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Pamela Yip: Take steps to keep medical bills from getting out of hand

By Pamela Yip

The Dallas Morning News (MCT)

Published: Monday, July 7 2014 5:00 a.m. MDT

Medical debt is a major factor in the filing of consumer bankruptcies. And it often invades your life when you least expect it.

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No expenditure can hurl you toward financial ruin as quickly as medical bills.

Medical debt is a major factor in the filing of consumer bankruptcies. And it often invades your life when you least expect it.

But you can take steps to keep your medical bills from getting out of hand.

“The best thing to do is to be prepared to the best of your ability,” said Susan Sylvest, certified financial planner at Murphy & Sylvest in Dallas. “Understand what your insurance will and will not cover.”

Sylvest speaks from personal experience, having dealt with health care providers for her own surgery as well her family’s health needs. She learned firsthand how to deal with medical bills.

Here’s what Sylvest and other experts say you need to know:

STAY IN NETWORK: Your insurance plan contracts with a wide range of doctors, hospitals, labs, radiology facilities and pharmacies. These health care providers are part of your plan’s network and have agreed to accept your plan’s contracted rate as payment in full for services.

The rate includes both your insurer’s share of the cost and your share. Your share may be in the form of a co-payment, deductible or co-insurance.

For example, let’s say your insurer’s contracted rate for a primary care visit is $120. If you have a $20 co-payment for primary care visits, you’ll pay $20 when you see a doctor in your network, and your insurer will pick up the remaining $100.

If you go outside of your network, you pay more because those providers haven’t agreed to a set rate with your insurer. Your plan may require higher co-payments, deductibles and co-insurance for out-of-network care.

“For somebody who’s been going to a particular doctor and may now have new coverage, they really need to be certain that the doctor they have a long-standing relationship with is part of their network,” said Mark Rukavina, principal at Community Health Advisors LLC in Chestnut Hill, Mass.

“If their doctor, who is part of the network, refers them out to a specialist or to a particular hospital for care, they need to make sure those providers are also in the network because that unpleasant surprise of co-insurance trips up lots of people,” Rukavina said.

Sometimes, asking the network question may be the last thing on your mind. In an emergency, you may not have the ability — or the desire — to ask for such details.

But in non-emergency situations, ask whether all your providers are in your network.

ASK ABOUT COSTS: Before undergoing a procedure, ask how much it will cost and how much your insurance company will cover. Much of that will depend on whether you’ve met your deductible and annual out-of-pocket maximum.

Your insurance company can help you with this.

“The biggest thing that I have found is that when I’ve called the insurance company, there is usually something called either a case advocate or a nurse advocate,” said Sylvest. “They are generally nurses who understand insurance as well.”

She said the questions you should ask are:

—What do you know about my diagnosis?

—Should I get a second opinion?

—How much is this going to cost? Who’s going to be involved?

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