Ah, the dreaded medical bills. Even if you are healthy and have a good health insurance plan, they can be daunting. It seems as though the healthcare industry is a enigma of service organizations. They almost never tell you what anything will cost up front, there is no negotiating the price, and you pay whatever they bill you. With most other service industries, the customer is allowed all the information they want and can ask questions all day. It is not weird to ask how much your monthly internet service will be before signing up but it is impossible to find out how much an outpatient procedure will cost you until months later when you receive the bill. Now, a lot of insurance plans just have you pay a co-payment for each visit or procedure, but we have a high deductible health plan. This means we pay everything up front until we reach our deductible and then our insurance company pays 95% (of most things, read the fine print...blah blah blah). Regardless of what type of health plan you have, you should review all of your bills and your plan before paying anything.
I can tell you from experience that the healthcare industry has some major billing issues. The time leading up to and after the girls were born were full of weekly doctor visits and a 2 week stay in the NICU. This meant that we were getting bills galore (over $250,000 for the girls' hospital stay). We are still receiving bills from over 10 months ago!
So here are a few tips to decoding your medical bills, making sure you are paying what you should, and making sure your insurance company is paying what they should.
1) Before getting anything done, be sure to contact your insurance company to make sure you do not need pre-authorization or referrals. Just call your insurance customer service line and tell them exactly what you are going to do. Be sure to check what they say with your insurance plan booklet (usually found on your insurance's website). The booklet is your holy grail, read it thoroughly so if there is an issue, you can back it up with the booklet.
2) Talk with your doctor (or healthcare provider) about what they require for payment up front. Also be sure you know what their policy is if your insurance company delays or denies payment.
3) Look online to see what things typically cost by going to the Heath Care Blue Book. This is a great resource to use before an appointment so you can budget correctly.
4) Finally, once you've received your bill, please please please please please (did I say please?), double check that the medical codes (CPT codes) actually match up with what was done. There are a lot of line items that you could get billed for that you never actually had done. Go to FH consumer cost lookup to check the code and estimated out of pocket. For example, we were billed for a stay in the nursery at the hospital when my girls never actually stayed there. We saved over $2000 by just calling our insurance and reporting the incorrect billing.
Remember, everything in business is a negotiation. Don't be hesitant to work out a deal with your doctor, insurance company, or billing department. They can setup cash deals and discounts so be sure to ask. And if they are not willing to negotiate, no harm done but at least you did your due diligence in getting a fair value.
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