- More than 20 states have legislation to protect users from "balance billing," or out-of-network costs that can run into the thousands.
- "Will your practice take my insurance?" is the wrong question to ask your doctor.
When it comes to managing health-care expenses, having insurance is only part of the battle.
Carolyn McClanahan, an M.D. and director of financial planning at Life Planning Partners in Jacksonville, Florida, discussed the best ways for patients to rein in those costs at the American Institute of CPA's Engage conference in Las Vegas on Monday.
Workers with family insurance coverage paid average premiums of $5,714 in 2017, according to the Kaiser Family Foundation.
Yet there is more to paying for medical expenses than just footing the premium for your policy.
"Health-care plans will look the same, but if one costs more, often it's a difference in the network that's covered," said McClanahan. "A lower cost plan has a narrower network, but you will pay out of network costs if you go elsewhere."
These are the levers you can use to manage your expenses.
It's no longer enough to ask your doctor's receptionist, "Will you take my insurance?"
"When you're making an appointment, don't ask if you're covered under your plan," said McClanahan. "Everyone will take your insurance."
Your doctor's office may accept your insurance, but that won't spare you from a surprise bill weeks later if he or she is out of your network, McClanahan said.
The correct question for your doctor's receptionist is, "Are you in my network?"
Be sure to document who gave you the answer and the date so that you're prepared to fight back if you get a bill that says otherwise, McClanahan said.
Speak up when your doctor recommends tests and prescriptions. Ask questions such as: "Is the testing facility in-network?" or "Are the doctors evaluating the tests in-network?"
Don't be shy about asking your doctor for an explanation if he or she recommends that you undergo a test. Learn more about the test and find out how the results will affect the approach to treatment.
"If they can't provide a clear answer, ask, 'Is this test really necessary?'" said McClanahan.
Finally, curb costs on prescriptions by asking whether your medication is covered under your plan and if a cheaper version is available.
Sometimes it's cheaper to pay cash for your medication than to claim it on your insurance, McClanahan said.
She suggested digging up drug price information on GoodRx.com and comparison shop.
"Know the benefits and risks, how long will you be on medication, and what are the alternatives to the medication prescribed," McClanahan said.
Understand what your policy covers, including the details on out-of-pocket maximums, deductibles and co-insurance.
Get familiar with your state's laws against "balance billing" – a practice in which insurers only partly cover an out-of-network cost and leave consumers to pay the remainder, which can be thousands of dollars.
More than 20 states have some kind of legislation on the books to protect consumers from balance billing, according to the Commonwealth Fund.
When you are admitted to the hospital in the event of an emergency, write on all of your paperwork that you will only permit in-network care, said McClanahan. Be sure to take a photo of this document or make a copy of it.
"Once you get the bill, if they charge you for out-of-network care, you have ammunition," McClanahan said.
If balance billing is illegal in your state and you receive a massive out-of-network bill, be sure to reach out to your doctor first, as it may be an error. Pull in your insurer to help.
If neither your doctor nor your insurer will help you address the bill, then it's time to contact the regulators, said McClanahan.
That means you should reach out to your state medical board and your state's insurance department.
If your insurance plan is self-funded – one in which your employer assumes the financial risk for providing your health-care benefits – then you should contact the U.S. Labor Department's Employee Benefits Security Administration.
Maintain a health-care log so that you're equipped to fight back in the event of a dispute with your insurer. Keep track of any communications you have with your insurance company and your doctor.
If needed, hire an expert to act as your advocate, McClanahan said. She suggested reaching out to the Alliance of Claims Assistance Professionals.
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