Portland Legal Services - Joanne Reisman, Attorney at Law
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Avoiding or Reducing Medical Bills Not Covered by Insurance

The first thing to check for is to be sure that the medical location and the medical providers are in your Network.  Be careful with the myriad of convenient urgent care clinics that are springing up all over the place in shopping malls, in pharmacies, and at other suburban locations.  If the care facility is not specifically contracted with your medical insurance network it is not likely to be covered.

Medical Services that aren't covered are often billed at the highest prices for medical services.  There are three tiers of pricing for the same service - #1 the rack retail price, #2 the insurance discount price (that they give you if you run it through insurance even if you end up paying for it), and #3 the in-network contract price which is the lower amount they have agreed to accept from your particular insurance carrier.

Tip:  If you are ever stuck with a medical bill not covered by insurance you can try to negotiate for the lower "insurance" price.  The incentive for them to negotiate with you is to get the bill paid directly to the provider rather then the provider having to sell the debt at a great discount to a collection agency which is what they often do with their bad debts. They get more money collecting from you even if the bill is discounted.  Some larger hospitals have plans to help people deal with large medical bills.  Discounts, grants, etc.  It always pays to ask. 

There is one more trap that you all need to be on the alert for and avoid - it is the out-of-network doctor at the in-network urgent care location.  So even though you go to an in-network urgent care location, it is possible that the doctor on duty that day is out-of-network.  You always have to ask and make sure that not only the location is in-network, but also the doctor you are seeing at that location!!!!!


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