Surprise Medical Bills are NOT Homogeneous.
Learn 4 Types of Surprise Medical Bills:
1) Out-of-Network Providers: There Are 3 'Sub-Reasons' that Make Out-of-Network Bills Surprising... A) Separate Out-of-Network Deductible, B) Higher Out-of-Network Coinsurance (40% Patient / 60% Insurance) vs. In-Network Coinsurance (20% Patient / 80% Insurance) and C) No Network Discount Off of Billed Charges Since Provider is Out-of-Network.
2) Medical Policy: Health Insurance Will Deny Payment and the Patient Will Be Stuck with the Bill if the Doctor's Test or Procedure is Not Considered Appropriate by the Insurance Company for the Clinical Scenario.
3) Non-Covered Services: Health Insurance Will Not Cover Certain Medical Services Regardless of the Clinical Situation.
4) Confusing Plan Design: Health Insurance Frequently has A) Primary Care Copays, B) Specialist Copays, C) In-Network and Out-of-Network Deductibles, D) Embedded Family Deductibles, E) In-Network and Out-of-Network Coinsurance, F) Pharmacy Tiers with Different Copays or Varying Coinsurance Up To Varying Amounts for the Various Tiers.
These Confusing Plan Designs Leave Patients Surprised by the Bills That They Still Owe.
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