Self-Insured? Ask These Questions to Avoid Unexpectedly Hefty Medical Bills (+ Tips To Make The Best of Your Health Insurance Plan)
Noor A Ali, MBBS, MPH
I connect creative founders to hidden🧐health insurance plans ⚖️// Founder, Think Like A Woman// Building, Happy Panda
Unexpected health bill?
When discussing health insurance planning, we have to take our capitalist economic structure into consideration.
It’s difficult for a customer to see the bright side of healthcare insurance offered by private conglomerates. Especially when staring out at an unexpected bill after paying months (or even years) of insurance premiums.
As a solo health insurance consultant, I can’t change the way the big insurance offers, but what I can offer is an honest assessment of your situation and apply my understanding of global healthcare systems to leverage the best outcome.
For example, I’ve talked about how the self-employed and self-insured can choose the best options for health insurance. Start with a state-sponsored public marketplace plan when your business or practice is new to take advantage of tax credits or subsidies.
As soon as you cross the subsidy qualifying threshold, that’s when health insurance options protect growing finances and give you quality coverage.
Read more here: Own a Small Business? Here’s How to Pick the Right Small Business Health Insurance Plan
Even with those options presented to you, I can easily tell you that 50% of my self-employed customers don’t use their health insurance plan to their fullest potential.
In fact, many of them come back to me when they’re suddenly slammed with unexpected medical bills that cost a pretty penny! We go through the best ways for them to avoid paying hefty out-of-pocket expenses, but sometimes it’s too late because they have already engaged a healthcare service without consulting me and I can’t turn back time.
To address this recurring problem, I’ve decided to come up with this informative blog post to help you avoid hefty medical expenses in the future.
4 questions to ask to avoid unexpected health bills
Before I talk about the four questions you should ask yourself, I want to point out a very important thing:
You NEED to ask your care provider questions during your health appointments.
As I’ve only practiced medicine abroad in Asia, where there is no health INSURANCE system, I don’t know if this is appropriate for me to answer.
However, coming from a cash pay-per-fee model of the healthcare payor system, sometimes a patient can save more money by seeing a nurse, or a physician assistant, rather than a specialist for a commonly treatable illness. This may not be relevant, but still sharing!
And to be guided to the right place, you need to ask questions along the way. The four most typical questions you can ask are:
1. Is there a non-hospital imaging center nearby?
Tertiary level hospital systems charge more and bill higher for the same services you can get done at a smaller imaging center. You can get the same service and same quality but your out-of-pocket will be less simply because of the facility you choose.
2. Can I have this procedure done at an outpatient facility?
Inpatient facilities come with ward, food, nursing service and equipment use fees. For simple in and out day surgeries, opting to have it done at an ambulatory center will help avoid all these service charges and reduce your out-of-pocket expenses.
Recommended by LinkedIn
3. Can I get this medication over the counter or with a prescription coupon service?
Check out these vetted pharmacy resources.
4. Can I get my issue resolved with a virtual medical consultation rather than an in-person visit?
Virtual medical care through telehealth apps has grown in popularity, especially during the pandemic. In addition to saving tons of TIME, virtual visits may have zero to low copays for the same medical advice.
My favorite platform is MDLIVE, which is an app my family and I use all the time.
Did you know you can get telemedicine-only plans for under $20/month? Grab some time with me on my calendar for a free consultation to learn more.
You can read more about virtual care versus urgent care and emergency rooms via my blog, too.
Making the best out of your health insurance plan
One point I often realize is this: we always WAIT to fall sick and then panic to check if our insurance will benefit us or not.
There are some other ways you can reduce medical costs even without falling sick.
1. Get an annual physical for you and your team
Use your health insurance to get your routine blood work BEFORE you sense something is wrong. Cover your bases by being proactive. Remind your team to do the same if you’re a small business owner!
2. Understanding how much you need to pay and when you need to pay it
Asking the above questions will help you assess it. Again, it goes back to having a transparent and healthy discussion with your healthcare practitioner to know what costs you’re talking about, where your insurance can help, and where your out-of-pocket expenses come in. This is all part of my concierge services for all my clients, where we plan for both preventive care as well as planned big medical expenses.
3. Know your options
Not satisfied with your existing plan? Before the next open enrollment season comes around, talk to your trusted healthcare insurance planner (HI!) to know what other options you have to protect yourself against heavy medical bills.
More details via 4 Ways to Reduce Medical Spending During Periods of High Inflation.
Wondering how health insurance can help you reduce hefty medical expenses and unexpected health bills? Schedule a free chat with me to discuss your health insurance needs.