billing and ask if you can pay the hospital in installments.
After all is said and done, you got stuck with a $12,000 medical bill for a emergency room visit. Or maybe it was a surgical procedure like a cardiac bypass where the insurance said you are somehow responsible for 25% of the cost, leaving you with a hefty bill. If this happens, the most important thing is to NOT ignore it. You don’t want the bill to go into collection (which usually happens if the bill lapses for a month or even less depending on the institution). Then you will be straddled with bad credit AND a interest on the bill. Call the hospital or the clinic and try to work out a payment installment option. Either pay a set amount monthly or do a split payment. This will save you your credit rating AND money by avoiding interest payments.
deductable = the amount of money you have to spend before your insurance will start paying the medical cost
benefit gap = amount range where your insurance is not covering for the cost and when the catastrophic coverage kicks in. This occurs with medicare part D patients, but can also occurs in regular insurances
max out of pocket = maximum amount of money patient will pay before insurance will covering some/all the cost
benefit cap = maximum amount insurance will cover. After that, patient is left to foot the bill