4 Tips to Avoid Out of Network Health Insurance Overcharges…Before They Happen

May 7th, 2009. By LucyC

If you’re interested in how to avoid paying for insurance overages for out of network bills, these tips—from Consumer Reports Health blog (Ginger Skinner, 5/9/09) may help. Remember though, these are preventative measures—if you feel you’ve already been overcharged for out-of-network medical reimbursements, it may be time to seek out an evaluation with a lawyer.

 

• Get cost estimates from the hospital and the physicians, and try to find out if there are any incidental fees you can avoid.
• Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider “reasonable and customary” [or “usual and customary (UCR)]. This may be a lot less than what the hospital and doctors charge; you’ll be responsible for the difference. And find out if your insurance company will pay the entire “reasonable and customary” portion, or if you’ll be responsible for some of it due to deductibles or co-insurance.
• Ask doctors if they are willing to accept your insurance company’s payment for their services as payment in full, especially if they work in a hospital that’s covered by your plan.
• Don’t be afraid to negotiate with your insurer in advance. They may be willing to pay for a procedure at an out-of-network hospital, or performed by an out-of-network specialist, if there aren’t any in-network options. Your physician should help you justify the necessity.

Want to know more?

Read our previous blog on this

Tags: Aetna, Blue Cross Blue Shield, Cigna, Health Link, Unicare, United Health Care, Wellpoint/Anthem

This was posted on Thursday, May 7th, 2009 at 9:08 am and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.