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3 Tips to Avoiding Consumer Healthcare Sticker Shock

The term “sticker shock” isn’t exclusive to items like clothing, jewelry, or electronics. Believe it or not, consumer healthcare can also evoke gasps of disbelief.

Consider this: You’re undergoing general surgery and you consequentially end up being treated by three doctors during the procedure. Afterward, you come to find out that one of the doctors who treated you is not covered by your health insurance and you’re slapped with a huge bill. Unfortunately, this is textbook medical bill sticker shock.

It seems this particular type of sticker shock is becoming more and more common and this unpredictability has led to some turmoil in consumer healthcare costs. Fortunately, there are ways for consumers to better understand these costs.

3 Ways to Avoid “Sticker Shock”

1. Talk to the experts.

Before heading into any type of procedure or medical service, you need to understand what type of coverage you have and what the potential pitfalls might be. When it comes to Medicare, for example, some plans only cover doctors or hospitals in the insurance company’s network. Talk to your insurance company or your doctor to get a better understanding of what is covered by your insurance. This will help you avoid costly situations, including treatment from out-of-network doctors.

2. Know the scenarios.

There are a number of surprising situations that could arise and hit you with medical bill sticker shock. Consider some of these more common situations (so that you’re prepared if faced with one in the future):

Multiple doctors involved in a procedure. Ensure that you’re aware of each doctor that could be involved in a surgery or procedure you’re having done, from the assisting surgeon to a doctor who is providing specialized equipment. If you have a network-based plan — if even one of the doctors is out of your network — you could get an unpleasant bill in the mail.

You go out-of-network. You should try to stay in-network as often as possible, but if a situation arises where you’re forced to visit a doctor who is not in-network, you should be as prepared as possible for what to expect from a billing perspective so that you’re not surprised by anything. This can happen more frequently if you have a Medicare Advantage plan.

3. Consider your needs.

When exploring your coverage options, you should take into account some important considerations. You know what type of medical needs you have – but you also need to take into account your lifestyle. You should do this because the better you know your lifestyle and medical needs, the better you can choose a plan with coverage that best accommodates costs for these needs.

Ask yourself:

– How often do I go to the doctor each year?

– How often do I see a specialist?

– Do I plan on being a “snowbird” and living in more than one state during the year? (This could impact your coverage)

– How many prescription drugs do I need on a regular basis?

As consumer healthcare continues to evolve, those who rely on coverage should be prepared to advocate for themselves to avoid situations that could cause medical bill sticker shock. Simple steps such as calling your insurance company and taking into account your lifestyle and medical needs can help you better understand costs and ultimately make smart healthcare decisions.