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As health care costs increase and many consumers are watching their spending amid economic concerns, some may put off needed medical care due to financial constraints.
“Medical bills are in the hundreds and sometimes thousands of dollars, those bills are expected to be paid within 30, 60, maybe 90 days [but] most people don’t have that in their bank account,” explained Patricia Kelmar, Senior Director of Health Care Campaigns for the U.S. Public Interest Research Group (PIRG) Education Fund. PIRG helps raise awareness of consumers’ medical billing rights to better protect their health and their pocketbook.
An independent polling report on the impact of medical debt found 24% of adults say they currently have medical debt or dental bills that are past due, or they are unable to pay. Medical debt can lead to many issues for consumers, including potential home foreclosures, personal bankruptcy, and a declining credit score. Not only can medical debt impact finances, but it also has health-related consequences. People may delay necessary treatment due to costs or the risk of falling into debt.
Kelmar says one way consumers can protect themselves is by asking the correct questions upfront.
“Don’t ask, ‘do you take my insurance?’ Ask the question, ‘are you in my insurance network?'” Kelmar explained. She adds, an office or clinic may take insurance but be out-of-network, which results in higher costs for a consumer.
Another important question to ask is if an office or clinic charges a ‘facility fee.’ Kelmar says it’s becoming more common to see hospitals buying provider offices – like your local pediatrician or oncology office – and adding a hospital facility fee to the doctor practices they own. Ask about potential fees upfront so you don’t get a surprise on your bill!
On the topic of surprises, if you need to go to an emergency room, remember that you have some protections under the No Surprises Act.
“When you are in an emergency, you should go to the closest care, and that’s what the No Surprises Act allows you to do, because you won’t be charged extra. You’ll just be charged your regular in-network rate,” said Kelmar, adding, “That protection exists in the case of emergency rooms, air ambulances – like the helicopters or airplanes that might have to transport you – and in a situation where you are in an in-network hospital, but perhaps the anesthesiologist or the radiologist is not part of your insurance network. Those specialists can only charge an in-network rate for you.”
But hospitals are not the only place where you might see a higher-than-expected bill. Let ABC15 Know viewers have reached out to the team asking why a trip to an urgent care center was billed as an emergency room visit. Kelmar says it can happen. It comes down to how an urgent care center is licensed because some may actually be outlying emergency rooms, even though they are not attached to a hospital. A little pre-planning can help consumers avoid unnecessarily large bills. It’s recommended that each year, when a consumer receives their insurance information, they spend a few minutes checking urgent care centers in their area to learn which ones are in-network and if they have any hospital affiliations. This can help consumers know which centers to go to if they need care and help save money in the long run.
If you need a routine check-up or procedure, consumers can ask for a good-faith estimate. You can make the request by phone for a written document from the provider to give you a sense of how much you would pay for a procedure you’re scheduling. Make sure to get as much information as possible included in the estimate, like your name, the name of the provider, and a date. Kelmar says, if the final bill is more than $400 over the estimate, then you have the right to file a dispute against the provider.
“Sometimes different things happen and you need a different intervention, which is going to cost more; but at least for the normal procedures, for example, colonoscopy, breast cancer screening, or blood work, you should get a good faith estimate and hang on to it,” Kelmar explained.
Regardless of your insurance status, check out some best medical billing practices below:
Consumers should appeal any kind of claim denial for the care that they needed. The insurance company may have looked at the information wrong, or perhaps the doctor did not put in enough information to demonstrate why a consumer needed a specific treatment or drug. To increase your odds of approval, ask the doctor to write a letter to support your appeal.
See PIRG’s full report, which includes resources and what to do in specific medical billing situations, on their website.
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