In last week’s blog, I discussed the importance of considering not using your insurance for certain health care costs and looking at whether you would actually hit your deductible within the year. My sole purpose is to help my clients save money, and so in today’s blog, we will look at how ‘doing your homework when it comes to your health care coverage for a planned procedure or hospitalization, is vital in saving you money and not being over-charged by thousands.
Let’s use a client example. I talked to a client recently that has a family member in the hospital. This family member has a plan that has a large deductible of $8700 – this plan pays basically nothing until they hit the $8700. This family member has been in the hospital for five days, which means that the deductible has been met.
Using this scenario, we can learn a few important tips.
- If they ask you for any money, do not pay them anything.
They need to file it all to your insurance. How it should then work, is that the insurance company should come back and say you owe the value of your deductible. Many times this is the out-of-pocket maximum as well, which is the most that they should bill you.
- It will take a long time for them to send you this bill; when you do, call me.
About three months later, when you get the bill for $8,700 (example), I instruct my clients to call me. I’m going to review it and make sure that it’s correct. If it’s $8700, this should be correct, and you should owe nothing else, as long as the doctors were in-network.
- Did you know that if any doctor involved in the planned surgical procedure is out-of-network for you, they have to notify you of this at least 72 hours in advance, or the insurance will need to pay the in-network fees? You have to agree to these added in-network fees.
My tip: if they tell you within the time window that they are out of network, you should ask them for a cash discount.
- Once we have the bill, I recommend that we apply for financial assistance.
Almost everyone qualifies for some kind of financial assistance – it’s not based on your assets; it’s based on your ability to pay. Depending on what the bill is, depending on your income, they will determine how much of the bill they want you to pay.
By learning the above points, you are able to ensure that your bill is fair, and then negotiate accordingly. Once these things are done, I then advise my clients to go ahead and pay the bill.
As a takeaway for this blog, please remember that I always, always want my clients to call me when they have a large and planned medical procedure so that I can give them counsel on how to handle this, saving you money by avoiding being overcharged particularly for out of network services.