• The No Surprises Act protects patients from some unanticipated medical expenses.
• It’s important to understand what you’re responsible for paying. Don’t pay until you’ve done your research and explored all options.
• It is possible to negotiate a balance bill. Prepare with research and planning.

Don’t let a balance medical bill throw you off balance

What’s a balance bill? Simply put, it’s the bill you get from an out-of-network health care provider for the difference between the amount they charge and the amount that’s allowed. For example, if the provider’s charge is $100 and the amount allowed by your plan is $70, the provider may send you a balance medical bill for the remaining $30.

If you’ve gotten such a bill, you’re not alone — nearly one third of privately insured people have dealt with the same frustration and headache (Khazan, 2023).¹ And even though the No Surprises Act protects against certain unanticipated medical expenses, the problem hasn’t gone away. To help, we created Naviguard^®. For UnitedHealthcare members whose plans include Naviguard, we’re an ally in understanding, negotiating, handling, and resolving out-of-network medical balance bills.

How to know what’s considered out-of-network

Become familiar with your health plan to know what you’re responsible for paying and to plan for potential bills. Before any doctor visit, surgery or procedure, log in to your account to check your plan details, then use the provider search tool to see if your provider is in your network.

You can also call the number on the back of your health plan ID card to find an in-network provider. Taking the time to understand your plan is worth it.

What to do, and not do

If you get an out-of-network balance medical bill, especially one that’s unexpected and seems excessive, don’t pay it until you connect with Naviguard. You may have options.

It’s possible to challenge or negotiate a balance medical bill. You may be able to reduce it, get more time to pay, work out a payment plan, or even eliminate the bill entirely. Here are four steps that may be helpful.

1. Arm yourself with information. Gather the facts about what happened with your providers. If you thought all your services and providers were in-network, share why. Having concise and complete background information may help you later.
2. Strengthen your case with competitive research. Learning what other providers charge for the same service will give you a better idea if the amount you’re charged is fair and reasonable. One highly regarded source of information about health care costs is Fair Health Consumer. You can also call your provider and ask about the non-insured price for the services you received.
3. Get ready to negotiate. Consider ahead of time the outcome you’re hoping for. A reduced bill amount? A longer pay period or payment plan? Reversal of charges? Financial assistance? This will help you determine how to negotiate. And remember, there’s no harm or shame in asking. People who are experienced with health care do this all the time, and you’re well within your rights to be proactive.
4. Keep calm and carry on. It may take several phone calls, but don’t give up. Staying calm and organized can help smooth the way for resolution. Be sure to take notes during conversations and ask for written confirmation from your provider.

Naviguard’s track record of success

Our experts have helped tens of thousands of UnitedHealthcare members navigate difficult balance medical bills with significant success. This includes more than 30,000 cases, engaging with more than 2,000 providers across the U.S. in over 170 specialties.

Our website at Naviguard.com has many helpful resources. If you’re a member with a large out-of-network balance medical bill, we may be able to pair you with a dedicated Member Advisor who will personally guide you through the entire process and, depending on the claim, negotiate with providers on your behalf.

Naviguard — in your corner

The most important thing to know is that you’re not in this alone. Our services are available at no additional cost to UnitedHealthcare members whose employers have included Naviguard in their plans.  

Not a member? Our resources may still be able to help you understand your bill and avoid being overcharged. Plus, Naviguard can help you get organized, gather the necessary paperwork, and build your case for negotiation and resolution. To learn more about the services we offer, talk to your employer or visit our About page.

P.S. Finding in-network care is easy with the UnitedHealthcare Provider Search tool.

RESOURCES

• Learn how Naviguard can help reduce the cost of out-of-network balance medical bills.
• Learn about the experiences others have had with Naviguard’s services negotiating out-of-network balance medical bills.

REFERENCES

• Khazan, O. (2023) The agony of medical bills. The Atlantic.