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How to avoid outrageous medical expenses

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HOUSTON, Texas – For Sara Funderburk, just opening the mailbox each morning has become a frightening, emotionally painful routine. Reading that mail is even worse.

"We can't pay it. We cannot pay these bills; there's no way," Funderburk said.

For six months now, ever since she delivered her third child, Madilynn, by way of cesarean section, Funderburk and her husband Gerad Funderburk have been bombarded with surprise medical bills related to her daughter's birth, totaling more than $10,000.

These are bills the Funderburks never dreamed they would have to pay and thought  were covered by their medical insurance.

"I said to the woman, 'But we have insurance. We're in-network. We're covered,'" she explained.

The Funderburks said they work hard, they have medical insurance that they pay more than $700 a month for and they took great pains to make sure their new baby would be born in an in-network hospital and delivered by an in-network doctor.

"I checked. The surgery coordinator at my doctor's office ran all of my insurance information and told me that they were covered in-network," Sara Funderburk said.

But what no one told the Funderburks was that a whole list of other people who worked with Sara Funderburk were out of network.

People like the anesthesiologist, assistant surgeons, consulting physicians, lab techs and even the scrub tech were out of her health plan's network.

And just two weeks after giving birth to Madilynn, Sara Funderburk was flooded with big bills she thought her insurance would have to pay for.

Welcome to the world of balance billing. It's where doctors, hospitals and labs not connected to your health plan, charge you, the patient, huge fees to make up for all the money they can't collect from your insurance company.

"So if the doctor charged $5,000 for your care, and the health plan paid $2,000, then you may be charged $3,000 as a patient," according to Andrew Fitch of nerdwallet.com.

"There are millions of people in the state of Texas who are currently being ripped off by balance billing," said Shawn Fry, a medical billing expert who has worked for six large hospital systems and is now the CEO of Prevalent Health in Houston, Texas.

Fry called balance billing totally unethical.

"It's predatory. They are taking advantage of the consumer's ignorance in charging them, sending them a bill and just hoping it gets paid," Fry said.

So, what can you do about it?

It starts before you have any treatment done.

According to Fitch, you need to do the following four things:

  • Double-check your network. If you have time to plan, make sure all of your doctors (including anesthesiologists, assistant surgeons, etc.), hospitals, labs and pathologists are in-network with both your health insurance plan and your doctor's billing office.
  • Know your specific health plan. When double-checking, make sure you use your health plan's specific name and not just "Aetna" or "Blue Cross Blue Shield." For example, say Blue Advantage HMO versus Blue Cross Blue Shield of Texas.
  • Keep the evidence. Network lists on a health plan's website are notorious for inaccurate information. Print out a copy from your health insurance website confirming your doctor is in-network. If you do it by phone, then write down a call-reference number and the name of the representative you spoke with.
  • Plan for emergencies. Know which hospitals and ER doctors near your work and home are in-network with your health plan.