Al Waller: Welcome back to another episode of ClearPath – Your Roadmap to Health & Wealth SM. I’m your host Al Waller.
Let's face it, no one plans to get sick or hurt. But when it happens to you or a family member, it may wind up costing more money to get the care you need, or perhaps than you’ve been led to believe it was going to cost — because when it comes to surprise medical bills, it pays to understand how health insurance and billing works.
Joining me is Mihaela Vincze, public health expert for nonprofit Transamerica Institute® here to discuss strategies on how to avoid those surprise medical bills.
Thank you for joining us, Mihaela!
Mihaela Vincze: Thank you for having me.
Al Waller: If you have health insurance, you’re probably familiar with how difficult it can be to navigate insurance billing, because even when you think a service is covered, you could potentially wind up being hit with a bill out of the blue at some point down the road.
So, Mihaela, how can people avoid being on the receiving end of a surprise medical bill?
Mihaela Vincze: It’s common to get a surprise medical bill. I’ve personally received one while using a hospital that was covered by my health insurance, but I was seen by a provider or a doctor who was not covered. So, it was really upsetting when I received that hefty bill especially because I thought my health insurance was supposed to cover it.
To illustrate how costly medical expenses can be, whether they're surprised or expected, a Transamerica Center for Retirement Studies survey found that among workers who have taken a loan from their 401(k) or similar plan, 24 percent did so to pay for medical bills.
Al Waller: That's awful. Maybe I shouldn't be surprised, but it's hard to fathom that so many people face the same problem in something as dire as that.
What steps can be taken to address and prevent this from happening in the future?
Mihaela Vincze: Until recently, an emergency trip — let's say where you've lost consciousness and you were taken to an out-of-network hospital — that might have resulted in bills not covered by your health insurance. Even in hospitals which are in-network and have out-of-network providers, kind of like what happened to me, could result in a bill that you just didn't see coming — that was before the No Surprise Act.
Al Waller: You've got my full attention now. What exactly is the No Surprise Act?
Mihaela Vincze: Early this year, starting in 2022, the No Surprise Act protects people from receiving surprise medical bills. Specifically, the law doesn’t allow for out-of-network providers to bill patients more than in-network cost sharing for:
- Using transportation from air ambulance providers
- Getting emergency care at out-of-network facilities
- Receiving non-emergency services from out-of-network providers at in-network facilities (unless the provider obtains written consent)
These protections help patients avoid surprise bills. If you want to learn more and become a better advocate for your health, be sure to visit the No Surprise Act page at CMS.gov.
Al Waller: That’s pretty encouraging, and hopefully, makes the insurance billing process just a little more transparent going forward — because health insurance speak or lingo can be more than a little convoluted, especially when it comes to paying the bills. What other steps can individuals take to avoid surprise bills?
Mihaela Vincze: Yes! I’ve actually had other blunders where I’ve ended up with a surprise bill. For instance, I once asked my doctor how much a service would cost, and then I got a bill that was a surprise to me when my health insurance plan didn’t cover the cost.
Al Waller: That sounds like the classic old ‘bait and switch’ to me. Shouldn’t the doctors be a little more knowledgeable than this?
Mihaela Vincze: Yeah, that’s what I thought. Unfortunately, I learned that physicians are not aware of our specific health insurance plans and therefore, may not have the information necessary to make claims about your individual out-of-pocket costs. Call your health insurance directly to get information about this.
Also, you may want to become an expert on how your health insurance coverage works — or at least learn about it, understanding what your “deductible,” “coinsurance,” and “copay” are to avoid surprises.
Al Waller: Well, as our colleague, Catherine Collinson is often fond of saying “do your homework”. What I think we are saying is we should avoid relying on our doctors for billing information, and instead personally, be a little more vigilant checking with our insurance providers directly about deductibles, coinsurance, and copays.
Speaking of which, can you give us a quick refresher of these terms?
Mihaela Vincze: The deductible is the amount of out-of-pocket medical expenses you pay annually before your health insurance company starts to cover the cost.
For example, a health insurance policy that has a $1500.00 deductible, you would have to pay that amount in eligible medical expenses before your health insurance kicks in to cover the cost. Next, the coinsurance is the percentage of a health expense you pay after you’ve reached your deductible.
Lastly, the copay is the flat fee you pay each time you visit your doctor. To quote Catherine Collinson once again, “always do your homework” and get guidance from your health insurance plan provider to understand how much your copay, your coinsurance, and your deductible will specifically be for you.
Al Waller: Perfect. To recap, we've discussed the No Surprise Act and value of understanding how our individual health insurance plans work. Have you got any other tips for us today?
Mihaela Vincze: Always review your medical bill carefully because medical bill mistakes do happen, and there are ways to confirm they’re accurate.
Double check the bill by making sure you are not charged twice for something. The billing codes that you see on your bill, they are used to classify services and procedures as well as describe diseases. You can actually check those codes.
If your bill comes with a five-digit code, you can search the number and the letters (“CPT”) right before it, which stand for Current Procedural Terminology —and then you can find out what those digits stand for, and you can make sure that they line up with what you're being billed for.
Al Waller: I'd heard the term CPT coding in the past but never knew what it stood for — I'm going to make sure to double check that if something seems awry in the future. What do you recommend a person do if they receive a surprise bill?
Mihaela Vincze: Reach out to your health insurance and let them know what happened. If you’re informed that you did receive that bill incorrectly, you can reach out to the provider to amend it.
If both the provider and insurance do not fix the bill, then you would report the suspected medical surprise bill to the Centers for Medicare & Medicaid Services, CMS. The CMS set up a No Surprises Help Desk which you can reach by phone or online. They will review your complaint and let you know which steps to take next.
Al Waller: That sounds reasonable and pretty straightforward too. Any final thoughts you'd like to share before we wrap it up?
Mihaela Vincze: Medical problems that require care are a stressful experience for everyone involved, and unexpected medical bills can really add to the stress. Remember these precautions to avoid surprise bills in the future.
Al Waller: I agree, Mihaela. I mean, let's face it — nobody needs additional stress in their lives, especially on their heels after dealing with a series of medical issues. Again, I want to thank you for joining us today. This has been most helpful and instructive too.
ClearPath – Your Roadmap to Health & Wealth is brought to you by Transamerica Institute, a nonprofit private foundation dedicated to identifying, researching, and educating the public about retirement security and the intersections of health and financial well-being. You can find our weekly podcast on WYPR’s Podcast Central and mobile app, wherever you get your podcasts, and at transamericainstitute.org.
In case you missed it, check out our previous episodes on how to prevent heart disease. In addition, if you have comments or feedback, please reach out to [email protected]. Finally, if you have a topic you'd like to learn more about, by all means please send us your ideas.
ClearPath – Your Roadmap to Health & Wealth is produced by the Transamerica Institute with assistance from WYPR.
Until the next time, I’m your host Al Waller. Stay safe, be well and thanks for listening.
