With the rising cost of medical procedures, it’s important for consumers to know how to navigate the complex system of insurance, medical billing and payments. This applies not only to those with insurance, but those without, as there are usually more options than most individuals realize.
If you’re fortunate enough to be covered under an individual or group health plan, it’s important to become familiar with the terms of your plan. It used to be that the only question consumers needed to ask is whether a provider was “in network” or “participating” with a particular health plan. With today’s health plans, however, insured members need a far greater understanding of their benefits. Many policies offer only in-network benefits with a select group of medical providers, even though other providers may be contracted with the insurance carrier as a whole. The best way to determine if your medical services will be covered is to call your insurance company in advance or use their website, if available, for provider verification.
It’s important to note that the decision on where your medical care takes place is entirely up to you. This can’t be dictated by your insurance carrier, however your decision to utilize an out-of-network or out-of-plan provider might shift more or all of the payment amount directly to you. Don’t get caught unaware – know your benefits and get the most for your health care dollars.
Even if you have insurance coverage, a high-deductible plan still might leave a large amount owed to a medical provider. This also might be true if you require medical care and do not have insurance.
Most hospitals in Montana are recognized as not-for-profit 501(c)3 corporations. As such, they are required to provide “community benefit.” A portion of community benefit includes assisting individuals who meet criteria for financial assistance, which is sometimes referred to as charity care. This takes the form of the hospital forgiving all or a portion of the debt incurred for services received. While there is not a single model for hospitals to follow, most have similar processes to determine eligibility. Information regarding this should be available on the hospital’s website or by calling and speaking to someone in patient financial services. If you’re unable to pay a bill, it’s important to contact your provider to inquire about assistance or request a payment plan. Communication is key to keeping your account in good standing.
If you’re ever uncertain regarding insurance coverage or payment options, it’s advisable to contact both your insurance company and your provider in advance of a procedure if possible. This will ensure you have the best possible information ahead of time. If you believe you’re experiencing a life-threatening emergency, seek treatment first and we’ll figure out the financial part afterward, because without your physical health, it’s difficult to maintain your financial health.
Donald Miller is the director of revenue cycle at Community Medical Center.