Health Care Hacks Ep. 4 – Surprise Medical Bills


Surprise! Unfortunately not all surprises
are good. In this episode of Health Care Hacks, we’re talking about surprise
medical bills, and what you your family can do to avoid them. Hi my name is Jon.
I’m a health care hacker. Surprise medical bills, I really define them as when you
get charged for something even though you’ve got insurance that you’re not
expecting. It’s not your deductible, it’s not your coinsurance, it’s not your
copay, it’s something the insurance doesn’t cover. I talk to a lot of
people that say, “Ah, Jon! I’ve got great insurance. I don’t have to worry about
surprise medical bills,” and I say uh-huh, you do, unfortunately you do. Doesn’t
matter how great of health insurance you have, surprise medical bills can still
happen. There’s really two main causes: the first one is out of network. So you
might go to a hospital that’s in network but a surgeon that does the surgery is
out of network. Well, guess what? You’re gonna have to pay more for that surgeon.
And look, you’re unconscious, can’t decide where to go and take an ambulance ride,
there’s no way to fully avoid it, but if possible ask the question, is the surgeon
in network, is the anesthesiologist in-network, is the physical therapy in-network, that’s a good way to avoid some of those medical
bills where your insurance company ill only pay a little bit and you’ll be
responsible for the entire out-of-network amount. What do you do if you do get
that out of network bill? You negotiate is what I tell people, because it doesn’t
go through insurance. Basically insurance company, says we don’t a contract with
you, you’ve got to pay the full charges. That puts the onus on you. Most
organizations, most providers realize that they’re charging in more than they need to. Typically your insurance company will pay 40 to 60 percent of
what the charges are. So what I tell people is, look at what you can pay and
try to shoot for the 40 to 60 percent of what the charges are. One
other little piece of advice: you could also go on payment plans. Most providers
will offer 12 to 24 months interest-free payment plans, so if you
get that big bill you can ask to basically protect yourself so you don’t have to come up with the money right away and plan for over the next year or two. The second way people get hit with surprise medical bills is when your insurance company denies something. They might say this isn’t medically necessary, you don’t need that back
surgery. You can’t fully avoid this, but you can absolutely limit your exposure; and the way to limit is ask for something called a
predetermination. Anytime you’re getting outpatient surgery, infusion therapy, or
high-dollar radiology tests like a cat scan or an MRI, you should always ask for
predetermination, that’s where your doctor makes sure that that’s going to
be covered. They send your medical records and information to the insurance company to make sure that’s going to be covered by the insurance company before you have the services. Because if you have that services and the insurance company says, “no, no, no, Jon, you didn’t need that,” guess what? You’re probably gonna be
financially responsible. In summary, make sure that your doctors are in-network. Ask
the questions. If you go the hospital as much as possible. And secondly, if you can, on anything that’s scheduled try to get a predetermination, even if they say they
don’t require prior authorization, it’s different, ask for that predetermination,
otherwise you’re rolling the dice and you might end up paying tens of thousands of
dollars that you don’t need to. If you have questions about how to save money,
or problems you’re facing with healthcare dollars, email us on the
address on the screen.

Daniel Yohans

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