How To Avoid Surprise Medical Bills

You can't.

End of article.

OK, before you fly over and leave me a raging negative one-star review, let me explain...

Once upon a time in the 1980s health care was affordable and health insurance was so inexpensive that everyone had it. Someone at even an entry level job would be offered low or no cost medical insurance. It was so cheap that you barely noticed the decuction from your paycheck. Food was still coming from farms, cancer was rare, obesity was barely on the rise and food companies had yet to bring out their chemistry sets. 

Kids played outside, drank from the hose and cleaned cuts with mud and Mountain Dew. We were a pretty healthy generation. So no one really paid much mind to health insurance. That was for old people and newly weds trying to avoid maternity costs. Deductibles were so low you barely noticed them. You could go to the emergency room or have a baby and not have to file bankruptcy. Your local primary care physician took almost all insurance plans or you could pay cash and still feed the kids. Life was good.

Fast forward to present time - wooosh! ER visits are not covered by some insurance plans unless it is proven to be a true emergency. 4 hours in the ER, one MRI and 5 minutes with the ER doctor is $14,400! (true story and I can prove it) Deductibles are approaching $10,000 per person and many doctors won't take insurance unless it's from your employer or it's PPO coverage.

Americans have become less and less healthy. Cancer rates have skyrocketed. Obesity is a real pandemic. Healthcare costs are crushing insurance carriers and finally the good ole government of these United States had to step in to calm the chaos. Whew! Thank goodness.

So now insurance is more expensive, more complicated and people are just frustrated. Surprise medical bills are thing now. They probably were always a thing but they did not equal 6 months salary in the past. Folks just handled them or called the provider to figure something out. Now, you may have to take a week off from work to argue with both the insurance company and your doctor, take out a loan, refinance your house or file Chapter 13 when you get one. 

But, where do they come from? Is there some evil person posted in the billing department of the hospital printing them off arbitrarily? Is there a conspiracy between "big medical" and "big insurance"? If there was a conspiracy it would be the simpler explanation. 

I have discussed this with many health care and insurance professionals and there is no pat answer as to why this happens. Insurers are trying to save money and medical providers are trying to get as much of it as possible. So there's that. There is miscommunication between provider and insurance carrier when getting pre-approval. There is "it's better to ask forgiveness, than permission" when the provider is providing services. There is the sudden substitution of the anesthesiologist who is on contract and not on staff at the in-network hospital you so diligently secured. There there is the less-than-honest insurance agent telling you "it's covered" everytime you query something. There is the consumer that will just never understand the concept of a deductible. And don't even get me started on co-insurance. There is the consumer that does not remember a damn thing about his policy that he bought 4 years ago, but now desperately needs to cover his massive bill from a week-long stay at the hospital. And on and on...

Surprise just means someone was not expecting it. It does not mean it is not justified, correct or contractually acurate. It just means that the person that received it said "what the ____ is this?! I thought this was covered?" And not, oh yeah, this can sooner than I thought it would. The media has coined that term to sensationalize a common occurance. 

I get calls from clients that are raging about a bill they received and how they are going to sue the insurance company and me and my kids, too. Mwahahahahha.  So when they are done blowing steam I guide them to their policy and review the contract (which is what the policy is) and show them they have not met their deductible, or they maxed their annual benfits or it's not even covered at all. We go our separate ways, no lawsuits filed.

Sometimes a medical professional becomes ill, has a personal matter come up and just can't make it to work and the hospital has to jump through hoops so you can get your knee replaced or you can get your 9th botox treatment or they can save your life with a heart transplant. So they grab the nearest qualified professional to get the job done. That professional just happens to be there filling in for a staff doctor and is on a contract. Which means they likely do not accept insurance. They are going to bill you directly. Is this crappy? Yeah. But, you can always negotiate. Make payments. Work something out with your insurance company. 

Medical care and the insurance industry are two very complex and legally intertwined businesses that take entire staffs at the state level to regulate. It is not an easy thing to do. It is convoluted and confusing to point that only attorneys can really understand the language of the policy. I had a client read every single word of their policy. Every page, every word. Called me, emailed me, texted me questions. And in the end they still called me the day of their annual check-up completely up in arms. They had made it so complicated, they totally over-thought the process and botched the simple process of getting a wellness check. They made it sound like thousands of dollars were on the line when it was less than you might spend on your cable bill. 

So do your homework, I would be remiss if I did not recommed that. Keep you receipts for your deductible. Call around for rates when getting lab work, x-rays or any diagnostic work. You can get a great deal, pay cash and still get it credited to your deductible. Find the nearest in-network emergency hospital and save it in your phone. Do whatever you can to be informed as to what is covered and what isn't. What is your financial liability if you have a mojor claim? Get a review of your coverage every 2 years to make sure it still fits your needs.

We may have a slightly malfunctioning system, but you can do something about it. 

Learn how to shop for health insurance here - Shopping for health insurance.