How to Avoid Unexpectedly High Medical Bills

December 22, 2015

How to Avoid Unexpectedly High Medical Bills


It is very important to understand your health insurance benefits. I suggest you understand who your providers are before you need one, and whether they are covered by your insurance plan. Not all doctors and providers accept every insurance plan. Both an HMO and a PPO have a network of providers. An HMO has a closed network and patients must see a provider on that list. A PPO has a preferred list. Yes, you can see a provider outside of the network, but the benefits will less (which means you will likely pay a lot more for the same service versus seeing someone in the network).

You may even go to an in-network hospital and that employs a physician who is outside your network, so that’s why it is very important to understand whether each service provide you see is covered by your plan.

Many Americans are drowning in medical debt because they did not understand their insurance plan.

Others are victims of emergency situations where no one was able to speak on their behalf.

There is nothing worse than managing an illness and having unexpected medical bills. Fortunately, there are ways to lessen this risk. First as always, educate yourself on how your plan works and how you can receive the highest level of benefits. Next, when you call a doctor’s office and ask “do you take my insurance,” you are not asking the right question. Most provider’s will bill any insurance company and take any amount they pay, then bill you for the remainder, which could be quite high. If the provider is not in the network, they will not receive a satisfactory amount and bill you the rest. They are also not governed by any contract which may require them to charge a lower amount.

Instead, you should ask “are you in my network?” Then, give all the insurance information to the person scheduling the appointment. You should also call your insurance company and confirm that the provider is still in the network and ask for the amount of your portion of the bill. You can also ask if lab work can be in the office or if it has to be done in a network lab. Speaking with your insurance representative prior to visit will let you know what to expect. They are available to help you make wise financial decisions, so call them!

You should ask which hospital is in your network, and keep this information in your wallet as well as informing your family members and emergency contacts.


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About the Author

is a certified medical biller and coder (CPC) and a Certified Professional Compliance Officer (CPCO). She works as an academic coach at Ultimate Medical Academy for the Medical Billing and Coding, Medical Office and Billing Specialist and Medical Administrative Assistant programs. She has extensive experience in the insurance industry dealing with billing, auditing, compliance and sales.

The views expressed herein are those of the author and do not necessarily reflect those of Ultimate Medical Academy.

The UMA Blog covers information and advice for employers and workers at the intersection of healthcare, education and employment. Our contributors are intimately familiar with a wide range of subjects covering professional development, career advancement, workplace politics, healthcare industry specific topics, personal finance, education and so much more. Learn what you need to get ahead and stay ahead.

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