Forget illness – medical bills can be the death of you! If you have outstanding medical coverage through your health insurance provider, you probably will not need this information. However, you might have friends or loved ones who do not have terrific coverage, so you might consider passing on this information to them.
Each year, I have the option of signing up for health insurance through my husband’s work plan. During the last enrollment period, my cost for that would be a monthly premium of $700 per month for a $6500 deductible and $10,000+ out of pocket maximum. That’s a steep premium for less-than-stellar coverage and a high deductible, so I opted to get my health insurance through The Marketplace aka healthcare.gov (also lovingly referred to as Obamacare). My premium is “only” $479 per month for similar coverage and a high deductible. (I used to be on a great plan for business owners through Humana with lower premiums and deductibles and more coverage, but they ended that plan in July of 2017.)
By the way, if you didn’t fully understand some of the terms that I just mentioned, check out this super short but informative article from Forbes.
Last fall was the first time that I’ve needed to go to doctors beyond my primary care physician, which means it’s the first time I’ve had to navigate the world of insurance and medical billing first hand. I’ve set up filing systems for clients who deal with an overwhelming amount of medical paperwork, but navigating the world of medical bills and needing to become my only advocate in an unfamiliar world was a brand new experience. While I’m grateful that I’ve had excellent health up until now, the entire experience has left me with a very poor opinion of health insurance companies in the marketplace, as well as certain medical providers.
I wound up being charged over $1000 for a test that in the end was unnecessary. How can you avoid expensive medical bills from companies that care more about the money than the patient? It’s simple: ASK QUESTIONS. A lot of them. And don’t proceed with anything until you get the answers in writing.
Here are some basic questions to start with in order to prevent unexpected and expensive medical bills:
Question 1: Is the primary care physician that you’d like to use considered in-network by your health insurance provider?
The information on the Blue Cross Blue Shield website was far from current and accurate. Many of the in-network doctors that they listed on their website no longer worked at the addresses listed, and some no longer accepted my medical plan. Verify before your appointment that your plan is accepted and have the doctor’s office email you a confirmation so that you have it in writing.
Question 2: If you need to be referred to a specialist, is that specialist considered in-network by your health insurance provider?
My initial lab work came back “normal” which was great, but didn’t explain what was going on. My primary care physician couldn’t figure out the source of my pain, so she referred me to a specialist. I made sure he was in-network, and I didn’t go to my appointment until I’d received the referral and confirmation of coverage in writing.
Question 3: What are your co-pay and co-insurance for the specialist?
On the plan that I’d had through Humana, there was a minimal co-pay for specialists, and my co-insurance was 20% before the deductible was met and 0% after the deductible was met. I didn’t realize that with my new plan under Obamacare, my co-insurance was 50% of all charges both before and after the deductible. Fortunately, my total was “only” $80 for one office visit.
Question 4: Is the facility that a doctor wants you to go to for tests considered in-network by your health insurance provider?
I knew that the lab was in-network. My old plan paid for the majority of my bills, so when I used to go for blood work, I paid $40 at most. Under my Obamacare plan, I didn’t realize how much of a larger chunk I was responsible for. Are you noticing a trend? I should’ve studied my plan’s numbers more closely so I wouldn’t be shocked when the bills arrived. But I’m not even to the $1000 test yet!
Next week, I’ll share with you the questions that I should’ve asked in order to save me from over $1000 in unexpected medical bills!