By Dr. Donna O’Shea, chief medical officer of population health, UnitedHealthcare
Nearly everyone wants to save more money, including when it comes to paying for medical care. To help encourage that, various recent federal regulations have spurred a greater focus on health care cost transparency, both by hospitals and health insurance plans.
For instance, the No Surprises Act is designed to help reduce the likelihood of people receiving an unexpectedly large medical bill in certain emergency or surprise scenarios, something that more than half of Americans have experienced. Other recent regulations require hospitals to post prices online, while health insurers have been mandated to do the same.
While these efforts offer important protections for people and shine a light on health care price variation, there are various other ways to help avoid an unexpected medical bill. Here are five strategies to consider:
Comparison shop based on quality and cost. As of July 1, health plans are required to publicly disclose contracted rates with health care providers and facilities. However, this is only a first step in the process, with requirements for more consumer-friendly disclosures slated to start in 2023. Fortunately, some health plans already offer transparency resources featuring quality and cost information, available online, via a mobile app or through customer service. Before scheduling a medical appointment, check with your health plan to review quality and cost information, ideally for estimates based on actual contracted rates and customized based on your individual plan. Other approaches to consider include reviewingpublicly available transparency resources, asking your doctor or their support staff how much the service will cost, or calling around to other local health care providers to ask about pricing.
Stay in-network. Receiving care from an out-of-network provider or facility can lead to a surprise charge, with the total cost of this type of care exceeding $40 billion for Americans each year. While the No Surprises Act helps reduce the chance you will be left with a big bill if an out-of-network provider is involved with your care, it’s important to always start with in-network health care professionals and facilities for nonemergency care. That includes when referred by a primary care physician to labs for bloodwork, imaging (e.g., MRIs) and other tests. One red flag to watch for is if an out-of-network care provider seeks payment in full before delivering services, as this should be avoided. To help reduce the risk of surprise charges, some health plans are proactively contacting members before they go out of network, sending a text message, emailing, or calling to notify them about more affordable in-network options.
Recognize remaining risks. Even with upfront research, there are still a few potential risks to be aware of. Many health plans cover preventive services, such as wellness visits, mammograms or colonoscopies. However, some advanced screenings may not be considered preventive services and can result in an out-of-pocket charge. To help avoid that, confirm with your health plan that any services or tests are covered under your benefits. If needed, you can also work with your health care provider to complete a preauthorization form in advance, as well as check with your health plan to determine the status of the request. Separately, ground ambulance services were not included as part of the No Surprises Act, which means these rides could result in an out-of-network charge. While it is important to seek immediate medical attention during an emergency, keep in mind that some ambulance providers might not be in-network with your health plan.
Negotiate surprise bills. In the event of a surprise bill, there are several steps to pursue. First, talk with the support staff at the hospital or doctor’s office to request that the charge be waived or reduced. If needed, some health plans offer access to resolution support to help negotiate on behalf of members with hospitals and care providers. If you receive a surprise bill from an out-of-network care provider, call the number on the back of your insurance ID card to alert your health plan and check on assistance.
Consider plans with upfront pricing. Another way to help save on health care costs – and reduce the risk of a surprise bill – is by enrolling in a health plan that offers upfront pricing. Rather than receiving medical care and then waiting for the bill to arrive weeks or months later, some new health plans enable members to review – and pay for – out-of-pocket expenses before medical care is delivered. The goal is to make navigating the health system simpler and more transparent, in part by eliminating deductibles and using clear pricing to encourage people to select quality, cost-efficient health care providers and facilities.
In view of increased price sensitivity due to rising inflation and other factors, considering these strategies may help contribute to your physical and financial well-being while reducing the risk of a surprise medical bill.