Avoiding Unwanted Bills

Healthcare can be expensive; take steps to keep your costs down.

Avoid surprises in your medical bills

Understanding your health insurance, specifically your plan, can lessen your chances of a surprise bill. Here are a few terms you need to know.
In-Network providers: Doctors/providers/hospitals that your health plan has a contract to pay for services. Your health insurance pays these providers directly.
Out-of-Network providers: Doctors/providers/hospitals that your health plan does NOT have a contract to pay for services. You may have to pay more for their services.
Balance Bill: If a doctor or providers bill for services is more that what your health plan agrees to pay, you will be charged the difference or “balance.”This is called a balance bill.
Out of pocket maximum: One you have reached the out-of-pocket maximum spend on things like deductibles and copayments, you don’t have to pay for care anymore. But if you use an out-of-network provider you will have to pay their bills, even if you have reached your out-of-pocket maximum.
Your Rights and Protections Against Surprise Medical Bills [PDF]

What to Know About Hospital and Healthcare Facility Coverage

Just because your hospital is in-network doesn’t mean all of their staff is! There may be doctors or professionals that are NOT in network at your hospital, and this could mean an unexpected bill for you.

Below are tips to avoid this from happening based on your procedure.

For Scheduled Hospital/Facility Procedures

Before you receive care, check with your doctor/provider and the health plan to make sure they are in the network. Agreements often change.
If you need to have a procedure, ask where it will take place to be sure that facility is in the network.
Ask who else might be involved in your procedure and if they are in-network; for example, an anesthesiologist or pathologist.
Keep a record of the providers, the date you spoke with them, and the information you received.
If you think you received an incorrect medical bill ask your health plan to help you resolve the issue.

In an Emergency