Scared of Your Mailbox? Six Tips to Avoid and Combat Surprise Medicals Bills.

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Remember that jack-in-the-box you had as a kid? No matter how many times you would crank the handle, you were always surprised when the jack jumped out. While those days may be long behind you, there is a modern-day equivalent that is likely to give you a bigger fright: medical bills.

A growing number of Medicare recipients dread opening the mailbox out of fear of the bill that awaits them. According to a recent eHealth survey of Medicare enrollees, the majority (63 percent) of respondents worry about getting a surprise medical bill after receiving medical care. And surprise bills far outweigh respondent concerns over out-of-pocket costs and coverage for preferred medical providers. 


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Surprise medical bills typically arise when medical care is received from out-of-network providers, or when you are unexpectedly required to pay toward your deductible for certain medical services. Take control of your healthcare and your wallet by following these tips to help avoid surprise medical bills and deal with them when they arise.


  • Understand how your out-of-pocket costs work. Different kinds of medical care are often covered differently. Your plan may require you to make a copayment for some services, while your deductible or coinsurance may apply to other services. When shopping for coverage, make sure you understand what your out-of-pocket costs may be, and if you can afford them. If you have a question about why a claim was processed with “patient responsibility,” contact your insurer or your licensed agent.
  • Know the difference between preventive and non-preventive care. Many forms of preventive medical care (annual check-ups, immunizations, women’s well visits, some screenings, etc.) are covered free of charge – that is, without copayments or deductible. But often, patients will think they are seeing a doctor for a preventive service when really it is not. Know the difference before you arrive at the appointment so you can better anticipate costs following the visit.
  • Get pre-authorization for costly or serious procedures. Some surgeries, for example, are covered based on diagnosis alone, while other procedures may require a special authorization for coverage from your insurance company. Before a potentially costly procedure, contact your insurer, explain the situation and ask if pre-authorization is required. If so, work with your doctor ahead of time to provide the insurer with the necessary documentation explaining the medical necessity for your procedure to avoid the headache of dealing with a large bill while you recover.
  • Try to make sure your providers are in-network. It’s one thing to double check that your primary care doctor is in-network but it can be a challenge to know if others (lab technicians or anesthetists, for example) who may be involved in your care are covered. Always ask your doctor or specialist’s office to help ensure that everyone involved in your care is a part of your insurance company’s provider network.
  • Ask for an estimate of your total costs up-front. Your doctor’s office or hospital may be able to provide you with an estimate of costs before you receive care. While an estimate of costs will not typically guarantee your final out of pocket expenses, it can give you a more informed view of your total costs. Make sure your doctor has your current insurance information on file so that the estimate is accurate and remember that copays and deductibles may apply based on your coverage rules.
  • Negotiate surprise bills with your medical provider. If despite your best efforts you end up with a bill that wasn’t covered by your insurer, always negotiate. Ask for a discount or offer to pay 50 percent as oftentimes medical providers will accept payment lower than the total bill. In fact, that’s how most insurance works already: providers know they may not get the full amount and are often willing to meet you half-way. 


If you are one of the hundreds of thousands of Medicare recipients who have received a surprise medical bill, make it be your last. By following these tips, you can collect your mail with a little less fear of the unexpected bill that may await you and a little more courage to fight back against any sticker shock. 

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