By Dr. Donna O’Shea

Nearly everyone wants to save more money, including when it comes to paying for medical care. To help encourage that, various recent federal regulations have spurred a greater focus on health care cost transparency, both by hospitals and health plans.

For instance, the No Surprises Act is designed to help reduce the likelihood of people receiving an unexpectedly large medical bill, something that more than half of Americans have experienced. Other recent regulations require hospitals to post prices online, while health insurers have been mandated to do the same.

While these efforts offer important protections, there are various other ways to help avoid an unexpected medical bill. Here are five strategies to consider:

Comparison shop based on quality and cost. Health plans are now required to publicly disclose contracted rates with health care providers and facilities, with additional requirements for more consumer-friendly disclosures slated to start in 2023. Fortunately, some health plans already offer transparency resources featuring quality and cost information, available online, via a mobile app or through customer service. Before scheduling a medical appointment, check with your health plan to review quality and cost information, ideally for estimates based on actual contracted rates and customized based on your individual plan.

Stay in-network. While the No Surprises Act helps reduce the chance you will be left with a big bill if an out-of-network provider is involved with your care, it’s important to always start with in-network health care professionals and facilities for nonemergency care. That includes when referred by a primary care physician to labs for bloodwork, imaging (e.g., MRIs) and other tests. To help reduce the risk of surprise charges, some health plans are proactively contacting members before they go out of network, sending a text message, emailing or calling to notify them about more affordable in-network options.

Recognize remaining risks. Even with upfront research, there are still a few potential risks to be aware of. Many health plans cover preventive services, such as wellness visits, mammograms or colonoscopies. However, some advanced screenings may not be considered preventive services and can result in an out-of-pocket charge. To help avoid that, confirm with your health plan that any services or tests are covered under your benefits, potentially working with your care provider to complete a preauthorization form in advance.

Negotiate surprise bills. In the event of a surprise bill, talk with the support staff at the hospital or doctor’s office to request that the charge be waived or reduced. If needed, some health plans offer access to resolution support to help negotiate on behalf of members with hospitals and care providers. If you receive a surprise bill from an out-of-network care provider, call the number on the back of your insurance ID card to alert your health plan and check on assistance.

Consider plans with upfront pricing. Rather than receiving medical care and then waiting for the bill to arrive weeks or months later, some new health plans enable members to review – and pay for – out-of-pocket expenses before medical care is delivered. The goal is to make navigating the health system simpler and more transparent, in part by eliminating deductibles and using clear pricing to encourage people to select quality, cost-efficient health care providers and facilities.

In view of increasing price sensitivity due to rising inflation and other factors, considering these strategies may help contribute to your physical and financial well-being while reducing the risk of a surprise medical bill.
Dr. Donna O’Shea is chief medical officer of population health, UnitedHealthcare located in Cypress

We’re getting a better idea of what a new, second gymnasium on the Los Alamitos High School campus could look like and how much it might cost.

Currently in its design phase, the public got an update on the project during the September 20 Los Alamitos Unified School District Board of Education workshop. C.J. Knowland, the district’s Director of Facilities, Maintenance and Operations and Transportation, outlined the latest developments on the construction of the second gymnasium that is intended to serve basketball, volleyball and other sports teams as well as host assemblies and events.

It’s slated to be the final large-scale construction project paid for with Measure G bond money. That’s the $97 million bond measure local voters in Rossmoor, Seal Beach and Los Alamitos passed in 2018. Measure G already financed a new aquatics facility and the new multistory STEM building at LAHS. Funds from the 2008-approved Measure K bond measure were also used.

After a previous board meeting in March, it was clear that the board was going to have to make some tough decisions regarding the scope of the gymnasium project. The hope was to build a roughly 38,000-square-foot competition facility with three courts, bleachers for 2,000 people, multiple team rooms, a weight room, a ticket window and concession stand.

But with construction costs skyrocketing, the original $21 million budget is no longer enough. Board members ended the March discussion by asking for more consultation with high school staff before making decisions.

At the Sept. 20 meeting, Knowland had an update on what was called the Griffin Center. He said construction costs have continued to rise and increased by 35.6% since the start of the Covid-19 pandemic in 2020.

“That really makes things a little bit difficult as we’re trying to whittle our price down,” Knowland said and added, “It’s a constant battle. We’re hoping it improves. It looks like it’s plateauing but only time will tell.”

After speaking with stakeholders and looking at cost estimates from three general contractors and an estimating firm, Knowland said the plan is to reduce the overall size of the gymnasium and to break the project into two phases. The first phase would be the bulk of the project building a roughly 30,000-square-foot facility with the three courts, team rooms, restrooms and a concession stand. Phase two would add the weight room and outdoor fitness to bring the total size to around 33,300-square-feet.

The total projected cost for both phases of the project, including with estimated contingencies, is around $28,500,000, according to Knowland.

Superintendent Andrew Pulver, Ed.D., said it was hard to make any decisions about the costs until a cash flow analysis is completed, which is expected soon. He anticipated perhaps $500,000 being rolled over from the other big bond-financed projects once they are closed out. And he also talked about the possibility of getting matching funds from other government sources.

“We don’t know anything about matching funds yet but we certainly are applying for all of that as much as possible,” Pulver said.

Construction on the second gymnasium could start by the summer of 2023 with a possible duration of 18 months, according to Knowland.

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