Medical fees have the potential to drain a person or family’s lifetime accumulation of wealth in an instant. The cost for what seems to be a simple procedure can be thousands of dollars and more complicated procedures in the six figures.
Adding to the frustration is trying to anticipate, plan, and understand the total costs and who all will be sending bills, what amount is covered, etc. It’s challenging to get a clear answer from the insurance company and the doctors.
This is also a difficult area to nail down the total cost and the amount you’re liable to cover if you have insurance. There are surgery codes that are commonly used to define procedures and discuss with insurance providers. Get the exact surgery codes in advance of the procedure to help estimate your medical fees.
The Risk of Procrastination
As the saying goes “Bad news doesn’t get better with time.” The implications of not paying or a lack of effort to attempt to work out a plan or negotiate will likely result in lower credit score, potential interest payments on the money owed, debt collector contact, and even a possible lawsuit.
Working with the medical office or debtors doesn’t mean you have to agree to all the fees. Challenge anything that doesn’t make sense or seems outrageous. Document conversations and responses. You have nothing to lose by negotiating professionally and in good faith. It could result in avoiding significant medical fees.
Paying for medical fees with a credit card may be an option but be wary of credit cards fees. You may be able to get a 0% interest period which can buy a few months. If not careful with this strategy, you may just be shifting the debt from one source to another and not solving anything and possibly making matters worse.
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A hot topic within medical billing practices is surprise billing. Surprise billing or unanticipated billing are terms when the patient is unaware of extra fees when an out-of-network doctor is used at an in-network facility.
There is bipartisan support to mitigate surprise billing to better protect the patient. In mid 2019 several changes were made to get traction on this topic. However it’s complicated by many factors and even if there are new laws adopted, the hospitals and doctors are likely to find loopholes and other ways to get your money. Here is a link to an article that sheds some light on the topic.
But there is more to be aware of. Just about every time a doctor or nurse picks up a tool, uses an item (from gloves, bandage wrap, to heat pads), you will probably get charged for it. Even watching TV can come with a fee. Before asking for a particular medical test or procedure, ask how much it cost first.
In-Network vs Out-of-Network
Most health insurance plans have agreements with certain doctors and hospitals. This network of care is referred to as an “In-Network” group. This agreement comes with reduced rates compared to getting care from doctors and hospitals that are not in the agreement (i.e. Out-of-Network).
Therefore choosing in-network providers is often the most economical option for care. However, the surprise is when you’re not made aware of all the care providers involved. You may be aware of the doctor being In-Network, but what about the anethesiologist? It’s possible this person is not in the network and you may be billed a “surprise” that isn’t going to be a pleasant surprise.
As with any major potential expense, conducting research and planning ahead can have a significant impact on your overall fees.
- Contact your medical insurance provider to find out if your plan covers the doctor(s) and services providing your care. In some cases there should be medical codes that define the exact procedures.
- Get the responses in writing since insurance policies can change and especially if your care is likely to span over a long period of time. One step further, get confirmation or acknowledgement that the other party agrees or received your email (or letter).
- Ask your insurance provider if all providers of care are In-Network. This includes any provider that could be used for your care. This helps avoid the surprise use of an Out-of-Network doctor.
You can ask all the preparation questions that you know of and it still may not be enough to predict all the fees. Many times you don’t know what you don’t know and it’s impossible to ask the questions or anticipate all the possible outcomes and possible fees. However, ask as many questions as necessary to get the best case and worst case scenarios in terms of costs. Reiterate that you want complete transparency and disclosure of all the fees.
Ideas to reduce medical fees
More and more people are traveling out of the US for medical and dental procedures due to cost advantages while maintaining the similar level of care. Some may even accept your US insurance plan.
Obviously this can be expensive and time consuming depending on your location but if your procedure is costly it may be a consideration. The quality of care may not be as bad as some percieve but then there is the issue of follow up visits.
It may be possible that your medical (and dental) providers offers reduced rates for those with proven financial hardship or low-income. Make sure to discuss this upfront to understand the viablity of this option.
As with any fee, negotiating can only help and the best chances come when you’re prepared and respectful. Negotiate prior to paying the fees so there aren’t any surprises. Get any agreed terms in writing. If your being contacted by a debt collecting agency you often have more negotiating leverage. These agencies typically by outstanding obligations (debts) from businesses at very low cost (since they are assuming all the risk of ever collecting any of it).
Consider hiring a medical bill advocate if you don’t feel comfortable negotiating on your own and you have a hefty sum to pay, Make sure to understand their charges so you can determine if it’s worth it. Their strength is their expertise in the medical field. They understand the surgery codes, going rates, jargon, and can most likely find errors where most people can’t.
Get Insurance or a Discount Plan
This comes with a costs too but may be worth it if you have time to get it in place. Especially if you have more medical risks/costs looming in the future for you or your family. Before you ink in a plan, verify the following:
- Insurance company is registed in your state
- Your doctor’s office accepts that plan
Ask the doctor’s office to determine the amount covered by the plan and how much you need to pay out of pocket.
Filing a Complaint against a Doctor
If there’s a dispute with the services or fees from your doctor or medical office the first step is to attempt resolving with the office. Read the section on “Effective Complaining” to prepare yourself. If you’re not satisfied let them know you plan to contact your state’s medical board. If that fails, follow through with any of the following options.
You can usually file a complaint by email, online, phone or standard mail or a combination of them. It’s advised to keep as much in writing as possible with dates, names, and details.
As with any other type of complaint, find them on social media and voice your complaint and request a response. Another option is to file a complaint at the Better Business Bureau.
Filing a Complaint against Medicare Provider
The link below to Medicare.gov explains how to file complaints, check status, and even an appeals process. Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care you got from a Medicare provider. You can select any state and choose from several organizations within each state and usually get a phone and/or website for further information.
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