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How you can fight surprise medical bills when you think you're covered

Posted: 6:00 AM, Sep 27, 2019
Updated: 2019-10-06 20:25:56-04
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PHOENIX — An unexpected medical bill is the last thing you want to think about while recovering from a medical procedure. Unfortunately, that was not the case for the Lovegrove's.

Eva Lovegrove says she has spent hours on the phone trying to sort out a bill her husband received after an emergency procedure.

Lovegrove says they made sure the hospital and the surgeon performing the operation was in-network.

"We thought we were good to go," Lovegrove said.

Months after the surgery, Lovegrove says they got a bill for almost $3,000. According to her insurance, an assistant in the operating room was out of network.

"It was somebody who was chosen without us knowing about it," Eva said.

The insurance covered about $100 of that bill and said the Lovegrove's would be responsible for the rest.

Lovegrove contacted the provider and said at first they weren't helpful.

"They were saying we know you didn't choose this provider; however, we're not going to lower your bill," Lovegrove said.

Things changed after weeks of almost daily calls. Lovegrove says the provider decided they would cut the bill from $2442 to about $300.

After this experience, Eva and her husband say they are asking every provider involved with their care if they're covered.

"I'm just as concerned about the billing as I am about the medical procedure," Eva's husband Brian said.

WHAT STEPS CAN YOU TAKE TO PREVENT A SURPRISE BILL:

  • Ask any provider involved in your care if they are part of your insurance network - If they don't know contact your insurance company.
  • If it's a scheduled procedure, talk with the hospital or care facility about who will be part of your care. Express your desire that all participants are in-network providers.
  • Consider where you get small procedures like blood work and x-rays done. Have your doctor refer you to an in-network lab.
  • See if you can get pre-authorized for procedures through your insurance.
  • Talk with your insurance and ask for the billing codes they cover for the procedure you need to be performed. Talk with the provider to make sure these are what they are using. For example, your insurance may cover an ultrasound, but not a 3D ultrasound.

WHAT TO DO IF YOU GET A SURPRISE MEDICAL BILL:

  • Call your insurance to see if they can bill the provider as in-network.
  • Check to see if you qualify for help from the AZ Department of Insurance. Under state law, full-insurance consumers are protected from surprise bills and may not be responsible for the balanced bill.
  • Do your research about what your procedure should cost. Sites like https://www.fairhealthconsumer.org/ break down the costs. If your provider is asking for more, this could help you negotiate a fair price.