How to manage health care costs when you have a major health event

Undergoing treatment for cancer or giving birth are two health events that don’t seem to have much in common. But if you spend time in the hospital or need extra care, either one can result in unexpected costs. Sometimes those bills can total hundreds, or even thousands, of dollars.

In fact, 1 in 5 adults reported that they got an unexpected bill, and about 22% of them said it was for more than $1,000, according to a 2022 poll by Morning Consult.

“Many treatments, especially cancer treatments, are very costly even for someone who has insurance,” says Amy Clossick-Roudebush, R.N., B.S.N. She’s a nurse and Blue Cross and Blue Shield of Kansas City (Blue KC) case manager who specializes in oncology. “It can be a lot to manage and figure out, especially if you’re coping with the aftermath of a major health event.”

Here is how to make sense of the bills that may be coming your way.

Check to see if you’ll need preapproval

For some medical procedures or cancer treatments, health insurance companies require prior authorization or preapproval, which verifies that the service is medically necessary before it’s done. Some examples:

• You are going to be hospitalized.
• You require a complicated diagnostic scan.
• You anticipate being prescribed an expensive drug for cancer treatment.

You should call your insurance company in advance. If you don’t, and the procedure is done or the drug is prescribed before your insurance plan approves it, you could be on the hook for the full cost, according to the American Cancer Society.

“It can be very frustrating for a patient, because they don’t understand why, if their doctor orders something, their insurance company has to say okay,” says Clossick-Roudebush. “But it’s actually a built-in protection for patients. We want to make sure that national guidelines are being followed, so a patient isn’t being given unnecessary treatment or tests.”

It also ensures that there aren’t several doctors prescribing a procedure, such as a CAT scan, on the exact same area of the body.

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Know your deductible

Your deductible is the amount that you pay for covered health care services before your insurance plan kicks in. If you have a $2,000 deductible, for example, you’ll pay the first $2,000 for services yourself. After that, you’ll pay a copayment, or coinsurance, and your insurance company will pay the rest.

But if you’re required to pay 20% for health care services, it can still add up. Eventually, you will hit your out-of-pocket limit, which is the maximum that you need to spend on deductibles, copayments, and coinsurance before your health plan pays 100% of the cost of covered benefits. (While this amount varies from plan to plan, the out-of-pocket limit for a plan you buy on the health care marketplace can’t be more than $9,100 for an individual, and $18,200 for a family, in 2023, according to Healthcare.gov.)

Keep in mind that all of those costs are for in-network providers. If your doctors aren’t in the network, you’ll pay more. “If your out-of-pocket maximum is $2,000 for an in-network provider, it could be double that if you go out of network,” explains Clossick-Roudebush.

Check with your insurance company beforehand to make sure all the medical providers you want to see — and the hospital where you want to be treated — are in network.

Keep copies of all your bills

If you’re a paper person, make copies of all your bills and put them in a three-ring binder. If you’re more computer savvy, scan them and save in a folder on your computer, and keep a running tally of bills on a spreadsheet.

“It’s important that you keep all of them in an organized place, because you will most likely get a bill from every single provider who saw you in the hospital, which can be overwhelming,” Clossick-Roudebush says.

Check your bills against your EOBs

Once you start dealing with medical bills, you’ll begin to receive EOBs (this stands for explanation of benefits). An EOB is a document your insurance company sends to you to let you know a claim from your doctor or hospital has been processed. It will provide the following information:

• The services provided
• What the doctor or hospital charged
• What your insurance covered and didn’t cover
• What your insurance agreed to pay
• The amount you’re responsible for

While an EOB is not a bill itself, it’s important because it shows you how your bill is broken down between your medical providers, your insurance, and you.

“You should have the EOB before you pay any bill to a provider,” says Clossick-Roudebush. “That way you can make sure you’re not being overcharged.”

Be aware of your rights

Sometimes when you go to an in-network hospital or facility, you receive care from a provider who is out of your network. The No Surprises Act is a federal law that took effect in January 2022. It protects people with private insurance from getting surprise bills from out-of-network providers in certain situations:

• Emergency room visits
• Non-emergency care at an in-network hospital, outpatient department, or ambulatory surgical center
• Air ambulance services

If you think you’ve been wrongly billed, get in touch with your insurance company’s customer service team.

Request a payment plan

Is the amount of your medical bills more than you can reasonably pay at once? Don’t panic. Call your hospital’s billing office and ask if you can get set up on a payment plan. While you’ll still be responsible for the entire bill, you’ll be able to break it up into monthly installments.

This is usually a better option than putting it on your credit card, because most medical bills are interest free. It also won’t impact your credit rating, according to the Consumer Financial Protection Bureau.

Ask about financial assistance

The Affordable Care Act requires that nonprofit hospitals provide “charity care.” This is free or discounted health care to people who need help paying their medical bills. Some states even require all hospitals to do this. When you are admitted, ask for a copy of the hospital’s financial assistance policy. It will describe who is eligible and how to apply.

Even if you don’t qualify, there may be other options. If you’ve been assigned a care manager or social worker, ask them for help. “When patients struggle with financial issues, they want to go and hide and not answer the phone,” says Clossick-Roudebush. “But a care manager can help them figure out different options, including getting financial help from a local patient assistance agency or foundation.”

Do you have questions about whether a procedure is covered? Wondering if a doctor is in-network? Visit the MyBlueKC.com member portal. Or download the MyBlueKC mobile app. Prefer to talk to someone live? Call our local Care Team for help at 816-395-2060.

You can also download our free Blue KC Care Management app to get connected to find support and connect to a care manager. Use access code kclinksupport.

Additional sources:
Unexpected bill poll: Morning Consult
Preapproval: American Cancer Society
Out-of-pocket maximum: Healthcare.gov
No Surprises Act: CMS.gov
Credit rating: Consumer Financial Protection Bureau

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.