When it comes to consumers and health care, CNBC said it best: “Asking everyday Americans to navigate health insurance is like asking passengers to fly the plane. Without proper education and access to information, it’s nearly impossible to avoid turbulence along the way.”
If you’re like millions of Americans who are confused about what your health insurance plan actually covers and what all those numbers and seemingly random charges are on your medical bill, then here are four crucial questions you should always ask before seeking healthcare treatments:
Are You an In-Network Provider?
A major problem on the rise in the US is surprise medical bills from out-of-network providers. Astonishingly, there are several states where it’s acceptable (even normal) for an in-network hospital or medical facility to have out-of-network doctors and other medical professionals working for them, which leads patients to mistakenly believe their care will be mostly covered by insurance. Worse yet, some online listings for facilities and providers on your insurance company’s website may be out-of-date!
Unfortunately, this happens more often than you might think. A poll from the New York Times and Kaiser Family Foundation suggested that 2/3 of Americans who have dealt with out-of-network bills didn’t even realize their provider was out-of-network before receiving treatment.
To avoid these costly mistakes, the first thing you should ask a receptionist, nurse or doctor when you call or visit their office is: “Are you a participating provider under my health insurance company?”
Is This Covered by My Plan?
A 2014 study from the American Institutes of Research found that a whopping 42% of Americans were unlikely to check whether a service option or prescription would be covered by their plan before proceeding with the treatment. This can lead to thousands of unexpected medical bills that you previously assumed would be covered by your health insurance plan.
To prevent this from happening to you, be completely upfront about your plan and insurance company with your doctors beforehand. There are many different plans available under the same health insurance company, so don’t assume your service will be covered just because you’re receiving it from an in-network provider.
How Much Does a Particular Service or Drug Cost?
A 2014 survey from CNBC found that just a third of Americans negotiate their medical bills with hospitals, and only a third of Americans know how much a procedure costs beforehand. Would you ever agree to ordering a large meal at a restaurant without knowing the price of each appetizer, entree, beverage and dessert beforehand? Of course not, so why would you take an even bigger risk by not asking for the cost of medical procedures before you undergo them?
It’s extremely important to know what (and how much) is covered by your particular health insurance plan before signing any paperwork. This requires you to carefully read through your coverage benefits offered by your insurance provider and possibly speak with a health insurance expert for further assistance before you pursue any medical treatments.
Additionally, be sure to ask a any provider who prescribes you medication about generic options. Insurance companies almost always charge more for name-brand drugs, so don’t get stuck with a larger medical bill because you overlooked a more affordable medication option with the exact same chemical makeup as the name-brand drugs.
Can I Get an Itemized Bill?
Did you know that you’re entitled to an itemized list of expenses on your medical bills? The problem here is that most consumers don’t understand all the various codes and terminology you might find on a typical medical bill. Fortunately, you can either look these codes up yourself (you may very well find an error, depending on the service you’re being charged for and what you actually received from your doctor) or you can speak with a trusted health insurance professional about what you were charged for and how legitimate that charge may be.