It’s not uncommon to feel a pit in your stomach before opening a medical invoice — especially one you didn’t expect. In fact, more than half of Americans say they’ve been surprised by a bill for health care services.
“These bills can be both unexpected and very expensive,” said Dr. Donna O’Shea, chief medical officer of population health, UnitedHealthcare. “They can happen in emergency and non-emergency situations.”
In an emergency, a surprise bill sometimes occurs when a person receives emergency care in an ER from a health care provider who is not in their health plan’s network. The problem may also happen when a patient receives non-emergency medical services from an out-of-network care provider without realizing it, including when they’re referred by their doctor to another health care provider or facility.
To address these problems, lawmakers have mandated more cost transparency in health care. The No Surprises Act and other transparency-focused regulations have created important consumer protections, including a recent requirement that health plans publicly disclose their contracted rates with health care providers and facilities. Even more consumer-friendly disclosures are slated for 2023.
“While these changes offer increased protections, they will not eliminate all potential issues,” Dr. O’Shea said. “It continues to be important for people to be proactive about their care decisions and to understand what help is available if a surprise bill arrives in their mail or inbox.”
Here are five strategies to help avoid a surprise medical bill:
- Verify what services may cost – Before scheduling a medical appointment, check with your health plan to review available quality and cost information. Some health insurers offer personalized transparency resources through their websites, mobile apps and customer service representatives. For example, UnitedHealthcare members have access to quality and cost information for more than 820 common medical services to help them comparison shop for care.
- Understand preventive-care parameters – Health plans usually cover preventive services, such as wellness visits, mammograms or colonoscopies. But some advanced screenings may not be considered preventive and could result in an out-of-pocket charge. Be sure to confirm that all scheduled services will be covered under your policy. If necessary, your health care provider may complete the preauthorization process through your health plan before your appointment.
- Stay in-network for tests – When a primary care physician refers you to a lab for bloodwork, imaging scans like MRIs and other tests, be sure you’re using an in-network facility. Using an out-of-network lab could end up costing you more. Some health plans now proactively contact members in a text message or phone call — before they go out of network — to offer in-network options that may help lower out-of-pocket costs.
- Know what to expect in an emergency – The No Surprises Act applies in many but not all situations. For instance, the protections do not apply to ground ambulance services. While it is important to seek immediate medical attention during an emergency, it may be helpful to understand which emergency service providers are in your area before you need them, as well as recognize that some ambulance rides might not be in network with your health plan.
- Look for plans with upfront pricing – Some modern health plans enable you to review specific health care prices beforehand and access medical care without deductibles or coinsurance. The goal is to simplify the health care system with plans where:
- Treatment costs are clear in advance and based on plan details
- Patients can easily compare care provider or facility options and see how and where to save
- Effective and efficient treatments often cost less
Examples of this type of coverage include the Surest health plans from UnitedHealthcare, which may cost up to 15%1 less per member per month compared to high-deductible plans and reduce out-of-pocket costs for enrollees by 45%.2
If a surprise bill does occur, know your options for negotiating down the cost. Consider talking with staff at your hospital or doctor’s office to request that a charge be reduced or waived. Your health plan may also offer resolution support to help with negotiations.
For instance, eligible UnitedHealthcare members in employer-sponsored plans may have access to a resolution program. Call the number on the back of your insurance ID card to alert your health plan and check on assistance.
For more information, visit uhc.com.
1 Medical plan savings compared to UnitedHealth Group HDHP plans with similar population demographics, geography and disease burden, 2021
2 Surest and UHG plan sponsor members with at least 12 months of incurred experience in 2020 and both medical and pharmacy data; compared to matched comparison groups from a nationally representative commercially insured database matched by gender, age, urbanicity, and state using exact matching algorithms. Results are adjusted for member risk using commercial HHS-Hierarchical Condition Categories (HHS-HCC) risk scores