The Top 5 Unexpected Medical Costs You Must Prepare For
When I dislocated my shoulder in a minor bike accident last fall and got carted away in an ambulance, I figured my pretty decent health insurance plan would cover most of the costs. \
After all, I carefully chose an option with low deductibles and coverage for emergency situations. However, I ended up slammed with almost $3,000 of unexpected health bills simply for the out-of-network ambulance ride, ER facility fees, medications while there, and subsequent follow up appointments.
It was an incredibly stressful financial blow during an already painful recovery. And as I started asking around, I realized I’m not nearly alone struggling with medical gaps leaving people responsible for outrageously high expenses they never budgeted for or imagined they would be stuck with.
As an increasingly common crisis, we all need to become aware of the most prevalent sources of unplanned healthcare bills lurking out there. Let’s walk through the key gaps I uncovered where people often get financially sideswiped.
Over-The-Counter Medications
After getting overcharged for prescriptions to manage my shoulder pain, I figured I could save some money by switching to basic over-the-counter pain relievers and anti-inflammatories instead. How expensive could some ibuprofen and Tylenol really be?
Well, when you’re shelling out $15–20 frequently for name brand bottles it adds up shockingly fast. Not to mention cold medicines, sinus pills, acid reducers, bandages, braces, heating pads…it never ended.
I quickly learned that “over-the-counter medical costs” are completely uncovered as common “uninsured medical fees” by the vast majority of health plans.
So while it seems like a little insignificant thing, paying cash for numerous OTC remedies monthly impacted my budget dramatically. Some of my friends reported similar strains from requiring frequent heartburn medication, EpiPens for allergies, CPAP machines and masks, or physical therapy tools like resistance bands, massage balls, and braces.
It’s frustrating that insurers don’t classify critical therapies people rely on daily for chronic issues as necessary. Sure, OTC stuff seems convenience-oriented. But when your quality of life depends on it, those frequent small costs compound quickly and can equal a car payment every quarter! While it’s manageable periodically, you need contingency savings if you regularly require non-prescription items for health conditions insurance refuses assisting with. Once again — an unpleasant surprise no one warns you about!
Urgent Care Facility Fees
Since my shoulder injury wasn’t life-threatening, the ER sent me home pretty quickly after x-rays confirmed nothing was broken and put my arm in a sling. However, at my follow up appointment with an orthopedic specialist a few days later, I learned I had a severe Grade 3 AC separation that would require intensive physical therapy and possibly surgery down the road.
So essentially, I had a very serious injury despite the ER discharging me with basic pain meds. As the acute pain set in over the following weeks, I made a few desperate trips to an in-network urgent care clinic when I just couldn’t endure the spasms any longer. And each time I went, my co-pay was $75 which I wrongly assumed covered everything.
You really have to understand how to pay off unexpected medical bills in these situations.
Boy, was I wrong. A month later I received a bill for $650 for something labeled “urgent care facility fees.” Apparently the room charges, specialized machines like x-ray equipment, and supplies utilized during my rapid visits were all billed separately with very little coverage from my insurance. So those misleading $75 co-pays only represented a fraction of the actual fees, while the bulk got coded as uncovered facility costs I alone was responsible for.
It seems deceptively simple to pay your co-pay upfront and assume things are covered. But urgent care clinics depend heavily on stacking bogus “facility charges” for unsuspecting patients thinking they’re protected when the opposite is true. This has caused many people financial pain needing quick medical attention but lacking budget reserves the urgent care industry quietly preys on.
Out-of-Network Doctors & Specialists
When you’re in immense pain, researching every single doctor’s network affiliations isn’t your top priority — you simply need relief fast. And that moment of desperation causes many people to unknowingly establish care with providers outside their coverage network.
Even if a primary care doctor is in-network, they often refer patients to specialists like orthopedists, neurologists, physical therapists, and more without thoroughly vetting network participation.
This lack of confirmation upfront leads to enormous bills after the fact once insurance refuses to cover out-of-network care. For example, you break your wrist and need surgery quickly. The orthopedist your PCP refers you to isn’t covered by your plan unbeknownst to you. While they perform the urgent procedure, you later get slammed with the portion insurance won’t reimburse since the doctor isn’t in their network.
The same goes for ongoing care like physical therapy after injuries. You may pick a local practice without realizing they don’t participate in your network. Months down the road after you’ve paid numerous hefty copays, you discover thousands in uncovered charges for “out-of-network” services. This happens frequently with childbirth classes, lactation consultants, infertility specialists, and other niche treatment categories patients wrongly believe their insurance includes.
While being an empowered advocate is wise, it’s nearly impossible decoding every provider’s network status when needing immediate treatment. The phenomenon of inadvertent out-of-network care sinking patients financially is an opaque issue more education is critically needed on.
Dental Procedures & Equipment
During a routine teeth cleaning, my dentist noticed some decay under an old crown that had lifted slightly. He suggested getting the crown fully replaced to prevent further damage, quoting me $1500 based on typical dental insurance coverage. I figured my plan would pay its share so I agreed to the crown replacement.
However, when the insurance claim processed, they denied the entire $1500 as an uncovered “cosmetic” procedure instead of a medical necessity. Appeals didn’t work either. Turns out dental insurance often rejects claims for pricey treatments like crowns, veneers, implants, gum grafts, and teeth alignment services deeming the aesthetic focus unnecessary.
The same goes for dental devices like mouth guards to prevent teeth grinding or night guards for TMJ. As essential medical treatments for underlying conditions, patients wrestle fighting insurance to get those covered.
Invisalign braces, retainers after orthodontia, and teeth whitening also stand as popular uncovered costs that dentists push assuming insurance reimbursement but often bill patients directly instead. Beyond major dental work, something as small as a replaced night guard for $300 quickly becomes problematic to struggling households.
While dental insurance feels like an important add-on protecting your budget from large infrequent bills, there are plenty loopholes for things people expect coverage on. Comb through policies cautiously and clarify uncertainties to avoid major uncovered dental fees sneaking up on you. Having to unexpectedly front $1500 for a recommended crown when a $75 cleaning is covered demonstrates the extreme discrepancies.
Ambulance Transportation
When a terrible accident or health event occurs, ambulances arrive on scene to swiftly transport injured people to hospitals able to provide life-saving care. So you’d think emergency medical transportation would be covered, right? Wrong.
Ambulance fees averaging $1000+ for even short distance trips to the hospital represent unexpected medical bills catching many people off guard. Insurance often denies covering ambulance transportation entirely or only pays a small portion leaving the majority of staggering bills to families scrambling how to pay.
For example, an unconscious car crash victim gets taken by ambulance to the nearest ER. They ultimately recover fully, but get slapped with a $2000 fee for the 10 mile ambulance ride when discharged because insurance refuses reimbursement. For lower income households especially, bills like this destroy financial stability.
The same goes for people requiring ambulance airlifts during remote emergencies like hiking accidents far from hospitals. Air ambulance services can charge over $100,000 relying on uninsured patients getting stuck with crippling debt!
While premiums and deductibles balloon sky high, vital services like emergency transport worsen in affordability. Having an extra $1000+ per unexpected medical crisis proves impossible for already cash-strapped households. So this stands as yet another case of the system failing everyday people exactly when they’re most vulnerable. More reform is desperately needed around ambulances converting necessary services into family bankruptcies.
Final Thoughts
As we’ve explored, health insurance coverage stands riddled with surprising gaps placing financial hardship onto families and households least equipped to handle it.
From costly over-the-counter medications to ambulance transportation fees, copays and deductibles give many people a false sense of financial protection when the opposite holds true in practice.
As out-of-pocket maximums trend infinitely upwards, more categories of essential everyday healthcare get pushed into the “uncovered” bucket without sufficient forewarning. Ultimately we desperately need expanded education, policy reform, and consumer advocacy surrounding the most painful gaps where unexpected health bills destroy budgets. Only through transparency into where existing systems continue failing people can we drive meaningful progress.
