Never Pay the First Bill by Marshall Allen

Author:Marshall Allen [Allen, Marshall]
Language: eng
Format: epub
Publisher: Penguin Publishing Group
Published: 2021-06-22T00:00:00+00:00

Whenever possible, stay in network with your insurance plan.

If you have health insurance, make sure, if possible, that you avoid getting care with hospitals and other medical providers that do not have contracted rates with your insurance plan. These out-of-network medical providers can pretty much charge whatever they want to your insurance plan. Then you may have to pay a larger share than you would have, had you stayed in-network. It’s been the practice of some medical providers to come after patients for the balance. These are the notorious “balance” or “surprise” bills that can easily sneak up on patients, and they’re often for outrageous amounts.

Congress passed a ban on surprise medical bills at the end of 2020 that will require the bills to go to mediation to determine what should be paid. Hopefully, the ban will help, though some say it will still result in high costs. But out-of-network bills will likely still be with us, so try to stay in network.

Sometimes it’s impossible to avoid out-of-network care, like if you go to an in-network hospital for emergency care and get treated by an out-of-network doctor. You can’t possibly prevent that. But other times we can prevent it, like if we’re looking for a doctor or a facility where we can get treatment for ourselves or our loved ones. In those cases, we must do everything we can to stay in network so we can take advantage of the rates that have been set by our insurance plan. Make sure you always ask for the cash price, if possible, because sometimes it’s even lower than the negotiated insurance rates, as I discuss in the following chapter. But start by staying in network.

Check with both the health care provider and your insurance company to make sure the treatment will be in network. Their agreements can change at any time, or the person on the phone at your doctor’s office or hospital might not be properly informed. If you have health coverage, make sure you call your insurance company or the company administering your organization’s self-funded health plan. (Most American workers and their families are covered by self-funded plans, which means you should consult your organization’s benefits department and executives if you’re running into problems.) Once you have the medical code that’s used to describe the test or treatment you will receive, ask whether your insurance plan covers the service at a given location, and what your price will be after treatment. You want to make sure that whatever is being recommended is covered, and you also want to be able to see if you might be able to pay less without using your insurance, as I will describe in the following chapter.

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