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Ask Christina: What can I do to protect myself from high medical bills before I receive care?

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By: NerdWallet Health health finance expert Christina LaMontagne

 

Question:

I’m pregnant and due next spring—and trying to be proactive about receiving the highest-quality, lowest-cost care possible because I’m worried that my bills will be unaffordable. What can I do now to prepare for the bills associated with my pregnancy?

 

Answer:

Unfortunately, having a baby is expensive, no matter how you cut it. One large study found the average cost of childbirth to be tens of thousands of dollars; out-of-pocket costs to the patient (in simple English, what you actually pay for the delivery) averaged between $2000 and $3000, depending on the type of delivery. Combined with all of the other costs of having a baby (including prenatal visits, ultrasounds, screenings for conditions like gestational diabetes), your bill can add up quickly!

It’s great to hear that you’re already thinking about this. Here are a few tips to start with:

1. Spend some time getting to know your insurance policy: Make sure you’re clear on what your insurance covers, and what it doesn’t. Maternity and newborn care has been defined as an “essential health benefit” under the Affordable Care Act, which means that most health insurance plans are required to cover these services. However, states were given the option to choose what actually counts as “maternity and newborn care,” so this could vary depending where you live. The most reliable way to get a concrete answer is to call your insurance company and talk to a representative. Ask questions about what your copays and deductibles are for different services, which providers and medical facilities are in your network, and what your options are in case of a denial. When communicating over the phone, ask for the name of the rep and what’s termed a “call reference number.” You will also want to record the date and time. These details will protect you in case a claim is denied for something you were told would be covered.

2. Learn some jargon: It’ll be easier to communicate with your insurance company and your health care providers if you understand a bit of their language. What does it mean to need pre-authorization? What benefits are available to you should you obtain out-of-network care? There are both general health insurance terms and terms specific to Obamacare that will be helpful.

3. Ask questions at the office: Just because your doctor suggests a test or other service, doesn’t necessarily mean you need it! Ask questions about services before they’re provided. If your doctor wants to order a test or equipment for you, you can ask what it costs and determine whether or not it’s covered before agreeing. You may have other options that your physician won’t offer unless you ask, so be proactive and do some digging!

4. Mind your timing: If your pregnancy spans two calendar years, you should be careful about how and when you’re billed, as some women can get hit with two insurance deductibles for one pregnancy. If you are in this situation, and especially if you have a high deductible insurance plan, get in touch with your hospital and obstetrician to see how you can get all your bills submitted in one year or the other (and therefore, have all bills count towards one deductible).

 

NerdWallet Health helps patients reduce their medical bills. Have a question? Call us at (800) 503-5404 or sign up for a free consultation with a medical billing expert.

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Posted by on September 4, 2014. Filed under Columns. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

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