Avoid Medical Bill Sticker Shock

Before Lisa Beach, an assistant vice president for an Austin, Texas, credit union, had surgery for severe back pain two years ago, she did everything she could think of to make sure she wouldn’t have to pay a lot out of pocket.

“I wanted to know the names of anyone who would have any kind of involvement in my surgery,” she says. Then she ran the names by her insurance company, Aetna, to make sure the care would be covered.

In spite of her diligence, she received a $1,050 bill for services provided by an out-of-network doctor who, it turns out, wasn’t even in the hospital during her surgery. That doctor had simply provided specialized equipment used during the operation.

Aetna refused Beach’s appeal, she says, so she went straight to the equipment provider. They agreed to drop the bill to $700—but only if she paid that day. She handed over the last $522 in her flexible spending account but still gets bills for the remaining $178.

“I thought I did everything right, only to find out some information wasn’t disclosed to me,” Beach says.

Beach’s experience is all too common. A 2015 Consumer Reports survey of 2,200 Americans found that most with private insurance don’t know where to turn with complaints about their health insurance, and almost a third had received a medical bill for which they had to foot more of the cost than they had expected. Many of those people ended up paying the bill in full.

“These problems are happening much more frequently,” says Blake Hutson, who heads Consumer Reports’ health insurance advocacy efforts. “We’re expected to pay a larger and larger share of our health care costs, and getting hit with harsh penalties if, even unknowingly, we see providers outside of our network,” Hutson says.

That’s true not just for people who buy insurance on their own through state or federal marketplaces but for those covered through their jobs. Even people on Medicare face shocks if they don’t understand the details of their plans—something that happens easily.

How can you troubleshoot the increasingly tricky health insurance system? We’ve pinpointed seven situations that can cause medical bill sticker shock—and have advice on how to handle each…