Medical Insurance and Your Medical Bills

Understanding your medical insurance coverage and your medical bills is critical.  Here are some facts to consider:

Your Medical Insurance

Buy the best medical insurance plan you can afford. Generally, the less you pay in premiums, the more you pay when you utilize any medical services.

That inexpensive medical insurance plan might seem like a good idea at the time: you have been in good health and don’t anticipate any major medical events and you have other bills to pay. Surprise. One trip to the Emergency Room, an unexpected accident or surgical procedure could result in very large medical bills which your insurance plan doesn’t cover and for which you are now personally responsible.

Know what your medical insurance plan covers and how much it will pay:

  • Emergency Room visits
  • Hospitalization
  • Rehabilitation facilities, physical and occupational therapy and number of visits
  • Medications
  • Durable medical equipment: wheelchairs, walkers, hospital beds, etc.
  • Doctor visits

Know your financial obligations with your medical insurance policy

  • What is the monthly premium?
  • What is your annual deductible?
  • What is the co-pay for visits to the doctor and therapists and other skilled providers covered by your policy?
  • In network and out of network coverage
  • Medication coverage
Your Medical Bills
You have made an Emergency Room visit, had surgery or been hospitalized. You will be receiving medical bills from the facility and individual providers.
  • If this was an Emergency room visit, be prepared for possible out of network charges. ER doctors are increasingly contracted by the facility.
  • Surgery: some anesthesia services are also contracted and considered out of network.
  • Don’t hesitate to request your itemized medical bill from the Patient Billing Department of the hospital/rehab facility.

If you anticipate a hospitalization or surgery, contact your insurance company and hospital in advance to ask about standard charges and coverage for your stay/procedure.

Don’t pay any of your medical bills until you receive an Explanation of Benefits (EOB) from your insurance provider. This lists the portion of the bill they are going to pay. You will then receive a statement from the health provider with the portion of the bill for which you are responsible.

Be aware of the practice of balance billing.

Next Steps

Can’t pay your medical bill in one lump sum? There are options available to you: payment plans, financial hardship consideration, discounts in some circumstances. Even paying $100 a month will keep your account active while you negotiate the final expected payment amount.

Seek assistance:

  • from a healthcare advocate
  • from your insurance agent
  • Create an online account with your insurance provider and try to establish a relationship with a contact person.

Keep detailed records: Name of person contacted, date, time, topic of discussion, expected action

Be prepared to appeal a decision denying payment of your medical bills. Don’t delay in starting the process: there is often a time limit for filing an initial appeal.

Be patient: This process of dealing with settling your medical bills could take a long time.

Sooner or later we all will require medical services of some kind. Being prepared; physically, mentally, financially, and with knowledge, will make the process a bit easier.


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