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9 Ways Consumers Can Avoid Surprise Doctor Bills

by AHIP

November 1, 2018

No one wants to pay more than expected for health care services. Planning in advance will help give you peace of mind during a procedure like a hip or knee replacement. It can also lessen your chances of a surprise when you receive the bill for the surgery.

As with hip and knee replacement surgeries, patients often have a chance to choose a health care provider in advance. It’s important to understand whether that provider is in network and what that means in terms of the cost to you.

It is also important to understand that even if you choose a hospital that is in network, you may still receive care at that hospital from a doctor or other health care professional, such as anesthesiologist, who is not in network.

Just because a hospital participates in the health plan’s network does not mean all the health care professionals a patient will interact with at the hospital are also in network.

How can people avoid an unexpected bill in situations where they can schedule care in advance? According to a new Guide for Consumers from AHIP, the Healthcare Financial Management Association (HFMA), and the American Hospital Association (AHA):

  1. Ask what providers are in your health plan’s network.
  2. Ask how your health plan covers care from a provider who is not in network.
  3. When you need to get a service, check again with both your provider and the health plan to make sure that the provider is in the network.
  4. If you need to see a specialist health care professional, also check to make sure that the specialist is in the network. Sometimes your primary care provider will recommend that you see a physician specialist or other health care professional. Once you have a referral to a specialist, confirm with that specialist that they are in network when you make your appointment.
  5. If you need to have a procedure, ask where it will take place.
  6. Ask who else might be involved in your procedure. In addition to the doctor you have chosen for your procedure, there are often other health care professionals who are involved in a medical procedure. For example, an anesthesiologist or nurse anesthetist may give you medicine that helps you sleep through the procedure. You can get this information your doctor, the hospital or other facility where your procedure will take place, or your health plan.
  7. Give yourself plenty of time. Most health care services and procedures are scheduled in advance. Take advantage of this time to get answers to any questions about whether your health care providers are in network.
  8. Write down all the information you receive.
  9. If you think you received an incorrect medical bill, or question the amount of the bill, seek help.

In an emergency, you don’t have time to take the above steps for services or procedures you can schedule in advance. Read the full Consumer Guide for ways to lessen your chance of receiving a balance bill if you need emergency care. You’ll also find three examples of how these tips might play out in real life.