Americans are used to receiving bills in the mail — but one in particular tends to surprise many of them.
More than half of American adults have been surprised by a medical bill they thought was covered by insurance, according to a new survey by the NORC at the University of Chicago (formerly known as the National Opinion Research Center). For a fifth of those respondents, the surprise came because their doctor was out-of-network, meaning that the doctor didn’t accept the patient’s health insurance.
More than half (53%) were unexpectedly charged for physician services, and another 51% said the surprising charges came from laboratory tests, the survey of more than 1,000 adults found.
See: More and more health care bills are over $1 million — and expensive drugs are playing a major role
‘The whole system is rife with manipulation’
Those surprising bills aren’t much of a shock to health care experts. The American health care system is difficult to navigate, said Carolyn McClanahan, director of financial planning at Life Planning Partners and a doctor of medicine. Some patients may not understand what they’re paying for, how they’re paying for it, or even who they should be paying. They may not know the differences between deductibles, copays and maximum out-of-pocket expenses, or what and who their insurer actually covers.
Out-of-network versus in-network is a source of tension, stress and extra expense for many patients. Doctors will usually take any insurance, McClanahan said, but when they’re in-network, it means they’ve made a special agreement with insurance providers to charge patients and those insurers a specific amount. If they’re out-of-network, they’ll still take many forms of insurance, but the insurer won’t cover as much of the bill — leaving the patient to pay the balance.
“The whole system is rife with manipulation,” she said.
Make sure labs and specialists are in-network, too
Patients also need to make sure that the professionals and facilities their doctors may send them to are also in-network. About 20% of emergency department cases were likely to lead to a surprise medical bill, compared to 14% of hospital cases from an outpatient facility and 9% of elective hospital admissions. Even planned procedures can end with a surprise bill if an out-of-network specialist participates — for instance, if an out-of-network anesthesiologist works with an in-network surgeon.
States including California, Colorado and New York, have passed laws to prevent these surprise bills, though they can’t always protect patients. New York has a law that protects patients from paying more than their in-network copayment, coinsurance or deductible for emergency services, even if they were conducted by an out-of-network doctor.
Also see: This man will help you get out of expensive medical bills
Know what your deductible is, and if possible, save an emergency fund to cover it
Emergency room visits might be hard to avoid, but individuals can take measures to prevent surprise bills in non-emergency situations. For planned services, patients should ask billing departments for estimated costs, and shop around if possible. Health care providers and insurance companies will also negotiate payment options. For unexpected out-of-pocket expenses, either establish a payment plan or ask for assistance through a financial hardship plan.
Lastly, take a closer look at your health insurance plan and your deductibles (the amount of money you need to pay up-front before the insurer starts paying). Then begin to save for an emergency fund that covers the entirety of your deductible, McClanahan said. “That way, if you don’t use it you have a cushion for next year,” she said.
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