Choosing New Medical Insurance Coverage? Expect The Unexpected: Surprise Medical Bills

When it comes to choosing health insurance for medical care, many people choose plans based on the costs of premiums and out-of-pocket expenses. However, sometimes surprise medical bills may have unexpected costs that may not be covered by insurance companies. In fact, a 2015 Consumer Reports survey estimated that 1 in 3 adults received surprise medical bills during the previous two years with private health insurance. Here are several examples of the types of surprise medical bills you may be hit with if you do not choose the right medical insurance policy for your needs, along with a few tips so you cope with the unexpected. 

Your current internist does not accept your preferred health insurance

If you've been seeing an internist, you'll want to be sure he or she accepts the health insurance plan you want to enroll in. If they do not, don't let that hinder you from continuing to consider the health insurance policy.  Speak with an internist at a medical clinic like Broadway Medical Clinic, LLP  and/or their billing department to see if they will consider accepting the medical insurance. This typically involves the office and the insurance company developing a contract after negotiating terms and conditions of payments.

If they do not, you will need to find another internist or primary care physician who is in the network of providers who accept the health insurance you are interested in. Keep in mind that, sometimes, health insurance companies choose providers. If you are particular about who you want to see, ask the insurance company who they would require you to see before you enroll, or you may get stuck with a particular provider you wouldn't choose yourself. 

Your prescription medication isn't covered by your health insurance

Another situation people can find themselves in is when their internist or primary care physician writes a prescription for medication that the insurance company will not normally cover. If you are already on prescription medication, you'll want to confirm with the medical insurance companies you are choosing from to see which ones will cover the costs of your medication.

If your preferred insurance does not, yet everything else about the policy is ideal, ask the insurance company how they handle formulary exceptions. Sometimes, health insurance companies will pay for medication they normally do not cover if they receive documentation or a phone call from the prescribing physician beforehand. This is called prior authorization. It's important to understand what hoops you and your physician may need to jump through for medication, treatment, and testing before you choose a plan. 

Someone on a medical team is out of the health insurance coverage network

Whether you require a trip to the ER or need surgery, there may be a chance that someone on the medical team is not in the network of providers covered by your chosen health insurance coverage. Although medical emergencies are supposed to be covered as if patients were taken care of in-network under the Affordable Care Act, there's still a chance that an out-of-network provider may attempt to bill a patient later for what the insurance did not cover.

Planned surgeries, however, are a different story, as they are not typically deemed as emergency medical situations. Therefore, when scheduling a surgery, it's a good idea to ask for a list of who will be on the medical team and call each one to confirm if they are in-network or out-of-network. Even if you do not currently expect to have surgery in the near future when choosing insurance, it's a good idea to make a few calls to see if various medical personnel at your in-network hospital, such as anesthesiologists and lab technicians, accept your preferred health insurance before you enroll.