INSURANCE

Q:A:No one likes being surprised by unexpected medical bills. Unfortunately, medical insurance coverage is complicated, and it is not up to your health care provider or doctor’s staff to interpret each patient’s individual policy. This is a situation where you are going to have to take steps on your own if you want to avoid billing surprises. Do you have any tips to help me avoid surprise medical bills?

I always recommend insureds begin by taking some time to become familiar with their specific plan’s Summary of Benefit. You can find this online or you may have a copy that was mailed to you when you enrolled. Every plan does not provide the same coverage or cover the same doctors, clinics, prescriptions, and other services so get to know your plan.

When you make an appointment, ask if your provider is in your plan’s network, even if your doctor has always taken your insurance and is listed in your Provider Directory. Changes can take place throughout the year.

If you are scheduling a procedure where more than one health care provider will be involved, ask if the other professionals are also in-network. This is especially true if your care includes anesthesiologists or radiologists, or if you need lab tests. These can often be a source for surprise medical bills.

If you need emergency care, the medical bill is the last thing that should be on your mind. In these cases, it may be best to address the problem after you get a bill. Insurers will often work with the hospital for emergency situations.

If you get a surprise bill contact your health care provider, whether it is a hospital or individual provider. Verify your bill against any personal records of your treatment. Ask about financial assistance, payment plans or other ways to reduce your bill. Hospitals often have these programs, but you may have to ask about it. You can also contact your insurance company and inquire whether they can help you negotiate a lower rate.

Please remember, your insurance policy is between you and your insurance company and not between your insurance company and your doctor.

If you have questions concerning life and health insurance, including Medicare Advantage Plans, Medicare Supplements, please contact me at 440-255-5700 or Lmutsko@mutskoinsurance.com.