Surprise medical bills can be a major headache for anyone, but they can be annoyingly common for those with high-deductible health insurance plans (HDHPs). In fact, half of patients with an HDHP state they have received a surprise medical bill, even though they have insurance coverage.
High-deductible plans typically feature lower monthly premiums but higher out-of-pocket expenses. However, these plans can leave patients on the hook for unexpected medical costs that they may not be able to afford.
Why Are Surprise Bills So Common?
One of the main reasons surprise medical bills are common, even with an HDHP, is that insurance plans often include a limited network of providers. To keep costs down, insurance companies may only cover certain hospitals, doctors, and other medical providers. If you receive care from a provider who is not in your plan’s network, you may be responsible for a larger portion of the bill than you expected. This can lead to receiving surprise medical bills that you simply can’t afford.
Another reason for surprise medical bills with HDHPs is that, with these plans, you usually have to pay a set amount–called a deductible–before your insurance starts paying for services. However, the money paid toward your deductible may not apply to all of the services you receive. For example, your plan may only cover a certain number of doctor visits per year, or it may not cover certain types of treatments. If you receive care that is not covered by your plan, you may be responsible for the entire bill, even if you’ve already paid your deductible.
Additionally, surprise medical bills can result from the way that insurance companies negotiate with medical providers. When you receive care from a hospital or doctor, they may bill your insurance company for a certain amount. However, the insurance company may only agree to pay a part of that amount, leaving you responsible for the rest. This can result in surprise bills that are much higher than you expected, particularly if you receive care from an out-of-network provider.
How To Protect Yourself Against Surprise Medical Bills
So, what can you do to protect yourself from surprise medical bills with a high-deductible health insurance plan?
Before receiving medical care, it’s important to review your plan’s network of providers and coverage limitations. Ask your healthcare provider for a cost estimate and confirm they are in-network with your insurance plan. You can also ask for an advance coverage determination from your insurance company to help you understand what services are covered under your insurance plan and what your out-of-pocket costs might be.
You may also want to consider using online resources that display transparent pricing for medical procedures. These resources can help reduce surprise bills by allowing you to compare prices and find the best value for the medical care you need.
Finally, if you do receive a surprise medical bill, don’t panic. Many medical providers are willing to work with patients to create a payment plan or negotiate the bill. You can also reach out to your insurance company for assistance. By staying informed and taking proactive steps to protect yourself, you can navigate the world of high-deductible health insurance plans and avoid costly surprises.
About Charlie Byrge
Charlie Byrge is the Senior Vice President of Tendo, a leading software company focused on creating seamless, intuitive, and user-friendly experiences throughout the care journey. With over a decade of experience, Charlie has a proven track record of successfully driving business growth through strategic partnerships, developing and implementing effective sales strategies, and leading high-performing teams. Charlie has worked at Caterpillar Financial, naviHealth, Shearwater Health, and MDsave, Inc. before joining Tendo as the Senior Vice President.