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  • Writer's pictureAhsan Malyk

Why My Insurance Didn't Cover My Hospital Bills?

The purpose of health insurance is to shield you from bankruptcy in the case of a medical emergency. However, this most certainly isn't the case for millions of Americans.


43.4% of American individuals between the ages of 19 and 64 had insufficient health insurance in 2020, as determined by high out-of-pocket expenses and deductibles in comparison to income, according to the Commonwealth Fund Biennial Health Insurance Survey.


35% of that group said they were making installment payments on medical debt, and more than one-third said they were having trouble paying their medical costs. 40% of individuals experiencing medical debt issues saw a reduction in their credit scores. As a result, 37% ran through their funds, and 26% could not cover basic expenses.


According to the Consumer Financial Protection Bureau, medical debt is the most prevalent collection item included on consumer credit reports, with estimates of the amount of medical debt in collections in the United States ranging from $81 billion to $140 billion (CFPB).


The average American has a medical debt of $1,000 or more.


Medical debt accounts for about 58% of the bills in collections on Americans' credit records.


Even without medical debt, consumers may still struggle with high medical costs. Even consumers with health insurance may face expensive medical expenditures due to excluded procedures, out-of-network physicians, and high copays.


How to Reduce Expensive Medical Costs


Here are some recommendations for minimizing high medical expenses.


Screen vendors


Verify with the provider that they are part of the provider network for your insurance plan before receiving services. Verify the network membership of all participating providers for more complex services, such as surgery.


Otherwise, you risk paying a lot of money as non-network providers (like the anesthesiologist who performed your surgery) are not bound by the prices your insurer has agreed to pay.


Verify the Accuracy of the Insurance Data


Inform your provider whenever your health insurance policy changes to prevent your claims from being handled using the old policy that is still stored. If you don't, your claim will be denied, and you can be required to pay for your own care.


Even though the billing staff may easily resubmit the claim to your new insurance provider, you risk getting into trouble with the collections department if you don't resolve the situation as soon as possible. Even worse, you can find yourself paying for procedures that your insurance plan should have covered.


Ask for itemised invoices.


There will inevitably be errors because medical billing professionals handle thousands of claims. The scope of the issue has been estimated by a number of organizations, with figures ranging from the American Medical Association's estimate of a 7.1% error rate for paid claims to reports of inaccuracies on as many as 80% of claims from billing review organizations, as reported by CNBC.


As a result, you should always ask for itemized bills and carefully check each line for errors, such as duplicate charges, omitted services, exorbitant prices, and other problems. Contact the billing division of your provider as soon as you find any errors to have them fixed.


A comparison of service quotes


Who says you can't compare medical providers before choosing one? The Affordable Care Act actually mandates that hospitals list the costs of all the services they offer. Unfortunately, the utility of such lists as comparison shopping tools is limited because a patient receiving emergency medical treatment in a hospital cannot possibly know what services will be required, much less if they are available elsewhere for a lower price.


In a 2021 survey, only 34% of participants even knew such lists existed, and 53% said their insurance plan was only somewhat understandable, compared to 33% who said it was completely understandable. More than 4 in 10 insured people, according to the same survey, have received an unexpected medical bill, and 75% of them are worried that paying for medical expenses will put them in financial hardship.


Even though it is obvious that the American healthcare system is far from having useful price transparency, the more questions you have about costs, coverage, and provider options, the less likely it is that you'll get a nasty surprise down the road. Compare the providers' out-of-pocket expenses. Also, hospitals and emergency rooms frequently charge significantly more for the same service or procedure than outpatient clinics and walk-in clinics.


What to Do If Your Medical Debt Is Buried


Here are some ideas if you're suffering with medical bills:


Make arrangements for payment


If your medical expenses are too costly to be paid in full by the due date, payment plans may be an alternative. However, if your financial status changes, it's crucial to make timely payments and get in touch with the medical provider right away.


ASK ABOUT PROGRAMS FOR FINANCIAL ASSISTANCE


Some hospitals and healthcare companies have internal initiatives or connections to charities that help patients in need. Contact the billing division to learn more.


Negotiate the Total Amount Due


You can meet with the billing administrator and make an effort to bargain the outstanding balance as a last option. Many hospitals and other healthcare facilities would prefer to receive a portion of the payment rather than none at all.


The adjustments were made as the Biden administration and regulators, notably the CFPB, renewed their criticism of the burden of medical debt and collection techniques. The Biden administration unveiled medical debt initiatives in April 2022, including a review of 2,000 healthcare providers' billing and collection practises, a CFPB investigation into whether medical debt should ever appear on a credit report.


Modifications to government loan programmes' underwriting criteria to do away with medical debt consideration.


Conclusion


The rising cost of medical treatment cannot always be contained by having adequate health insurance coverage. Thankfully, consumers can take proactive measures to comprehend their coverage, control expenditures, and protect their rights when it comes to medical billing and debt collection.


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