Essential Tips to Avoid Surprise Medical Bills

07 Apr

If you are planning to undergo a medical procedure or surgery, it is important to know how to minimize your chances of getting a surprise or an out-of network medical bill. This mostly occurs when your health care provider is not part of your health's care plan. Here are some guidelines for avoiding a surprise medical bill.

The first tip to prevent surprise medical bills is to ensure that you have the names of the specialist who will be providing your care. Many hospitals have different practitioners; hence, you need to ensure that anyone who is involved in treating you including the surgeon, anaesthesiologist and physician assistants are all in the plan's network. This will mostly work if you are having a planned surgery unlike an emergency where you won't have time to check if they are in-network providers. In the case that the anaesthesiologist does not have connection with your insurance plan, you will be provided with a billing balance where your insurance plan will cater for a small amount.

Before you go for a surgery of procedure, make sure you know what your insurance plan covers. When you know what is included in your plan, you will reduce your chances of getting surprise bills. Call your insurer to verify whether the procedure or surgery you are planning is covered under your plan. After you have understood your plans benefit, it is important to inquire if you will need approval before getting the service through

If you are not able to find a provider within your network, it is advisable to check with your insurer. They may be able to provide you with a lower price for your health care. Also, getting in touch with your health plan before the procedure is crucial since they are likely to change their network. This will help you verify that the professionals you are planning to see are still in network with your provider so you don't receive an unexpected bill. Watch a video at

Also, it is important to be aware of your states rules when it comes to surprise medical bills. Find out if your state has a policy that protects patients against balance billing which may be due to emergency situations done by doctors who are out of network. You can also contact your state insurance department and see if there are laws that may protect you or if your insurance provider will negotiate for lowered prices on your behalf.

Make sure you get an estimate from your doctor and the health plan so you will know how much the procedure and treatment costs. There are several websites and apps that will help you get an estimated cost. You can also check with your insurer as most of them have the price estimate tools on their website. You can read about the details of Apex EDI here.

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