Maximizing Your Benefits: Tips for Avoiding Surprise Healthcare Costs

Everyone deserves to have decent healthcare, but unfortunately, that benefit isn’t on the table for some people in the workforce. While healthcare costs can be astronomical (and potentially devastating to one’s savings account), there are certain things you can do to avoid surprise bills and keep those you do have to a minimum.


Find out if your doctor is “in network”

Being “in network” simply means your provider and the insurance company have made a special price arrangement in which the insurance company agrees to cover more of the costs—thus lowering the amount of money you have to pay out of pocket. Going out of network requires you to pay the full amount, so it’s almost never worth doing.

How do you find out if your doctor is in network? You can go to your insurance company’s website to print out a network list, call the number on the back of your insurance card to speak directly to someone at the insurance company, or search for a specific doctor or clinic via the insurance company’s website (most have a “doctor search tool” so you can plug in various doctors and specialists to see if they’re included in your network).

Find out if a procedure is covered by your plan

Before agreeing to have a (non-emergency) procedure done, be sure it’s covered by your insurance plan. How do you find out if the service is covered? You can either request a Summary of Benefits and Coverage (SBC) directly from the insurance company or through their website—many have a PDF form available online you can download and print; or you can go to your insurance company’s website to see if they have a cost estimation tool, where you can plug in a specific procedure at a specific location and see how much is covered versus how much you will have left to pay.

It also helps to request the specific medical codes for the procedure in question, or the Healthcare Common Procedure Coding System (HCPCS). This can clear up any confusion about what exactly is being done and can get you a more accurate price estimate.

Find out who to speak with to find out more information

If you can’t find the answers to your questions online (or just prefer speaking with a real live person), you still have options. One is to contact your Member Services team, which is a fancy name for insurance company representatives. They can answer all of your questions about what doctors are in network, which services or prescriptions are covered, and how much your out-of-pocket costs will be for a specific procedure. The back of your insurance card will have the number you can call to contact them. The other alternative is to contact your doctor’s office directly to speak with either a receptionist or billing representative. Either one of those people should be able to tell you if they accept your insurance carrier and specific plan for routine office visits—they won’t be able to provide much in the way of information about specific procedures, however.

Ask the right questions

Whether you search for it on your insurance company’s website or chat with someone on the phone, it’s important to know what to ask. Be sure you have access to a list of medications covered by your plan, and always check to see if there is a generic available (which is almost always cheaper than name brand). When considering getting any medical test done, be sure to find out whether it’s preventive or diagnostic. Diagnostic tests are often much pricier.

While good healthcare is still considered a “perk” of a job, it’s more important than ever to utilize this particular benefit wisely and judiciously. Take these steps to help protect yourself and your loved ones from scary unexpected costs.

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