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When you have medical insurance, you likely expect it to kick in and protect you in the event of a true medical emergency. Imagine going through an emergency surgery, or even one you know is coming, to return home thinking all is well. You likely assume the vast majority of the costs associated with your procedure will be covered by your insurance policy. After all, that’s why you have it, to pay for the medical care you need. Unfortunately, that is oftentimes not the case. The following are a few medical expenses you might not expect to get but should be on the look for:

Out-of-Network Providers

Obviously, you know to go to a medical facility that is part of your insurance company’s preferred network. However, did you know that oftentimes, physicians caring for you at this covered facility aren’t in your insurance’s preferred network? In addition, ambulance companies are notorious for not being in any company’s preferred network. The end result is a huge bill coming your way because you didn’t use in network professionals, even though you were in fact in a covered facility. This is a scenario that takes place all too often. Health Care Cost Institute studied some 620,000 hospital admissions. Of these admissions, one in seven of the patients were penalized for using out-of-network providers, even though they were in a covered facility. This is known by the industry as “balanced billing.” Costs like lab services, anesthesiology and/or emergency treatments often fall under the “not covered” category, making it your responsibility to cover these costs. These can be significant, and because the cost of the services provided are not restricted like those in agreement with your health insurance company, the charges are often exorbitant.

Out-of-Pocket Costs/ Large Deductibles

You insurance plan might pay great, after you hit a certain deductible. Unfortunately, until and unless you hit this number, you have to pay the costs for much of your medical care strictly out-of-pocket. To ensure you know what you are getting when purchasing health insurance, make sure you understand how your plan will pay before your deductible is met if at all and learn the amount of your deductible.

Billing Errors

Everyone makes mistakes from time-to-time and medical billing is no exception. Every medical procedure is coded using a specific set of codes. The humans responsible for inputting these codes sometimes enter the wrong code, causing your bill to go unpaid or to be processed improperly by your insurance company. It’s really a wonder that medical bills are ever entered correctly with the amount of hands the paperwork travels through and codes that need to be entered perfectly is considered. When you think about the fact that one hospitalization or surgery can include dozens of consultations, medications and services, there are countless opportunities for errors to occur.

Billing Fraud

While not as common as honest mistakes, sometimes the charges you find on your bill are outright phony. The National Health Care Act-Fraud Association say the following are the most common types of fraud they flag:

  • Billing for services or procedures that were not performed or were unnecessarily performed.
  • Billing for a type of service that is more expensive than the actual service performed.
  • Double billing for the same procedure.
  • Billing more than one copayment.

The above situations are a few that can come up that will cause unexpected medical expenses. Look out for them whenever you face a medical emergency or get a medical bill in the mail.

 

Sources:
https://www.healthcostinstitute.org/blog/entry/oon-physician-bills-at-in-network-hospitals

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