If you require any type of medical services, it is crucial to ask questions in advance to avoid incurring unexpected bills. Even if you have insurance, you shouldn’t assume that any of the services you receive will be fully covered by your policy. Making a few inquiries ahead of time could end up saving you hundreds, if not thousands, of dollars.
Communicate with Your Insurance Company
Before seeking medical services, call your insurance company. It is important to understand that having health insurance does not guarantee coverage, especially if a provider is not in your plan’s network. As these networks are created by each insurance company, the medical facility may not be able to answer your questions about coverage. In addition, not every procedure may be fully covered by your plan. To avoid unexpected costs, it is best to communicate with your insurance company to make sure both the provider and services are covered.
Be sure to document the conversations you have with any insurance company’s representatives. You should keep a record of the name of the representative, the time and date of the call, and the reference number. If an issue later arises, the insurance company will have to stand by the information that was provided to you.
Office Visits and Physicals
Whether you are going to a doctor for the first time or a routine check-up, first call the office to find out what procedure and diagnosis codes may be billed for any services you might require. Even if the visit is for a yearly physical, it is important to confirm with your insurance company that your policy still covers some or all of the services as part of a routine exam. Additionally, if blood samples will be sent out to a lab for processing, you need to confirm that the lab is in network. You will also need to review the procedure and diagnosis codes for the blood tests to determine which are covered under your wellness benefit.
Sometimes a doctor may recommend further testing. If the testing is not urgent, you may want to schedule another visit to first clear coverage with your insurance company.
Emergency Room Visits
Unfortunately, if you require a trip to the emergency room, you may not be able to ask many questions about billing in advance. Since a visit to the ER is usually the result of a critical health condition, you also may not be able to limit your services or procedures. As emergency room treatment can be very costly, it should be reserved for a true medical emergency. If your condition is not life-threatening, you may instead consider visiting an urgent care facility where you will be better able to limit the expenses you incur.
Hospital Visits & Testing
If your doctor recommends that you go to the hospital to have certain procedures done, it may be worthwhile to explore other cost-saving options. For example, if you require blood or radiology testing, your doctor may want you to have the tests performed at the hospital he/she is affiliated with. In this case, you should find out whether there is an independent facility within your network. Fees at the hospital will typically be much higher, and if you have a high deductible plan, it could end up costing you more. In either instance, confirm with your insurance company first whether the facility and procedure codes are covered.
Prescription & Medication Costs
When filling a prescription, you should be aware of cost-saving options. In some states, such as New York, electronic prescriptions are now mandated. This means that patients no longer are given a paper prescription to shop around for the best price, or even know how much the medication will cost.
There can be a wide disparity in the costs of prescriptions. If you don’t need the medication urgently, it is a good idea to find out the name and dosage in advance. This will give you the opportunity to shop around for the most cost-effective option before you are prescribed. Prices can vary greatly between chain stores, local pharmacies, and mail order fulfillment. You may also be able to find coupons online or fill the prescription through certain on-line pharmacy discount services. If the prescription is for a chronic condition, you may want to inquire about mail order services, as per your pharmacy benefits plan.
Contact an Experienced Medical Bill Advocate
If you have received an unwarranted or excessive medical bill, it is important to understand your rights and recourse. An experienced medical bill advocate can help fight an excessive bill and save you thousands of dollars. Systemedic is a nationally-recognized medical billing advocacy company with decades of experience in helping victims of fraudulent and unethical medical billing practices. If you are experiencing a medical bill dispute, contact Systemedic today at (845) 639-0007.