Update 2: Congress enacted the No Surprises Act in 2020, and while 33 states have taken it upon themselves to provide some sort of protection, it will now become a federal law going into effect January 1st, 2022.

Update 1: With the passage of AB-72, as of July 2017, California has protection in place to protect consumers from balance billing at in-network facilities.

It has happened to most of us, we visit the doctor, provide our health insurance ID card for services and then receive an unexpected bill a few weeks later. Over the past two years, nearly one-third of privately insured Americans have received an unexpected medical bill where their health plan paid less than expected. With Annual Out-of-Pocket Maximums now over $8000 for an individual, these balance bills are often extremely difficult to handle. To make matters worse, whether you’re disputing the charge or simply can’t pay, medical debts are quick to reach collection status. According to the Consumer Financial Protection Bureau, one in five consumers have an unpaid medical debt on their credit report.

Here are a few small, but important steps that you can take to avoid unexpected medical bills.

• Call your insurer ahead of a medical procedure as some procedures require pre-authorization. Carriers like to make sure that certain expensive procedures are medically necessary and if you have the procedure without making sure that it is authorized, you could get stuck with the bill.
• Familiarize yourself with your health plan. Dig into plan specifics related to deductibles, coinsurance and maximum out-of-pocket costs. Deductibles and coinsurance can be confusing if you do not know how they work on your specific health plan. Also, many people can be caught off guard by the individual vs family deductible. A quick email to your broker can help refresh your memory on material covered in your benefit orientation.
• Don’t assume that because your doctor or hospital is in-network, that you’re all clear. Some insurers have tiered-service networks, reimbursing some in-network providers more than others. Other times, surprise bills come from on-site service providers—say, those doing lab work or radiology during that hospital stay—who aren’t in the network, even though the hospital itself is. Anesthesiologists are many times out of network. If you are having surgery, work with your doctor to ensure the anesthesiologist is in network.
• It is also good practice to ask for an itemized bill from your provider. Most of the invoices that you receive in the mail are summaries.