How to protect yourself from unexpected medical bills, insurance denials

The US health care system is such a maze to navigate that trying to minimize medical bills is a difficult and time-consuming task.

That’s the equivalent of “a full-time job to figure out what insurance will pay,” said Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine-based patient advocacy group.

But there are ways to help lower bills and limit spending.

Just as prevention is the best medicine for staying healthy, planning ahead is one of the best ways to avoid large and unexpected medical bills. Instead of automatically going wherever your primary care doctor refers you for checkups and other procedures, for example, shop around to make sure you’re not overcharged. Once you’ve gone through the process, it’s much harder to negotiate a better price.

The costs of surgeries, health exams and lab tests can vary greatly. A simple preventive or screening colonoscopy can cost as little as $254 or $4,290 depending on location, according to the website

This website is a good place to start when comparing costs. But the cheapest provider you find for a service — whether it’s delivering a baby, an EKG or a hip replacement — isn’t necessarily where you want to go, Woloson said. Patients should be assured that they are receiving quality care, but also that they are not paying exorbitant amounts. It’s a difficult balance, she said.

In general, avoid routine checkups and medical services at a hospital, as the extra fees they often charge can add hundreds, sometimes thousands, of dollars to your bill.

Your insurance carrier also plays a major role in your final price, so checking with your carrier is also an important step. Your carrier may suggest a different provider than your doctor.

If you go to a provider outside your network, what you have to pay may be higher, even if the overall cost is lower, Woloson said.

It’s also important to understand the ins and outs of your health care plan. If you have a high-deductible plan and have already met your deductible for the year, it makes sense to plan for health services in the same calendar year instead of waiting until January when your deductible resets. Also, if you know you’ll need a procedure in the next year, you may want to set aside money in a health savings account. This allows you to set aside tax-free income to pay for healthcare services, effectively using the tax credit to reduce your costs. Contributions to a health savings account are also tax deductible.

If you receive a bill that doesn’t make sense or is higher than expected, the first step is to ask for a detailed breakdown or explanation.

If you’re still being charged more than you think is fair, you can appeal. But this is difficult because your negotiating power as an individual is limited.

To start an appeal of an insurance claim denial, follow the directions on your insurance forms.

If you end up finding that a procedure or service is not covered, your healthcare provider may be willing to give you a discount of up to 25 percent, and may also give you a discount if you pay your bill in full. You should ask for discounts whenever possible, Woloson said, because often the supplier will agree to one to get the bill paid sooner.

For free medical bill help, call the Affordable Health Care Consumer Helpline at 800-965-7476 weekdays from 8:30 a.m. to 4:30 p.m.

If your complaints to your insurance company or health care providers are unsuccessful, you can also file a complaint with the Maine Insurance Bureau.

Some disputes can be taken to court, but it’s a good idea to consult an attorney before filing a lawsuit.

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