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What you can do about surprise medical bills

There are two ways to combat surprise medical bills, whether they come from an air ambulance, a ground ambulance, or a health care professional: Prevent them in the first place, or fight them later.

Here’s some advice from Consumer Reports on dealing with unanticipated medical bills.

Most are the result of being treated by someone outside your insurance company’s network of providers. Avoid out-of-network providers whenever you can. That’s easier to do in nonemergencies, such as when planning a knee replacement or having a baby. In those cases, ask the person who handles billing in your doctor’s office to list anyone who could conceivably be part of your care — anesthesiologist, radiologist — including while you’re in the hospital.

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Then call your insurer to make sure that those people are in your network — don’t rely on online directories, because they can be out of date. Tell the physician that you only want in-network providers.

It’s harder to determine who’s in-network during an emergency, when there’s no time for such research. Still, it’s wise to find out — before you need to go to the ER — which nearby hospitals are in your network and use in-network ER physicians.

If you need an ambulance, you can ask to be taken to an in-network hospital, though the first-responder on board will make the final decision. So reserve ERs for true emergencies, and if it’s safe, go to one by car.

If you’re stuck with a surprise medical bill, call the provider and your insurer. Explain that you didn’t realize the care, which was essential, would involve out-of-network providers. Some physicians may accept the insurance payment and forgive the balance. Or the insurer and the non-network physician may agree to reduce the bill.

If you’re billed for emergency care or ambulance transportation, also ask the first responders or ER doctors to provide documents confirming that you had no say in how you were transported, and that it was medically necessary.

If all else fails, Consumer Reports recommends complaining to your state’s health insurance agency, said Caitlin Donovan of the National Patient Advocate Foundation.

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Those agencies can’t always help — for example, states have little power over air ambulances — but lodging a complaint could strengthen your bargaining power.

To contact your state’s insurance department, use Consumer Reports’ “surprise medical bill tool,” at ConsumersUnion.org/insurance-complaint-tool.

Also, the Patient Advocate Foundation has counselors who can help. Contact it at patientadvocate.org, or 800-532-5274.


For more, visit www.ConsumerReports.org.