Avoid unexpected medical bills

Staff Writer
Wayne Post
John Ninfo

I want to briefly look at those unexpected medical bills that we have all been hearing and reading about. I say briefly, because the bottom line is that today we all have to accept the reality that we have to do research and ask a lot of questions before we have any medical procedures, something we did not have to do in the “old days.”

Like so many other issues, the pandemic has highlighted and exacerbated this growing problem.

Briefly, these expenses result when you receive “out of network services” from a provider that is not part of your insurance coverage. It may happen because you unknowingly go to a non-network provider, or, because many medical services have been what I call “deconstructed.” What I mean by that is that in those old days you went to a hospital to have a hip replacement under the direction of your primary doctor and performed by a recommended surgeon. The surgery was all one cost, covered by your insurance. Today, because of deconstruction, the surgeon may be in network, but the anesthesiologist and/or the surgical assistant, providing services in the operating room, may be out of network, and billed separately. Also, you may have to pay separate fees, like a hospital facility fee for using the operating room. It’s a new game.

My recommendation is that you take the time to research this issue, like on aetna.com and other sites, and have a clarifying and planning conversation with your primary doctor when you next meet with them. How will you, as a team, handle this potential problem going forward?

In the meantime, here are some tips from aetna.com. 1. Research your preventive insurance coverage and the billing codes before any visit, and ask your insurer if your prospective procedure is covered. 2. Ask your doctor to always use in network labs and tests. 3. If appropriate, because they are not fully covered, shop around for the best prices on medical tests and procedures. 4. Look out for those facility fees from hospitals, emergency rooms, etc. 5. Know in advance what ambulances in your area are in your network.

On a different subject, the United States Postal Service has been all over the negative media of late, because of three issues. First, although the Service is a government agency, it is fully self-funded, and it is experiencing serious financial problems, with some reports estimating that it will run out of money in September of this year. Second, because of its financial problems, the Postmaster General has implemented some new internal practices and procedures, which are, in some cases, delaying the delivery of mail compared to delivery times in the past. Third, with all of the talk of increased voting by mail for the November presidential election, there is a lot of speculation as to whether the Service is up to the task of implementing voting by mail in a timely manner.

As an aside, I still mail in all of my bills, so I personally care about the Postal Service. However, because of the anecdotal reports on delayed mail, I am doing what I recommend that everyone do: I am mailing out my bills and any other important mail early. Speaking of bills, we know that Spectrum Cable, RG&E, and NYSGE bills are increasing, so it’s time to rework that budget.

As a further aside, I am still using my supply of stamps that I purchased in January of 2019 before the 10% price increase.

On another subject, I realize that it is in large part because of the pandemic, but, as I listen to all of the reports about additional stimulus and relief funding, the losses incurred by industries like the automobile and airline industries, the budget deficits of state governments, and more, it doesn’t seem that anyone is talking in the millions of dollars anymore. Everything is the billions of dollars, and then there is the Heroes Act of the House, which is $3 trillion, and if it became law, would theoretically take our national debt to around $30 trillion. It reminds me of the quote attributed to Everett Dirksen — “A billion here, a billion there, pretty soon you’re talking real money.”

Do you remember how much one billion dollars actually is? It is a thousand million dollars. If you had one billion dollars and spent $1,000 a day, it would take you 2,740 years to spend it all.

On yet another different subject, one of my favorite subjects was in the news recently – behavioral economics. The question was how does behavioral economics explain some people’s refusal to wear a mask, despite the current overwhelming evidence that if they were universally worn in public, in combination with social distancing and good hygiene, it would substantially reduce the spread of coronavirus.

Here are some answers from a recent NPR piece and some research that I did. First, in our society, we have become used to immediate rewards for our behavior if it requires a sacrifice. For some people wearing a mask to help prevent the spread of a disease has costs, inconvenience or discomfort, or a perceived limitation on their freedom, but no real needed immediate reward. Second, we react to the social norms of our society, tribe, group of friends, etc. However, mask wearing has not become a national social norm and expectation quite yet, so some people don’t fall into line, so to speak.

One possible marketing suggestion, to nudge more people to wearing masks, is to appeal to people’s sense of fashion, another thing we react to in our society, by showing great masks worn by admired entertainers and sports personalities.

On the other hand, it is important to emphasize that wearing a mask is not itself enough, so that people don’t take more unadvised chances, because they feel safe. Social distancing, avoiding large crowds, hygiene, staying home when you can, and meeting with people outside, rather than inside, are still necessary.

John Ninfo is a retired bankruptcy judge and the founder of the National CARE Financial Literacy Program. Find his previous weekly columns at http://www.mpnnow.com/search?text=Ninfo or at http://www.monroecopost.com/search?text=Ninfo.