10 Tips to Protect Your Family’s Financial Wellness.
1. Ask for a detailed estimate upfront
There is no reason to enter into any purchase without having at least an estimate of the cost. Healthcarebluebook.com and other free resource can provide insight into what the cost of care should be in your area and help you print an estimate to share with your provider. Knowing costs upfront will help you avoid surprises after you leave the doctor’s office or hospital.
2. Read your insurance policy thoroughly.
It may not be a fun summer read, but it is really important to understand your family’s coverage before you ever need it. (If you can’t find your policy, most insurers carry plan details on their web sites.) Review your plan annually to see if your needs have changed and if another plan might better suit your family.
3. Speak with your insurance company directly.
Contact your insurer prior to all non-emergency tests and procedures. Ask the representative to explain your coverage, and make certain you have any necessary pre-certifications in place prior to visiting your healthcare provider. You can also ask the representative how much of the test/procedure they typically cover and what your anticipated out of pocket costs might be.
4. Revise the “blank check” clause.
Among the documents you’ll be asked to sign in the doctor’s office or hospital is a patient financial responsibility form. Essentially, it says you will be held responsible for all costs not covered by insurance. We encourage clients to revise it to read, “I will be responsible for costs that are not the responsibility of the health insurer, are medically necessary and competitively priced.” By agreeing to pay all costs, patients leave themselves wide open to pay inflated prices and/or be subject to unnecessary tests/procedures.
Request that all forms be sent to you prior to your visit, and return them in advance of your appointment. You’ll have more leverage prior to your visit, and will be better equipped to handle any objection on the part of the healthcare provider to the revised clause.
5. Make certain all of your healthcare providers are in-network.
If you have a PPO insurance plan, make sure your doctor and hospital(s) are in your insurance provider’s network. Out of network healthcare providers can substantially increase the amount you pay for care.
If you are undergoing a procedure such as a colonoscopy, make sure that the anesthesiologist in particular is in-network. We have seen cases recently where the anesthesiologist was not in-network resulting in bills in the thousands of dollars.
6. Negotiate costs before and after treatment.
Healthcare costs can be negotiated! Most healthcare providers will offer discounts if you pay for the services in cash, for example. Shopping around for better costs should be part of every non-emergency healthcare experience. One patient found that the back MRI he needed was $3000 at the imaging center recommended by his doctor, and $300 for the same test at another facility. With rising deductibles, it’s smart to haggle!
7. Don’t pay your medical bills immediately.
We often make the mistake of paying medical bills before we know what portion will be covered by the insurance company. Often, the medical bills arrive well before the insurance company has processed the claim. Wait until you receive the insurer’s EOB (Explanation of Benefits) before you pay.
8. Question every bill and claim denial.
According a University of Minnesota study, 30% -40% of medical bills contain errors (http://www.wsj.com/articles/SB10001424052748703312904576146371931841968). Healthcare providers must provide you with an itemized bill, complete with billing codes, when requested. Checking bills for errors can save patients thousands of dollars.
If any part of your claim has been denied but you feel it should be covered, appeal it! It may take more than one appeal to get the coverage you’ve paid for, but it is worth it.
9. Document all contact with billing departments and your insurer.
It makes good sense to have a paper trail of interactions with your healthcare provider(s) and insurance company. Capture the name, dates and a summary of the conversation. If the representative has an employee ID number, you should capture that as well. Having this information on hand will help when you need to contact the healthcare provider or insurer in the future regarding your case, and will be beneficial if you need to pursue litigation to resolve a billing or claim dispute.
10. Be fearless and follow through.
Managing the financial aspects of your healthcare is business, not a personal relationship. It’s hard to keep emotions out of the equation when you feel you’re being taken advantage of, but you must. Don’t be afraid to shop, negotiate, question and appeal. It is your money, and you want to be treated fairly. Lastly, do not stop until you reach a resolution that you feel is reasonable.
Sarah O’Leary is a nationally recognized healthcare advocate. She is the founder and CEO of http://Exhalehealth.com.