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Medical Bills • 3 minute read

How To Avoid Surprise Medical Bills

How To Avoid Surprise Medical Bills
By Mason Frenzel
Published by Ruby

Ruby's online tools and app helps you organize your medical bills and save money.

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An unwanted surprise.


When you undergo a planned medical procedure or seek treatment due to a medical emergency, receiving a bill in the mail is no surprise. What does come as a surprise though, is when your medical bill is significantly higher than anticipated. Unfortunately, this experience is so common that a term was coined for it: a surprise medical bill.

The Commonwealth Fund defines a surprise medical bill as an unexpectedly high bill, resulting from when a patient is treated at an in-network facility, but by an out-of-network provider, like a doctor or physical therapist. Many patients do not realize that, even if your insurance plan covers treatment at your designated healthcare facility, the care you receive from the medical professionals at that facility is not necessarily covered. And this misunderstanding can lead to serious financial consequences.

The situation.

A surprise medical bill can throw your economic situation completely off-track. In a Commonwealth Fund survey, almost half of employed adults indicated that they could not pay off an unexpected $1000 medical bill in thirty days’ time. When patients find themselves in this situation, they have some difficult decisions to make.

For instance, if you choose to prioritize paying off the medical bill in order to protect your credit score, what other expenses do you sacrifice? This is a dilemma that many patients with surprise medical bills face. Thankfully, there are strategies you can use to take control of your healthcare and avoid a surprise bill.

The plan.

The following are a couple of ways you can plan ahead so that you are equipped in the case of a medical procedure or emergency:





  • Communicating thoroughly with your doctor and insurance provider is one of the most effective ways to prevent surprise medical bills.


  • If you are unsure about your price of treatment, it is a good idea to ask your doctor beforehand so you know what to expect.


  • Physicians sometimes point patients toward the hospital’s billing office, and if this is the case, you will need to get the Current Procedural Terminology code for your procedure from your doctor. This code will help the billing office identify your specific procedure, and enable your insurance provider to verify the price for you.



Ask questions.


  • Before a medical procedure, it is a good idea to check, and even double-check, that both your healthcare facility and provider are in-network.


  • According to AARP, you should double-check that your provider is in-network because certain procedures or healthcare providers may be part of your network plan initially, but are no longer included at the time of your treatment.


  • Make sure specialists are included in your network, even if your in-network doctor recommends them.


  • Find out everything you can about your procedure, like if it will require anesthesia. You do not want to be surprised by an out-of-network anesthesiologist’s surprise bill later.



Be vigilant.


  • It is important to record and keep track of information from your doctor and insurance provider. If there are any errors in your bill later, you can reference these records.


  • The earlier you begin your research on your cost of treatment, the better. When you have more time, you have more flexibility to scout out better prices and ensure your insurance coverage.


  • To prepare for a possible emergency, it helps to learn which medical facilities in your area are in-network, and if your plan covers ambulance rides. While the choice of healthcare facility ultimately falls to EMTs, you or a loved one can request that you be taken to an in-network hospital.


Speak up.


  •  If you receive a surprise medical bill and something just doesn’t add up, do not hesitate to question it. Billing errors are not uncommon and it does not hurt to get more information.


  • Some states actually reimburse patients who are charged for out-of-network care at an in-network facility, and Colorado, New Mexico, Texas and Washington passed laws this year protecting patients from surprise medical bills.
Ruby is here for you.

If you have received a surprise medical bill and are struggling with your next steps, Ruby is here to help. We can assist you in making a medical bill payment plan and even help you negotiate down the amount you owe. To learn more, visit our website!

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