AVOID SURPRISE BILLS

Balance billing — or a surprise medical bill — happen when you get a bill from a doctor, hospital or other health care provider who isn’t part of your health plan’s network. Outof-network providers haven’t agreed to treat a health plan’s members at discounted rates. Steps to take to help keep your medical costs down:

Use your plan’s preferred provider directory to choose doctors and other health care providers in your plan’s network.

Check Page 1 of your summary of benefits and coverage to see whether you need a referral or prior authorization before seeing a specialist or before receiving certain services, such as surgeries or hospital stays. Review your policy or evidence of coverage to find out which services require prior authorization.

You have the right to find out estimated costs before receiving a medical procedure. Ask your insurer to confirm that the procedure is covered under your plan and how much you could owe.

Request in-network, facility-based providers. Even if you use an in-network facility, some of those treating you might be outside of your plan’s network. For instance, if you have surgery, your doctor might be in your network, but the anesthesiologist might be out-of-network. Your plan might not cover all of the anesthesiologist’s charges and you may be billed for the balance. Ask the hospital facility ahead of time about their providers and whether you will have access to your insurance plan’s preferred providers at all stages of your procedure.