How to protect yourself from unexpected medical bills, insurance denials

The American health care system is such a maze to navigate that trying to minimize medical bills is a difficult and time-consuming task.

It’s the equivalent of “a full-time job figuring out what insurance will pay,” said Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine-based patient advocacy group.

But there are ways to help lower bills and limit costs.

Just as prevention is the best medicine for staying healthy, planning ahead is one of the best ways to avoid large, unexpected medical bills. Instead of automatically going wherever your primary care doctor refers you for exams and other procedures, for example, shop around to make sure you’re not overcharged. Once you’ve gone through a procedure, it’s much harder to negotiate a better price.

The costs of surgeries, health tests and laboratory tests can vary greatly. A simple screening or preventive colonoscopy can cost as little as $254 or as much as $4,290, depending on location, according to the website

This website is a good place to start when comparing costs. But the least expensive provider you find for a given service, whether it’s delivering a baby, an EKG or a hip replacement, isn’t necessarily where you want to go, Woloson said. Patients need to be assured that they are receiving quality care, but also that they are not paying excessive amounts. It’s a tricky balance, he said.

In general, avoid routine checkups and medical services at a hospital, as the extra fees they usually incur can add hundreds, sometimes thousands, of dollars to your bill.

Your insurance company also plays a role in your final cost, so checking with your carrier is also an important step. Your carrier may suggest a different provider than your doctor does.

If you go to a provider outside your network, what you’ll pay may be higher even if the total cost is lower, Woloson said.

It’s also important to understand the pros and cons of your health plan. If you have a high-deductible plan and have already met your deductible for the year, it makes sense to schedule health care services during the same calendar year, rather than waiting until January when your deductible resets. Also, if you know you’ll need a procedure in the next year, you may want to set aside money in a health savings account. Doing so allows you to set aside untaxed income to pay for health care services, effectively using the tax break to lower your costs. Contributions to a health savings account are also tax deductible.

If you receive a bill that doesn’t make sense or is higher than expected, the first step is to ask for a detailed breakdown or an explanation.

If you’re still being charged more than you think is fair, you can appeal. But this is difficult because your bargaining power as an individual is limited.

To start an appeal of an insurance claim denial, follow the instructions on your insurance forms.

If you ultimately find that a procedure or service is not covered, your health care provider may be willing to give you a discount of up to 25 percent, and may also offer a discount if you pay your bill right away. You should ask for discounts whenever possible, Woloson said, since often a supplier will accept one to pay a bill early.

For free help with a medical bill, call the Consumers for Affordable Health Care Helpline at 800-965-7476 any weekday from 8:30 am to 4:30 pm

If your appeals to your insurance company or health care providers are unsuccessful, you can also file a complaint with the Maine Bureau of Insurance.

Some disputes can also be taken to court, but it’s a good idea to consult a lawyer before taking legal action.

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