Unexpected Medical Bills Thought to Be Covered by Health Insurance


Did you know that around 57% of Americans have received unexpected medical bills?

In fact, out of all the surprise medical bills received, 20% came from out of network doctors. While not all unexpected bills for medical services can be avoided, it’s better to be safe by knowing where these “surprises” come from.

Here are some common ways that people wind up with unexpected medical bills:

Out-of-Network Specialists

Be mindful that medical providers aren’t always upfront about the costs you’re incurring.

Most people know that seeing a doctor that isn’t covered by your insurance will result in a large bill. What you might not know is that you can encounter these doctors at a hospital covered by your insurance.

Doctors stationed at hospitals don’t necessarily have to take the hospital’s insurance. This means that the doctor you are paired with might not accept your insurance, resulting in an out-of-network charge.

Anesthesiologists, pathologists, and radiologists are the medical professionals most likely to not accept your insurance. Cardiologists, and other specialists brought in for consultations, also have a high likelihood of not taking your insurance.

The next time you visit a hospital, specifically request doctors and specialists who take your insurance. It could save you thousands of dollars.

Preventative Care

If your insurance plan doesn’t consider certain procedures preventative, you will be charged the full amount for the services you’ve received. You’d think that services like physicals, mammograms, and colonoscopies would count as preventative care, but not in the eyes of insurance.

Those receiving preventative treatments often run into the most trouble. When sending claims to insurers, doctors often code annual preventative exams as a test for a pre-existing condition. This will result in a surprise medical bill for the patient.

In fact, this lack of coverage for preventative care is part of the healthcare crisis.

To avoid this, call your insurance company to make sure a certain form of preventative care is covered. You will also want to double-check with the medical provider’s office to make sure it’s true.

Lab Tests and Scans

When it comes to surprise medical bills, lab tests and scans are common pitfalls. For instance, one woman had to pay over $17,000 for a urine test that her insurance company refused to pay.

In the case of lab tests, “surprises” happen when a laboratory’s services aren’t covered by your insurance. Be picky about where you get your lab tests done.

These issues can also happen with scans. Call the medical provider beforehand to make sure the place you’re receiving a scan is covered by your insurance.

No More Surprise Healthcare Bills

As of now, senators are trying to pass legislation to prevent surprise medical bills. Currently, only a few states have laws to prevent surprise medical bills.

Hopefully, this will make unexpected medical bills less of a problem in the future.

Looking to help your employees avoid these medical bill pitfalls? The Benefits team at GIGA works closely with business owners to implement top-notch employee benefit programs. After a brief information gathering session, they will reach out to a variety of insurance providers for a business, matching them with only the best benefit packages.

The GIGA Benefits team can also identify cost savings and administrative efficiencies in the areas of services around benefit administration, education, implementation, and benefit enrollment.

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