Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult an attorney for advice specific to your situation.
Detailed Answer
1. Verify Your Insurance Coverage
Before you seek care, contact your insurer to confirm coverage, deductibles, copayments, and coinsurance. Ask for your policy documents and verify in-network providers. Under Utah’s Prompt Pay Act, insurers must process and pay clean claims within 30 days of receipt. See Utah Code §31A-21-303.
2. Request Cost Estimates
Although Utah law does not mandate written cost estimates for all services, many providers comply. Request a detailed, written price estimate before treatment. Use estimates to develop a payment plan and compare costs across facilities.
3. Document All Communication and Bills
Maintain a dedicated file for appointment summaries, itemized bills, receipts, and Explanation of Benefits (EOBs). Record the date, provider name, services rendered, quoted costs, and payment details. This practice helps you spot billing errors and provider liens under the Utah Hospital Lien Act. See Utah Code §78B-5-502.
4. Use State and Federal Assistance Programs
Explore Utah Medicaid or CHIP if your income qualifies. Visit medicaid.utah.gov to apply. Inquire about hospital financial assistance, sliding-scale clinics, and charity care policies. Consider Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) if available through your employer.
5. Challenge Incorrect or Excessive Charges
Compare itemized bills with your EOB. To dispute charges, submit a written appeal to your insurer under Utah’s grievance procedures. See Utah Code §31A-21A-302. Contact the provider’s billing department in writing. If unresolved, file a complaint with the Utah Insurance Department at insurance.utah.gov.
Helpful Hints
- Keep copies of all EOBs for reference.
- Compare billed charges to contracted or average facility rates.
- Ask for CPT or ICD-10 codes to research typical costs.
- Set calendar alerts for billing deadlines and appeals.
- Use a single digital folder or spreadsheet to track expenses and communications.
- Consider free or low-cost community health clinics for basic care.
- Consult a patient advocate or billing specialist for complex disputes.