EAST TEXAS (KLTV) - The cost of health care can be significant, even more so when those expenses arrive unexpectedly. This season's influenza epidemic is forcing millions to seek medical care. The Centers for Disease Control and Prevention said this week that 54 out of every 100,000 people are being hospitalized due to complications from influenza.
After the Raycom Investigative team examined the rising cost of health care, the KLTV Investigative team decided to find some helpful tips viewers can use to help keep those medical costs under control. Here they are, in no particular order:
Know your network and coverage
Dig into you policy before you need to use it. Policies can be dense and hard to understand, but pay attention to emergency room visits and copays for doctor visits. Those are the two you will likely use most. Make a list of what hospitals and emergency rooms are in your health plan and keep the list with you. We recommend using the notes app on your smartphone.
We found several websites that offer consumers a place to compare prices on prescriptions and procedures. We tested them, and recommend using multiple sites and forming an estimate on your own. Remember, these are estimates only.
Ask for an estimate
Texas law allows consumers to ask for an estimate before a procedure, but gives businesses 10 days to respond. So, ask early. A Texas insurance expert said most facilities have an expert on staff that can contact your insurance company and ask about specific benefits and explain the cost upfront. Ask as many questions as you need, health care coverage can be complicated.
Inspect billing statements
Hospitals communicate with insurance companies through thousands of codes. Each procedure has its own. One mistake in how the medical facility requests payment from your insurance company could be the difference between no co-pay and a large bill. The codes aren't secret, ask which one was used and why. Also, request an itemized bill from the medical facility and all providers. Check insurance statements and bills for any errors, and contact both if you find one.
Every hospital we contacted offered some sort of internal program to help patients pay bills. Ask. The worst thing you can do is nothing at all.
"We offer financial counselors that work with patients to work out payment plans or other financial options, ahead of or following their procedures. We also offer cash pricing options and work with patients to determine their options for self-payment. Patients can also apply for a range of financial assistance that is available to those who qualify," said CHRISTUS Trinity Mother Frances Health System spokesman Will Knous.
Kerri Camp, a health care professor at the University of Texas at Tyler, said mediation may be the answer.
"I would start with the provider and make sure that they billed it correctly, sometimes they haven't used the correct codes so the insurance company has denied it because the provider didn't use the correct codes in order to get reimbursed, then I would talk to the insurance company remember we purchase insurance, we are the consumer of our insurance, so they can call the insurance company directly and see if there are some other ways to mediate the payment," Camp said.
If you have health coverage through a preferred provider organization (PPO) and the bill is more than $500, the Texas Department of Insurance may be able to help. Consumers who went to a facility in their health plan's network, but were billed by a facility-based doctor or other health care provider who is not part of the network can call a hotline (1-800-252-3439) for assistance in mediating the bill. More information can be found here.