Understand your insurance to avoid big bills
Know what your needs are
One of the things I am most passionate about in my line of work is educating people about the importance of learning the basic aspects of what your insurance offers and does not offer so that you know how to use it properly.
Most people think they get this insurance card, and it’s magic, they just go to the doctor or the hospital and hand them their card, and then they’re shocked when they got a big bill.
The important factors are:
- Understanding who’s in network with your insurance
- Does a provider have out-of-network benefits?
- Where can you go to get your treatment?
- Are there places that charge more than others? (You could check with three different hospitals, and they’re all going to charge a range of different prices for the same exact procedure).
Let’s look more closely at this issue of what various facilities charge. Why do the prices vary? Well, it is because we do not have transparency in our healthcare system. To help explain this point, I joke with everyone that if you’re in the market to buy a big screen TV, do you walk into Best Buy and hand them your credit card? Just like you would hand the hospital, your insurance card? And say to the BestBuy employee “pick one out for me, just put it on my card.”? No! Nobody does that. The same goes for health care procedures. You’re going to shop and you’re going to look to find the best price because it’s your money. It is your money that you’re spending, whether you’re sending a ton of money on the premium, or on the out-of-pocket costs.
Knowing what a facility charges can be difficult. But I advise you to just give them a call and request the cash patient price. Wouldn’t it be great if hospitals and medical facilities had to post their pricing online? Think about that. If healthcare was more consumer-driven, how that would change the way the whole healthcare system works? How would it change how you’re charged? Because those prices they charge in hospitals are not real prices.
So for example of this, I have recently had a client that had a knee replacement done in a big-name private hospital in Dallas, Texas. The hospital had them pay $3,000 upfront to cover their deductible. And then insurance paid out, and they paid several thousand dollars. The client then got a big bill of $174,000 for the knee replacement, which is already more than three times the average cost to complete.
What happened? Well, the provider she used was not in-network. My conversation with her went something like this:
“Did you call me before you had the surgery? No.
Did you ask the hospital if they were in-network when you went? No, I just handed them my card.”
Okay, well it is my job to help you deal with this on the back end. So, what did I have this client do? I had her call the hospital and tell them that they never told her she was out-of-network. And that they needed to now re-price her bill for the ‘cash price’. Of course, they didn’t want to do that. And, you know, making excuses. I advised the client to call every other day. Finally, about two weeks later, she gets a bill, and after the $3000 deduction, her final bill was $1,500. Really, really?
The takeaway here – do your homework before your procedure!
One other quick tip, not everyone in the family has to be on the same insurance. Why is that important? Because if you have one person in your family that maybe isn’t as healthy as everybody else, why would you pay inflated rates for everyone that’s healthy, just for the person that needs some special treatment, whether they need a certain medication, or have some chronic issues they’re dealing with. You don’t want the whole family budget being blown, because you’ve got one person that has some different needs than the rest. So it’s just something I do when I consult with everyone, figure out what your needs are, what makes sense, and I have an array of options of plans. Putting the family on different plans can be one solution.