Managing your arthritis already takes a toll on your wallet. But a hospital stay or trip to the ER can have harmful financial consequences if you’re not vigilant. Nearly one in three Americans say they’ve been hit with unexpected medical charges in the past two years, according to Consumer Reports National Research Center. Here are some tips to help you ensure you’re not paying more than you should.
Stick with in-network facilities. Make sure you go to a medical facility that’s covered by your insurance. During an emergency, you won’t want to call to find out which ones are in network, so do it now.
Make sure providers are in-network, too. If you have a surgery scheduled, call the hospital in advance to find out who’s on your medical team, including the surgical assistant, anesthesiologist, radiologist and pathologist, then make sure all are in-network. If the hospital can’t provide their names, write a request in advance for care only from in-network providers.
For an ER visit, make it clear that you want only in-network providers, says Robin Gelburd, president of FAIR Health, an independent nonprofit for health cost transparency. “Document who you speak with and when,” she says. “That can help if you need to challenge a charge.”
Petition your plan. If your plan doesn’t adequately cover specialists and you have a hard time finding one, write to your insurance company. Ask that your specialist be reimbursed as if he or she were in-network and that any remaining cost you incur be counted toward your deductible.
Get an estimate up front. If you have a procedure scheduled, call the hospital and your insurance plan to get estimates of the costs – in writing, if possible, says Caitlin Donovan, director of outreach and public affairs at the nonprofit National Patient Advocate Foundation. “This may be useful if you need to appeal a surprise bill.”
Request in-network labs and imaging centers. Ask your insurance company which ones are covered by your plan, and ask your doctor to send orders for tests and imaging to those. Confirm that the radiologist is covered by your plan, too.
Know your doctors. Nine percent of elective procedures done at in-network facilities with an in-network doctor also used an out-of-network provider, according to one study. And 22 percent of patients who went to an in-network ER got a bill they weren’t expecting from an out-of-network provider, another study found.
Although some states have passed laws restricting the practice for emergency care, it is still common. A doctor who’s out of network may be part of your medical team, and you can be charged the difference between their fee and your insurance’s payment. This practice is called balance billing.
Check your status. Hospitals can keep patients up to three days under “observation” and still count you as an outpatient, which usually comes with higher copays and (for some Medicare patients) higher deductibles than if you were admitted. Also, observation days don’t count toward Medicare’s requirement for coverage for a stay at a rehabilitation or skilled nursing facility. Ask to be admitted as a patient, says Donovan.
Say “no” to unnecessary items. Don’t be afraid to refuse or question devices you don’t need or can buy cheaper at your local pharmacy, such as slings, braces or walkers.
Author: Sharon Liao