Navigating the Sea of Medical Bills

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The world of health insurance can be complex and sometimes confusing for consumers, especially in understanding medical bills.

Why does receiving a medical bill evoke anxiety in most? Is it the lack of knowledge around health care coverage? Is it the fear of overpaying?

Whether it's a bill for a yearly physical or a more serious matter, such as surgery, people sometimes feel overwhelmed or just plain confused when they see their statement. By becoming your own health care advocate, this doesn't have to be a stressful experience.

Health coverage can be intimidating. But if you take time to be a proactive, informed, engaged patient and consumer—and if you use the resources available to you through your health plan—you can save yourself much of the stress of medical bills.

Consumers should take time to review and understand their current health plan. To test your knowledge of your health plan, ask yourself these questions.

  • Is my plan an HMO or PPO?
  • Does the provider and the facility accept my insurance?
  • Do I have coverage through state programs like Medicare or Medicaid?
  • What is my plan's deductible?
  • What is my out-of-pocket maximum under my current plan?

Your health plan determines the amount you pay for a doctor visit and affects what medical services are covered, where you can receive care, and the amount of money you pay out of pocket. Don't hesitate to contact your health insurer to ask specific questions about your plan or any planned procedures you have. Advocating for yourself or for a family member and being prepared for potential costs will take the guesswork out of future medical bills.

Cost transparency tools such as Priority Health's Cost Estimator instantly calculate out-of-pocket costs, based on a member's personal health plan and what's been spent so far for hundreds of procedures, among them X-rays, MRIs, lab tests, and surgeries. The tool can also share drug prices, even before prescriptions are filled.

No one would ever purchase a car without first checking the price. People are beginning to think similarly regarding their health care. Consumers seek more cost transparency, and cost estimator tools help lift the veil and equip them with the information they need to make informed decisions.

Mistakes can happen occasionally. When you receive a medical bill, read it carefully. These are a few common errors to watch for.

  • Upcoding: A medical billing code is mistakenly entered as a similar, more serious treatment or diagnosis.
  • Unbundling: Charges that should normally be entered under one code are listed separately.
  • Duplicate billing: You receive multiple bills for the same treatment or service.

If something doesn't seem right on your bill, contact your health care provider or your health insurance provider. When mistakes happen, consumers need to advocate for themselves.

Looking ahead, people should take advantage of no-cost preventive care. Because of the Affordable Care Act, most health plans must cover certain preventive care services, such as well-child visits, flu shots and physicals, which help prevent illness before symptoms occur.

These services are covered at 100%, before deductible, when performed for preventive purposes by an in-network provider. This means that even if someone hasn't met their deductible, there will be no out-of-pocket cost.

Many consumers are unaware of preventive health benefits or avoid them out of concern for added costs, so it's important that they consult their health insurance provider to see what's covered under their specific plan. We can't predict when we'll need medical care, but we can take the needed steps to be prepared and informed.

Though most people don't enjoy going to the doctor or hospital, it can be necessary in maintaining good health. Being your own advocate and taking time to understand your health insurance plan and costs of medical services is your best bet.

Carrie Kincaid is Vice President of Individual Markets for Priority Health. Michigan's second-largest health plan, Priority Health serves more than 1 million members each year. Learn more at PriorityHealth.com.

This article originally appeared in the Feb/Mar 2020 issue of West Michigan Woman.


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