Out-of-Network Medical Bills Can Hit Your Budget Hard

Seeing a doctor or undergoing a medical procedure is stressful enough without adding an unexpected medical bill to your worries, especially since once you face a hospital admission, you can’t always choose your medical providers.

Some surprise bills can be mistakes. For example, you make an appointment with your primary care physician, but she’s not available when you arrive, so you see another provider. If that doctor or nurse practitioner is not an “approved provider” for your health plan, you may face an unexpected bill. Or if the anesthesiologist the hospital uses for a surgery you’ve scheduled is not approved by your plan, you may receive another unexpected bill.

How do you avoid surprise medical expenses? When you schedule surgery, talk to your insurance carrier to make sure all who will care for you are approved providers. Don’t ask if your health insurance “accepts” each provider; instead, ask if the providers are in your “insurance network.” Following this procedure can help ensure that your health plan approves all your providers.

If you do get an unexpected bill, call that provider’s billing office and ask if they are network providers. If they are, they will resubmit the billing to your insurance for proper payment. These errors often happen upon the first submission of a medical bill.

If your provider sends you out of network, you have a case for payment by your provider. Your providers should verify they make referrals only within your plan’s network if possible. If you must see an out-of-network provider, ask for an estimate of all costs before you see that provider.

If all else fails, your state department of insurance may have some solutions. As many as 28 states have enacted legislation to fix this costly problem, and both the US House and Senate have considered similar legislation.