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Know Your Benefits: How to Handle a Surprise Medical Bill

How to Handle a Surprise Medical Bill

If you’ve ever received a surprise medical bill, you’re not alone. According to a survey conducted by NORC at the University of Chicago, over half of American adults have been surprised by a bill that they had assumed would be covered by their medical insurance. Moreover, only 1 in 5 of these surprise bills were the result of a patient actively seeking out-of-network care.

The situation in which you would receive a surprise medical bill is commonly referred to as balance billing. This article will explain what balance billing is, how to handle a surprise medical bill and tips to help you avoid receiving one in the future.

What is surprise medical billing?

When you seek medical care, you often choose where you go to obtain care based on in-network providers. Choosing in-network care is typically the most affordable option.

Unfortunately, even if you choose an in-network provider or care facility, you may be hit with an unexpected costly bill. This is known as a surprise medical bill or balance bill. There are typically two situations in which surprise medical billing occurs:

  1. Medical services are performed at an in-network facility by an out-of-network provider (situation includes both emergency and non-emergency services)
  2. Emergency medical services are performed by an out-of-network provider

In either of these cases, while there was little patient control over provider selection, the patient will be responsible for the percentage of the bill that insurance doesn’t cover. Essentially, you’re billed the balance that remains on the bill. In the majority of cases, patients were unaware of the out-of-network provider until they received the surprise medical bill.

How common is surprise medical billing?

According to the Kaiser Family Foundation, out-of-network charges resulted in a surprise medical bill in 24% of emergency room services provided at an in-network facility. The same study revealed that 18%of inpatient admissions resulted in such charges as did 15% of admissions in an in-network facility.

Medical services that can often result in balance billing include:

  • Services performed by anesthesiologists, pathologists, neonatologists, intensivists,
    hospitalists, radiologists and ER doctors • Ambulance services, including air ambulances
  • Post-procedure medical equipment (e.g., crutches and wheelchairs)
  • Services performed by a provider not chosen by the patient (lab test analysis)

As previously discussed, the majority of patients didn’t know that the provider of their services weren’t in-network. In fact, 7 out of 10 individuals with costly surprise medical bills had no idea until they received the bill.

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4 Tips for Reducing Your Health Care Costs in 2022

Health care costs continue to rise each year, and 2022 will likely be no exception. Experts predict a 6.5% increase this year in medical expenses alone. Consider the following four tips to reduce your health care costs this year:

  1. Pick an affordable health plan that addresses your unique needs. When deciding on a plan, pick one that meets your budget and health care needs. To reduce your overall spending, it’s also critical to know what your health plan does and doesn’t cover.
  2. Stay in network. With health plans, your health insurance company partners with select providers to lower care costs. If you go elsewhere (out of network), you will not have these discounts.
  3. Plan and budget your care. Think about your potential upcoming health care costs, review your plan coverages and budget accordingly.
  4. Ask questions. Don’t be afraid to ask your doctor questions. If you require care, ask them if there are comparable procedures or services that are more affordable while still effective.

Don’t simply avoid the doctor. Instead, take meaningful steps to lower your costs without risking your health. If you reduce your quality of care, it may end up costing you more in the long run.

Staying Healthy to Prevent Severe COVID-19

With much of everyday life reopening, you may be wondering how to keep yourself healthy amid the pandemic. There’s a direct relationship between your diet, physical activity and overall health, so lifestyle choices like the following could potentially lower your risk of serious COVID-19 complications:

  • Eat a nutritious diet rich in healthy grains, fruits, vegetables and fiber.
  • Get quality sleep and drink plenty of water to keep your immune system strong.
  • Work out regularly to lower your chance of becoming severely ill and to help you recover more quickly.

A healthy lifestyle can help you avoid disease in general, and being up to date on your COVID-19 vaccine doses is the best way to prevent severe illness related to COVID-19. Monitor your health daily, and contact your doctor if you have any concerns.

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Long-term Care Insurance

Long-term care insurance is a benefit that allows employers to attract and retain top performers. A recent survey from the Employee Benefit Research Institute revealed that 22% of
companies offer long-term care insurance to their employees.

What is long-term care?

Long-term care (LTC) refers to a wide array of medical care, personal assistance and social support services for people who are physically or mentally unable to independently care for themselves for an extended period. This care can be provided in a nursing home, an assisted living facility or in one’s home. Individuals needing LTC require assistance performing basic activities for daily living or suffer from severe cognitive impairment. Generally, the disabilities requiring LTC are caused by accidents, illnesses or advanced age.

What is long-term care insurance?

To combat the high costs of long-term care, LTC insurance protects individuals against incurring large out-of-pocket expenses in the future by paying affordable monthly premiums now. There are two different types of long-term care insurance policies available:

  • Individual long-term care insurance
  • Group long-term care insurance

Individual policies are generally purchased by people whose employers do not offer a group policy, or by those who feel that they need to supplement their employer’s policy to obtain the most coverage possible. If employers and associations offer long-term care insurance to employees in the form of a group long-term care insurance policy, the policy may not offer the same level of protection afforded by individual long-term care insurance policies. Prior to purchasing a group policy, it is wise to compare the level of protection offered and the level of protection guaranteed in comparable individual policies. Long-term care insurance policies should also clearly state if they are individual or group policies.

How does long-term care differ from disability insurance?

Although long-term care insurance evolved from income disability insurance, major medical insurance or disability insurance does not protect a policyholder in the same way. Unlike a health plan that may cover 30 days of recuperative time, a long-term plan will cover two years or more. Beyond that, disability insurance replaces only salary at the time of the injury, and does not cover the cost of care. The policyholder would then have to pay out-of-pocket for any ongoing long-term medical care due to his or her accident or injury.

Won’t Medicare cover the expenses of long-term care?

Medicare should not be considered as a resource for handling any substantial long-term care expenses. Medicare reimburses the qualified user for a maximum of 100 days, with the average period for repayment of expenses being a mere 28 days. This will not suffice, as long-term care can be extremely expensive.

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