How to protect yourself against unexpected medical bills, insurance denials

The American health care system is such a maze to navigate that trying to minimize medical bills is a time-consuming and difficult task.

It’s “the equivalent of a full-time job to figure out what insurance will pay,” said Ann Woloson, executive director of Consumers’ Affordable Health Care, a Maine-based patient advocacy group.

But there are ways to help lower bills and limit costs.

Just as prevention is the best medicine for staying healthy, planning ahead is one of the best ways to avoid large and unexpected medical bills. Instead of automatically going where your primary care physician refers you for screenings and other procedures, for example, shop around to make sure you won’t be charged more than necessary. Once you go through the process, it becomes very difficult to negotiate a good price.

The cost of surgery, medical examinations and laboratory tests can vary widely. According to the comparemaine.org website, a simple preventive or screening colonoscopy can cost as little as $254 or as little as $4,290 depending on location.

That website is a good place to start when comparing costs. But the least expensive provider you find for a given service — whether it’s delivering a baby, an EKG or a hip replacement — isn’t necessarily where you want to go, Woloson said. Patients need to be assured that they are receiving quality care, but not paying too much. It’s a difficult balance, she said.

In general, avoid routine screenings and medical services at the hospital, as the extra fees they often charge can add hundreds, sometimes thousands of dollars to your bill.

Your insurance carrier also plays a major role in your final cost, so checking with your carrier is also an important step. Your carrier may recommend a different provider than your doctor.

If you go to a provider outside your network, the total cost you’ll pay may be lower, but higher, Woloson said.

It’s also important to understand the ins and outs of your health care plan. If you have a high-deductible plan and you’ve already met your deductible for the year, it makes sense to schedule health care services in the same calendar year instead of waiting until January when your deductible resets. Also, if you know you’ll need a procedure in the coming year, you can set aside money in a health savings account. Doing so allows you to set aside tax-free income to pay for health care, effectively using tax credits to lower your costs. Contributions to health savings accounts are also tax-deductible.

If you receive a bill that makes no sense or is higher than expected, the first step is to ask for an itemized breakdown or explanation.

If you’re still being charged more than you believe is fair, you can appeal. But it is difficult because your negotiating power as an individual is limited.

To start an appeal of an insurance claim denial, follow the instructions on your insurance forms.

If you eventually find that a procedure or service is not covered, your healthcare provider may be willing to give you a discount as high as 25 percent, and may even give you a discount if you pay your bill in full immediately. You should ask for a discount whenever possible, Wolson said, because often a provider will agree to pay the bill sooner.

For free help with medical bills, consumers can call the Affordable Healthcare Helpline at 800-965-7476 any weekday from 8:30 am to 4:30 pm.

If your appeal to your insurance company or health care provider is unsuccessful, you can also file a complaint with the Maine Bureau of Insurance.

Some disputes can be taken to court, but it is a good idea to consult with an attorney before starting legal action.


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