Have You Been Overcharged for Healthcare?
As healthcare continues to get more expensive, we must take steps to be sure we have not been overcharged for services.
See if this sounds familiar: Your doctor sends you for a variety of tests, or to visit a specific specialist. The bills arrive and seem way too expensive and out of line. Later you learn that your insurance didn’t cover the testing center, or the specialist you were referred to, because they were considered “out of network.”
Out-of-network indicates that those professionals, services or facilities have no contractual agreement with your insurance plan. That means they may bill you whatever amount they please. It’s called “balance billing” and it costs us patients millions of dollars each year.
Some states, but not all, have made balance billing illegal. Regardless, we patients must monitor referrals and outsourcing ourselves to be sure we aren’t paying premium prices for out-of-network services. Even if balance billing is illegal in your state, you'll want to be vigilant.
If you have health insurance, you can take some control over decisions about these referrals. When your doctor orders tests or suggests you seek treatment from a specialist, work with her staff to decide where those referrals will be made.
Before you leave the doctor’s office, ask questions like, “Is the lab that will do my blood analysis covered by my insurance plan?” Or, “Does that specialist accept my insurance, too?”
The dozens of insurance companies your doctor works with represent hundreds of plans, each of which is different. Further, doctor – facility – insurance agreements change every year, and sometimes more frequently. Just because a certain testing lab or specialist was covered by your insurance last year, does not mean it will be covered this year.
Knowing those agreements may change, you’ll want to insist that your doctor’s staff person double checks your coverage for you, even if she thinks she knows the answer. No one can know about every contract with every plan for every insurance company.
Yes, we are patients, but we must think like consumers, too. While it’s not easy controlling costs for our healthcare, this is one aspect we can take charge of. Stepping up to work with your doctor’s office to make consumer-type decisions is a good way to manage some of your healthcare expenses. |
