Overview:
Unexpected medical bills are stressful, even with insurance. One in three insured adults has received a higher-than-expected bill, according to KFF. From understanding preventive vs. diagnostic care to using cost estimator tools, here are five practical ways to reduce surprise medical costs and feel more in control of your health and budget.
Unexpected medical bills can be frustrating and stressful. Even with insurance, many people are caught off guard by costs they didn’t see coming. If that’s happened to you, you’re not alone.
According to a recent KFF Health Tracking Poll, 1 in 3 insured adults said they’ve received a medical bill that was higher than expected. Many also reported putting off care because they were worried about costs.
So the big question is: How can you know ahead of time what your visit might cost? Here are a few ways to stay one step ahead, and avoid surprise bills.
Know the difference between preventive and diagnostic care
This one trips up a lot of people.
Let’s say you go in for your annual physical, mammogram or colonoscopy, routine preventive care that’s typically covered 100% by most insurance plans. But if your provider finds something that needs a closer look, such as ordering more imaging or a biopsy, the visit may shift to diagnostic care, which often comes with out-of-pocket costs.
Even if it happens in the same visit, your care may now be classified as diagnostic and subject to your plan’s deductible, copay or coinsurance. That difference can be hard to spot until the bill arrives.
That’s why insurance companies recommend asking your provider upfront: “Will this test still be considered preventive, or might it be billed as diagnostic?” Understanding this ahead of time helps you make informed decisions and feel more in control of your health and your wallet.
Here’s an example: Imagine you’re Anna, 44 and healthy, heading in for your annual checkup (covered). But your doctor notices high blood pressure and orders a few labs. Those labs? Now billed as diagnostic. A few weeks later, you get a bill.
It’s not a billing error, but it’s definitely frustrating if you weren’t expecting it. Asking that one question at your visit can make a big difference.
Compare prices: Yes, you can
Need an MRI or blood work? Depending on where you go, the cost can vary significantly.
Your insurance company may offer tools or support staff to help you compare prices across clinics, hospitals, and outpatient centers. The exact same scan might cost far less at an independent facility than at a major hospital.
Of course, follow your provider’s medical advice, but don’t hesitate to ask for cost-effective options. Your insurer is there to help you find care that fits your health needs and your budget.
Use your plan’s cost estimator tool
Many insurance companies now offer online cost estimators that show what you might pay for specific services or procedures based on your plan and location.
If your plan doesn’t have a tool, call member services. They can help confirm whether the service is covered, what portion of your deductible or out-of-pocket maximum you’ve met, and give you a general idea of what your share of the cost might be
Ask: “Are you in-network?”
Always confirm whether your provider is in-network. Even if you’ve seen them before, networks can change.
In-network providers typically offer lower rates, and your plan will cover a higher percentage of the cost. It’s perfectly fine, even smart, to double-check.
Call ahead for a cost estimate
It might feel awkward to call a clinic and ask about pricing, but you won’t be the first to do it.
Some clinics have billing staff trained to walk you through costs based on your insurance plan. Have your insurance card handy and ask about the costs of common services, like blood tests or imaging, before your visit.
Bottom Line: Know before you go
It shouldn’t require detective-level skills to understand your medical bills. But asking the right questions and using the tools available through your insurance plan can go a long way.
Your health matters, and so does your peace of mind. While insurers can’t predict every cost, they can help you make more informed decisions.
Because informed means empowered.
The “Understanding Health Insurance” column is provided by Medica. The author, Andrew Marshall, is Medica’s Minnesota market president.
Medica is a nonprofit health insurance company headquartered in Minnesota, serving communities across the Midwest. For more information, visit www.medica.com.
