How do you protect yourself against unexpected medical bills, insurance denial?

The US healthcare system is such a maze that trying to minimize medical bills is time-consuming and difficult.

Ann Woloson, general manager of Affordable Health Care for Consumers, a Maine-based patient advocacy group, said it’s the equivalent of “a full-time job figuring out how much insurance will pay.”

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

Just as prevention is the best medicine to stay healthy, planning ahead is one of the best ways to avoid big and unexpected medical bills. Instead of automatically going to where your primary care doctor directs you for scans and other procedures, for example, shop to make sure you won’t be overcharged. After going through a procedure, it is much harder to negotiate for a better price.

The costs of surgeries, health screenings, and laboratory tests can vary widely. According to the website Comparemaine.org, a simple preventive or screening colonoscopy can cost as little as $254 or $4,290, depending on location.

This website is a good place to start when comparing costs. But the cheapest provider you’ve found for a particular service β€” whether it’s a baby, an EKG, or a hip replacement β€” doesn’t have to be where you want to go, Woloson said. Patients need to be assured that they receive quality care while not paying excessive amounts. β€œIt’s a difficult balance,” he said.

In general, avoid routine screenings and medical services in a hospital because the extra fees they often incur can add hundreds, sometimes thousands, of dollars to your bill.

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

Woloson said that if you go to a provider outside of your network, what you have to pay may be higher even if the overall cost is lower.

It’s also important to understand the ins and outs of your health care plan. If you have a high deductible plan and have already met your exemption for the year, it makes sense to schedule healthcare within the same calendar year rather than wait until January when your deductible resets. You may also want to fund a health savings account if you know you will need a procedure within the next year. Doing so allows you to set aside untaxed income to pay for healthcare and effectively use the tax deduction to lower your costs. Contributions to a health savings account are also tax-deductible.

If you receive an unreasonable or higher-than-expected invoice, the first step is to ask for a detailed breakdown or explanation.

If you are still charged more than you believe is fair, you can appeal. But this is difficult because your negotiation power as an individual is limited.

Follow the instructions on your insurance forms to start appealing an insurance claim denial.

If you eventually find that a procedure or service is not covered, your healthcare provider may be willing to give you a discount of up to 25 percent, and may also give you a discount if you pay your bill in full promptly. You should ask for a discount whenever possible, Woloson said, oftentimes a provider will agree to an earlier payment of an invoice.

For toll-free assistance with medical billing, call the Affordable Healthcare Consumers helpline at 800-965-7476 any weekday from 8:30am to 4:30pm.

You can also file a complaint with the Maine Insurance Bureau if your appeals to your insurance company or healthcare provider are unsuccessful.

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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