How to Minimize Surprise Out-of-Network Bills

Are you undergoing surgery or an outpatient procedure? Before you schedule your appointment, ensure your health plan covers all the providers who will work on you. There is no ruder awakening than receiving a big out-of-network bill after undergoing a medical procedure.

You may not know that, while your physician may be covered, the anesthesiologist or a radiologist who assists in the operation may not be a member of your health network. The same can hold true for primary care physicians. Consider taking the following steps before you’re unpleasantly surprised:

  • Each time you schedule an appointment with your primary care physician, ensure he or she still accepts your health insurance plan. Be sure to ask if the physician is a “network” provider.
  • Undergoing lab or radiology tests? Be sure the provider is part of your insurer’s network.
  • Before you undergo outpatient procedures, call the facility and ask for the names of all providers who will render care. Ensure those providers are in your network. Your insurer’s website should be up to date, but don’t rely on it. Call your health insurer prior to undergoing a procedure to be sure you won’t be surprised by an out-of-network charge. Write down what is said during the call and the name of the person who spoke to you.

If you do receive an out-of-network charge, call the provider to ensure they billed the insurer correctly. Sometimes providers use the wrong tax identification number, and the insurer considers them out of network. If the charge stands, call the provider and try to negotiate the amount. If you’re on a fixed or reduced income, some providers will accept the amount your insurer would have paid or that amount plus a smaller contribution from you.

If you’re experiencing network issues, meet with your agent to ensure the plan you have now is still the best one for you.