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4 steps you can take to avoid surprise medical bills

How steps like having a health-care advocate and asking for insurance codes can help make sure you aren't surprised with a major bill on the other side of a medical emergency.

Reyna Gobel
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Twenty/20

When Ameriprise financial advisor Joseph Stemmle's friend went into the hospital with a minor sprain from a kickball injury, he had no idea his bill would be $5,000, or $2,000 over his annual deductible. 

Stemmle's friend had selected a high-deductible plan to save on monthly premiums. He didn't realize, though, that the deductible isn't the maximum you pay, but rather the amount you have to pay before your medical insurance kicks in. And Stemmle's friend is hardly alone in his confusion: Nearly half, or 47%, of Americans don't know what their deductible is, according to a January 2020 survey from HSA Bank. 

Even if you do have a solid understanding of what your insurance plan entails and which physicians are in your network, you can still end up with a surprise fee. A February 2020 study in the Journal of the American Medical Association found that 1 in 5 Americans who used an in-network surgeon still faced bills from out-of-network service providers that were required for the surgery, and that the bills averaged over $2,000.

Given that only 41 percent of Americans have $1,000 saved for an emergency, those kinds of fees can pose a huge problem. So what can you do to protect yourself from unexpected medical bills? Here are four steps you can take.

1. Ask for insurance codes and preapproval

During checkups and nonemergency appointments, make it a habit to ask your doctor for the insurance codes associated with the tests and procedures they recommend. 

Before you get the test the doctors recommend, reach out to your insurance company to ask for preapproval, which is approval from your provider ahead of time, so you know the tests are covered. Taking a few minutes during your appointment to step out and make that call can save you hours of time disputing a bill, Stemmle says.

If you find out that a prescribed service you need is out-of-network, you may want to go elsewhere to an in-network provider. If this is the case, you can ask your provider to find in-network options or ask for a referral from your doctor. 

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2. Map out your emergency resources 

"Make a list of the nearest ERs in your area and check which ones are in-network," says Karen McDade, director of financial planning at Ashton Thomas Private Wealth. Since practices and hospitals can go in or out of your insurance plan's network, it's important to run that check every 3 to 6 months.

And make sure you know how ambulances are covered by your plan. You can be hit with an unexpected fee, for example, if an emergency happens out of town and you're taken to the hospital by an out-of-network ambulance.

Your plan may charge you in-network costs at an out-of-network provider if the situation was an emergency and you went to the nearest practice or hospital. Just make sure to get a note from your doctor stating your condition and the urgency of the procedure. And it is always worth it to see if you can negotiate a bill down or ask for a payment plan with help from that additional documentation. 

3. Learn about ER policies for contractors

Depending on the hospital, McDade says that the institution may have contractors on staff. An example of this could be an anesthesiologist or radiologist who works on an as-needed basis but isn't a full-time employee. 

Contractors may not be in-network, even if the hospital is. When you are doing those regular checks with your insurance company, do some additional due diligence. Get a breakdown of which medical professionals, who could be involved in an emergency situation, have their own additional fees. 

With that information in hand, in the event you need medical attention, depending on the urgency of the situation, you can ask to see another provider who is in-network who might work on a different schedule, or look into other hospital options.

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4. Have a health-care advocate 

It can be difficult to pay attention to procedure and cost details when you're in the midst of a high stress situation. A good way to make sure you aren't surprised by a bill on the other side is to ask a person you trust, whether it's a friend or family member, to act as your health advocate. 

Fill out a medical proxy form (each state has its own paperwork) and let your medical team know that this person will be advocating for you, either in person or on the phone, should the need arise. 

Being armed with the information you need, and deputizing someone to work with you on your behalf, can help put your mind at ease and save you time and money in the long run. 

Reyna Gobel, MBA and M.J., is a financial and physical fitness journalist, author, and professional speaker who's been quoted by Money Magazine, Real Simple, and The Washington Post. She's been published on reuters.com, weightwatchers.com, and theatlantic.com.

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