IHF Community Corner

Dr. Eigen reviews questions from the community about everything related to medical debt and medical bills and provides feedback based on his expertise as a physician leader. If you have a question that you would like Dr. Eigen to address, please submit the question through this email: info@indianahealthfund.org

For this month’s blog, Dr. Eigen has prepared a response about medical costs:

How to save money on medical costs

It has always surprised me that patients pay hospital and doctor bills even before they have gotten a final bill and understood what they were paying for. If you are going to have a procedure that uses a hospital facility or surgery center, you should get a good faith estimate of the costs before the procedure or surgery.

The No Surprises Act of 2022 introduced new requirements for providers, facilities, and providers of air ambulance services to protect individuals from surprise medical bills. These requirements:

•Prohibit providers and facilities from directly billing individuals for the difference between the amount they charge and the amount that the individual’s plan or coverage will pay plus the individual’s cost-sharing amounts (i.e., balance billing) in certain circumstances

•Require providers and facilities to provide good faith estimates of charges for care to uninsured (or self-pay) individuals upon request, and for individuals with certain types of coverage, to submit good faith estimates to the individual’s plan or issuer

•Create a patient-provider dispute resolution process for uninsured (or self-pay) individuals to contest charges that are “substantially in excess” of the good faith estimate

•Limit billed amounts in situations where a provider’s network status changes mid-treatment or individuals act on inaccurate provider directory information.

This list is not complete, and further details can be found on the CMS website (cms.gov). Once you know what to expect you should pay your portion of the bill promptly. But before you do be sure that the bill has been properly submitted so that you are getting all the benefit of your insurance and that all insurance payments have been applied to the bill. For example, a friend received a bill for $1800 for a specialized lab test. She had not received an estimate of the cost and before paying such a high amount she called the hospital and the hospital found that the bill had not been coded properly. The doctor corrected the documentation and coding and the charge to the patient was reduced to $36. A huge savings just by checking on how the bill was submitted. This is not an unusual occurrence. Pay what you owe but don’t pay more than you owe.


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