Key Take Aways:
- The No Surprises Act protects patients from some unanticipated medical expenses.
- It’s important to understand what you’re responsible for paying. Don’t pay until you’ve done your research and explored all options.
- It is possible to negotiate a balance bill. Prepare with research and planning.
Don’t let a medical balance bill throw you off balance.
When you receive a medical bill for an amount beyond your deductible, co-pay and co-insurance, it’s called a “balance bill.” Quite often, a balance bill is prompted by medical care that’s considered out-of-network, or services from a provider who doesn’t have a contract with your insurance company.
If you’ve gotten such a bill, you’re not alone—in fact, 57% of patients have dealt with the same frustration and headache. And even though the new federal No Surprises Act protects against certain unanticipated medical expenses, the problem hasn’t gone away. To help, we created Naviguard. For our members, Naviguard is an ally in understanding, negotiating, handling, and resolving out-of-network medical bills.
How to know what’s considered “out-of-network” for you?
Every health care plan is different. Get familiar with yours to know what you’re responsible for paying and to plan for potential bills. Before any visit, surgery or procedure, log into your account to check your plan details, then use an online provider search tool to see if your doctor is in your network. You can also call the number on the back of your insurance card to find an in-network provider. Trust us, taking the time to understand your plan now is worth it.
OK, now let’s dive into the details.
How do I get rid of a balance bill? Am I required to pay it?
Well…not yet, and not necessarily in full. Our advice? Don’t panic, and don’t pay any charges until you’ve explored all options. Because medical billing is complicated, it’s possible that the bill is a mistake. We recommend that you double check your Explanation of Benefits (EOB) letter and call your insurance company’s member services department to confirm that the claim is accurate, and your out-of-network benefits were applied correctly. Even if the bill is correct, you may be able to challenge it. Like we said, you have options.
Can I negotiate a balance bill? How do I ask for a lower bill?
Yes, it’s possible to negotiate a balance bill. You may be able to reduce it, get more time to pay, work out a payment plan, or even eliminate the bill. But here’s what you need to do to prepare first.
How To Negotiate a Balance Bill
Arm yourself with information.
Gather the facts about your experience and your providers. If you originally thought that all your services and providers were in network, be able to share why. Having concise and complete background information will help you later.
Strengthen your case with competitive research.
By learning what other providers are charging for the same service, you’ll have a better idea if your charges are fair and reasonable. Fair Health Consumer and Centers for Medicare & Medicaid Services are good sources of information. You can also call your provider and ask about the non-insured price for the services you received.
Get ready to negotiate.
Consider ahead of time the outcome you’re hoping for: Reduced bill amount? A longer pay period or payment plan? Reversal of charges? Financial assistance? This will help you determine how to negotiate. And remember, there’s no harm—or shame—in asking. People who are experienced with healthcare do this all the time, and you’re well within your rights to be proactive.
Keep calm and carry on.
It may take several phone calls, but don’t give up! Staying calm and organized can help smooth the way for resolution. Be sure to take notes during conversations and ask for written confirmation from your provider.
Naviguard — in your corner.
Naviguard has helped tens of thousands of members resolve their out-of-network billing issues and saved a lot of money and anxiety in the process. In 86% of cases where Naviguard was engaged to negotiate with the provider on behalf of the member, we’ve been successful at helping members negotiate better rates.* Our website at Naviguard.com has a variety of helpful resources. If you’re a member* with a large out-of-network medical bill, we may be able to pair you with a dedicated Advisor who can personally guide you, and even negotiate with providers on your behalf.
The most important thing to know? You’re not in this alone! We can help.**
**Our services are currently available at no additional cost to UnitedHealthcare members in Naviguard participating employer benefits package plans. If you’re not a Naviguard member, our resources can help you avoid costly, preventable medical bills and help you understand every detail of your medical bills. Plus, Naviguard can help you get organized, gather the necessary paperwork and build your case for negotiation and resolution. To learn more about the services we offer, talk to your employer or visit our About page.
P.S. Finding in-network care is easy with the UnitedHealthcare Provider Search tool.
*Based on Naviguard’s engagement with its members during January 2021 through April 2022. Negotiation success rate is based on claims negotiated to less than billed charges. Negotiation success rate may vary and is not a guarantee of future results.