5 Reasons You Were Over-Billed at the Doctor’s Office

It would be nice if your employer-provided health insurance offered blanket coverage that could pay for any medical appointment and procedure you needed. While it doesn’t generally work that way, many patients still find themselves surprised to be paying more than anticipated for the services they need.

If you’re struggling to understand why you’ve been handed a bigger-than-expected bill for services received at the doctor’s office, make sure you check out these five potential reasons.

Reason #1: Your Doctor Doesn’t Take Your Insurance

You took a recommendation from a friend or another doctor, and never thought to check whether or not your new provider would take your insurance. If they don’t, that may leave you responsible for the full amount of your visit.

It’s important to choose a doctor that takes your insurance before proceeding with service, since that can have a significant impact on your out-of-pocket payments.

Reason #2: You Didn’t Recheck for Coverage

You’ve recently visited a doctor that you haven’t seen in several years, and the bill was far higher than you expected. It looks like your insurance didn’t even touch it! If so, it may be that the office no longer takes your insurance or that they’ve changed tiers within your network and are no longer a preferred provider.

If you’re heading to the doctor for the first time in a while, always take the time to confirm that they still accept your insurance.

Reason #3: You’ve Gone to an Out-of-Network Provider

Your doctor may take your insurance, but that doesn’t mean that they’re a preferred provider for your insurance company. When you make an appointment with a new doctor or confirm an appointment with a doctor you haven’t seen in a while, it’s important to confirm that the practice is in the preferred tier for your insurance company.

While you may receive some coverage for out-of-network visits or for visits on lower tiers, it won’t be as comprehensive as you’d hoped, leaving you stuck with higher fees.

Reason #4: You Don’t Understand the Breakdown of Terms

There are several key terms that you need to understand when evaluating your health insurance policy. A stronger understanding of those terms will make it easier for you to understand what personal expenses you can expect when filing health insurance claims.

• Copay: This is the amount you’re responsible for paying when you have medical expenses. This fixed amount is often collected by providers upfront.
• Coinsurance: With coinsurance, you are responsible for paying for a percentage of your medical claim.
• Deductible: Your deductible is the amount you must pay toward your personal medical expenses before your coverage kicks in.
• Family vs. Individual: Often, you’ll have family deductibles and individual deductibles. A family deductible applies to the entire family as defined under your coverage, while individual deductibles apply to each member of the family. When you meet the family deductible in a calendar year, no other members of the family must meet their individual deductible in order to receive full coverage under your policy.

Reason #5: You Haven’t Updated Your Address

If you’ve moved recently and haven’t updated your address with your insurance company, it’s important that you do so as soon as possible! It’s not your employer or HR’s responsibility to keep up with your address change, and it’s not up to the insurance company to hunt you down.

When you update your address, you’ll receive EOB (explanation of benefits) notifications and new ID cards, which will make it easier for you to estimate the cost of future medical expenses.