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By Dr. Donna O'Shea, Chief Medical Officer of Population Health, UnitedHealthcare
Nearly everyone wants to save more money, especially when it comes to paying for medical care. To help encourage this, various recent federal regulations have spurred a greater focus on health care cost transparency, both by hospitals and health insurance plans.
The No Surprises Act, for instance, is designed to help reduce the likelihood of receiving an unexpectedly large medical bill in certain emergency or other hospital scenarios, something that more than half of Americans have experienced. Other recent regulations require hospitals to post prices online, and while these efforts offer important protections for people, there are various other ways to help avoid an unexpected medical bill. Here are five strategies to consider:
1. Pick a plan with upfront pricing
One way to help save on health care costs — and reduce the risk of a surprise bill — is by enrolling in a health plan that offers clear upfront cost and coverage information. Rather than receiving medical care and then waiting for the bill to arrive weeks or months later, health plans such as UnitedHealthcare's SurestTM enable members to review out-of-pocket expenses before medical care is delivered. The goal is to make navigating the health system simpler and more transparent, in part by eliminating deductibles and using clear pricing – and variable copays – to encourage people to select care providers and facilities that offer more value.
People who know the price in advance are more likely to access preventive physical exams and screenings. By making it easier to comparison shop for care providers and facilities, the Surest plan reduced out-of-pocket costs for members by 54% and lowered the total cost of care by up to 15% for employers.
2. Comparison shop based on quality and cost
Even if you don't have access to a plan with upfront pricing, health plans are required to publicly disclose contracted rates with health care providers and facilities. Some health plans have for many years offered transparency resources featuring quality and cost information. For instance, millions of UnitedHealthcare members have access to health care quality and cost information for more than 820 common medical services, with the information available online, via a mobile app or by calling customer service. Before scheduling your next medical appointment, check with your health plan to review quality and cost information, ideally for estimates based on actual contracted rates and customized based on your individual plan. Other approaches to consider include reviewing publicly available transparency resources, asking your doctor or their support staff how much the service will cost, or calling around to other local health care providers to ask about pricing.
3. Stay in-network
Receiving care from an out-of-network provider or facility can lead to a surprise charge, with the total cost of this type of care exceeding $40 billion for Americans each year. While the No Surprises Act helps reduce the chance you will be left with a big bill if an out-of-network provider is involved with your care, it's important to always start with in-network health care professionals and facilities for nonemergency care. That includes when referred by a primary care physician to labs for blood work, imaging (e.g., MRIs), and other tests. One red flag to watch for is if an out-of-network care provider seeks payment in full before delivering services. To help reduce the risk of surprise charges, health plans like UnitedHealthcare offer members access to important care provider information, including network status and patient reviews. Newer programs may proactively contact members before they go out of network, sending a text message, emailing, or calling to notify them about more affordable in-network options.
4. Recognize remaining risks
Even with upfront research, there are still a few potential risks to be aware of. Many health plans cover preventive services, such as wellness visits, mammograms, or colonoscopies. However, some advanced screenings may not be considered preventive services and can result in an out-of-pocket charge. To help avoid that, confirm with your health plan that any services or tests are covered under your benefits. If needed, you can also work with your health care provider to complete a preauthorization form in advance, as well as check with your health plan to determine the status of the request.
5. Negotiate surprise bills
In the event of a surprise bill, there are several steps to pursue. First, examine the explanation of benefits to help determine if your health plan may be able to negotiate with the doctor for you. While it may be possible to talk with the support staff at the hospital or doctor's office to request that the balance bill be waived or reduced, it is often more effective to check with your health plan to determine what type of resolution support may be offered to help negotiate on behalf of members with hospitals and care providers. If you receive a surprise bill from an out-of-network care provider, call the number on your insurance ID card to alert your health plan and check on assistance, including resources such as Naviguard® that can negotiate for a member.
No one wants a surprise medical bill. Consider these strategies to help contribute to your physical and financial wellbeing while reducing the risk.
Learn more about how to avoid surprise medical bills at surest.com.
This article was created by UnitedHealthcare with Insider Studios.