Debunking Healthcare Billing Myths

Health insurance is becoming more costly and more confusing at the same rate. Not fully understanding your insurance benefits can end up costing you more money in long run.

Here’s a list of a few common medical billing myths:  

Myth #1: Prices for healthcare services differ depending on your insurance.

Many people believe a provider will change prices for services based on a patient’s health plan. This is absolutely false. The price for a service is the same; however, the out-of-pocket for each patient is dependent on his or her specific health plan.

For example, two patients have the same MRI on their right leg. Both patients’ insurance plans will be billed the same price of $600. The first patient has a plan with a $50 radiology co-pay, while the other patient has a high deductible that must be met. While the patients may be billed differently by hundreds of dollars, the $600 charge for the MRI was the same for both cases.

Myth #2: I have a primary and secondary plan. The secondary will pick up everything the primary doesn’t pay, so I should owe nothing.

Having a secondary plan does not necessarily rid you of any out-of-pocket costs. Like your primary plan, the secondary plan will have a deductible and out-of-pocket maximum that must be met before the plan will begin to pay 100 percent.

If you are a Medicare beneficiary, you may select a Medicare Supplement, or Medi-Gap policy. Some of these supplement plans will pay any remaining deductible, co-insurance or co-pay that Medicare applies to your patient responsibility. However, if a service is denied by Medicare, the secondary insurance will follow suit and deny as well.

Myth #3: If something is covered, that mean insurance pays 100 percent.

Many presume “free of charge” when they see the word “covered.”  When a specific service is covered by insurance, that means it’s allowed, or accepted. Coverage, however, is contingent upon any remaining deductible, co-pay or out-of-pocket maximum based on the patient’s benefits. This is very similar to an auto insurance policy: while you may be covered for accident protection, you are still responsible for any applicable deductible.

Myth #4: All plans offered by the same company (Blue Cross Blue Shield, Aetna, etc.) cover the same services; the only difference involves my deductible, out-of-pocket maximum and co-pays. 

Let’s say you change employers, and both employers offer health insurance through the same carrier, such as Blue Cross Blue Shield. You might assume the new coverage is the same as before, only with different co-pays or deductibles. Unfortunately, this is incorrect. Each insurance company is broken down into several groups, and each group plan can have distinctive benefits.

Myth #5: I’ve had the same plan for years – it never changes.

Benefits can change yearly. Your insurance company may deny a service that was previously covered. Look for yearly updated benefit books or refer to your health plan’s website. If you are unsure whether your treatment will be covered, call your plan’s Member Services phone number.  

Myth #6:  A baby born in the hospital does not have his or her own deductible.

For those currently planning to expand your family, congratulations! However, along with that little bundle of joy comes another deductible.  Keep in mind when budgeting that you will be paying for two patients – mother and baby.

Never be afraid to ask questions. If you are unsure about something, speak up. Ask your provider. Call your insurance company.

For any questions about your bill at Northern Arizona Healthcare, call our Customer Service team at 928-773-1848 or 866-733-3017. Or stop by the Central Business Office located at:

1000 N. Humphreys, Ste. 130
Flagstaff, AZ 86001

Open Monday through Thursday from 8 a.m. to 4:30 p.m.; and Friday from 8 a.m. to 4 p.m.