Americans are used to receiving invoices by mail – but one of them tends to surprise many of them.
More than half of American adults were surprised by health insurance, which according to NORC's insurance policy was at the University of Chicago (formerly known as the National Opinion Research Center). One in five respondents were surprised that their doctor was not on the network, which meant the doctor did not accept the patient's health insurance.
More than half (53%) were unexpectedly charged for medical services and a further 51% said the surprising cargoes came from laboratory tests, which resulted in surveys of more than 1
See: More and more health care costs amount to over a million dollars – and expensive medicines play a big role
"The whole system is full of manipulation"
These surprising bills are not one Shock to health experts. The American healthcare system is difficult to navigate, said Carolyn McClanahan, head of financial planning at Life Planning Partners and a medical doctor. Some patients may not understand what they pay for, how they pay for it, or who should pay for it. You may not know the differences between deductibles, costs and maximum expenses, or what and who your insurer actually covers.
Out-of-Network versus In-Network is a source of tension, stress and additional costs for many patients. Doctors would usually take out insurance, McClanahan said, but if they're on the network, that means they've made a special agreement with insurers to charge patients and insurers a certain amount. If they are outside the network, they will still have many forms of insurance, but the insurer will not cover so much of the bill – so the patient has to pay the balance.
"The whole system is full of manipulation," she said.
Make sure there are labs and specialists in the network
Patients must also make sure that the doctors and facilities their doctors can send them to are also on the network. About 20% of cases in the emergency department would probably lead to an unexpected medical bill, compared to 14% of outpatient hospital cases and 9% of hospital admissions. Self-planned procedures may end in a surprise bill when an out-of-network specialist participates – for example, when an anesthetist is working outside the network with a surgeon on the network.
States such as California, Colorado, and New York have passed laws to prevent these surprising bills, though they can not always protect patients. New York has a law that protects patients from paying more than their in-network co-payment, co-insurance or deductible for emergency services, even if they were performed by a doctor outside the network.
See also: This man will help you get rid of expensive medical bills
Know what your deductible is and, if possible, save an emergency fund
Emergency visits are difficult but individuals can take action to prevent surprise bills in non-emergency situations. For planned services, patients should ask billing agencies for estimated costs and if possible shop. Healthcare providers and insurance companies are also negotiating payment options. Either set a payment plan for unexpected expenses, or ask for support through a financial hardship plan.
Finally, take a closer look at your health insurance and deductibles (the amount you must pay in advance before the insurer begins to pay). Then you start saving for an emergency fund that covers the entirety of your deductible, McClanahan said. "If you do not use it, you have a pillow for next year," she said.
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