Independent FA Practices: How to Avoid Surprise Medical Billings

Hospital visits with unexpectedly high bills continue to plague independent FAs

Surprise Medical Billings from Hospital Visits Can Badly Disrupt Independent Wealth Management Business Owners

Many of our readers can relate to this: A happy – and nervous – husband and wife race off to the hospital as mom is in labor. While laboring, there’s something the doctor doesn’t like, and mom is wheeled down the hallway for a test, returning a little while later. 

I find your lack of transparency disturbing.

While this happy couple did their homework, making sure their doctor and the hospital were in network, it wasn’t enough. They’re enjoying their new little bundle of joy, when a couple of months later, they receive a bill for $1,500. 

And the bill wasn’t for the delivery – it was for the test because, as it turns out, the test and technician were out of network and the parents were never given the opportunity to know that and make a conscious decision as consumers of their healthcare. 

When you’re an employee of a large firm, events like these can be painful enough.

But for owners of independent wealth management businesses, especially newer or smaller practices, surprise medical billings can create significant and unnecessary financial headaches.

Soon, however, this scenario could be a thing of the past – no more a threat to a patient than doctor-recommended leeching from yesteryear. 

Enforcing the No Surprises Act

The No Surprises Act, signed by President Trump before he left office in December, will likely go into effect on January 1, 2022. The Biden Administration is close to finalizing the rule that will enforce the legislation.

Keep calm – a surprise is coming!

The legislation aims to prevent patients from paying any more for out-of-network expenses than they would for in-network expenses for emergency services. And for planned, non-emergency services, the provider would be required to give advance notice with the patient agreeing to it and the cost. 

Also, there is supposed to be a consumer reporting line for patients that do get surprise bills, and it forces insurance companies and providers into arbitration if they cannot work out a balanced bill. 

Surprise billing can happen in many ways, in addition to the above scenario – a real-life example that happened to my wife and me with our first of seven children – that kicked off my latest column in WSR’s Health & Wealth section. 

Doing Your Homework Isn’t Currently Enough

Especially egregious in hospitals, a patient could do all the homework possible, knowing for a fact that the hospital, the lead doctor or surgeon are all in network. 

And yet, all of a sudden, another doctor on the surgery team you weren’t aware of is added to the mix, or the medical team supporting you brings aboard an anesthesiologist.  And if any of these additional healthcare professionals are not in network, the unknown costs will soar without any advance warning or consent. 

Just think about the absurdity of it, given today’s data-driven, accuracy-obsessed, digitally-powered modern economy.

Using just one of an endless supply of examples, while anyone can walk into a fast-food restaurant and know the price and nutritional value (or lack thereof) on all the food items, good luck trying to figure out what you’ll pay in total for an MRI or a procedure in an emergency room, until weeks or months after the fact. 

Only time will tell if this new rule is a success or whether providers of healthcare simply find workarounds to keep the patients guessing and paying higher and higher costs for their healthcare.

Removing the Surprises – Once and for All

This is one of the reasons why we at the Financial Services Institute (FSI) created our health plans for individual financial advisors. Besides having rates unavailable on the open market, our ACA-compliant plans utilize reference-based pricing, which pegs everything to Medicare, keeping the out-of-pocket expenses down for our members and the overall plan.

Our plan makes every effort to take the surprises out and, more importantly, to significantly lower the ever-rising costs of healthcare. It’s the wave of the future as costs and premiums continue to soar. 

Chris Paulitz, Head of Strategic Initiatives, FSI

We often tell our members that we can lower the cost burden of healthcare, but we can’t fix a broken, ailing system. 

Hopefully the No Surprises Act can vaccinate all of us from extremely high out-of-network costs and allow all of us to be true consumers of healthcare.  

In the meantime, independent financial advisors need to actively look out for their best interests by making sure they’re enrolled in the right healthcare insurance plan for themselves, their families and their businesses.

Chris Paulitz is Head of Strategic Initiatives at the Financial Services Institute, where he oversees CoveredAdvisor.

To learn more on CoveredAdvisor visit and use the Special Access Code FSI4ME. 

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