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HEALTH INSURANCE: Don't Put the Check in the Mail
Too confused by your E-O-B to ask W-H-Y?
If you get a bill from a doctor or laboratory or hospital saying you owe more than you think you did, don't assume the mistake was yours. 
In fact, don't assume it was a mistake. According to Business Week, US consumers are paying an estimated $1 billion a year in medical bills that they don't really have to pay. It's a practice called balanced billing - charging insured patients more than their co-pay and deductible - and it's illegal in 47 states. (Exceptions are made for certain elective and out of network procedures etc). People pay because they think they have to, fear damage to their credit rating, or don't know how to fight back.
Part of the problem, of course, is that our health insurance system is just too confusing for consumers, and too little is in plain English. (Remember that study a few months ago that found that 55 percent of insured people don't understand the "critical details" of their health policies, which prompted us to ask at the time, who are the 45 percent who do understand them?) We don't think transparency is the sole solution to our health care woes, but it would sure help if both the insurers and providers explained the rules a little more clearly. And if regulators acted assertively to stop abuses, and made sure that when doctors and health plans have disputes, the patient doesn't get the bill. Literally.
Riules have to be both clear and fair. And the payment system has to make sense. Which is why we are so eager not to just cover more people in a reformed system, but cover them in a way that works. A system where the parts fit together, instead of playing tug of war with one another.
(Hat tip to the WSJ health blog for noticing this article while we were still distracted by our Google searches for Sarah "Barracuda" Palin...)..
Medical Procedure Fee's "Aka- Medical bills"
I agree completely with this article; Well I have only been saying that most folks (even those with health insurance) really don't understand how their health insurance plan works. When it comes to medical procedures and bills, I would say 95% of folks just pay any bills that come in the mail. In my experience- I would say that this problem is going to grow as more and more Americans purchase high Deductible type plans (because of lower premiums).
We are about to enter a the "Perfect Storm" in medical billing in America, First we have a recession, inflation as we enter September 2008- Most Americans are looking for ways to lower health insurance premiums. One easy way is to alter plan design and offer employees high deductible plans, these normally offer much lower premiums. These type of plans necessitate that the consumer to be a "Smart Shopper", this means shopping for Medical procedures. Recently I was speaking to a large group of folks regarding High Deductible Health Insurance plans (specifically Health Savings Accounts Eligible plans)- I asked the group (over 50 people) if they knew the cost of a simple X-Ray at a local outpatient clinic? No one in the room could answer (beyond the cost of copays)- then I asked the cost of a Oil change- everyone quickly raised hands to answer.
The Most important part of purchasing a High Deductible health insurance premium (or any plan for that matter) is knowing the Medical Procedure Schedule (or quite simply- get in writting the exact cost of popular medical procedures) ie. X-Ray costs, MRI Costs, Office Visit Costs, these are items that health insurance companies throughout America should be sharing with clients. I advice my clients to purchase High Deductible plans when and only when the health insurance corporation will disclose at least 100 of the most popular medical procedures. You might be wondering what is the medical procedure costs and what will that tell me. Well lets say I have a 3500 Deductible plan (which I do) that means I must pay all medical costs up to 3500 if I go to visit a PPO provider within the network of physicians- lets say I need a X-Ray of my arm this week - I can go to my sheet of medical procedure costs and find out how much I will expect to pay ($85.) and where I can go to get that X-ray. Buying a HSA (high Deductible type plan) without such knowledge is like going to a auto dealership that does not list prices on cars- and buying the car going home and then two weeks later receiving a bill in the mail for a price that has never been discussed.
Some folks call this "Medical Transpariency" some call it "Consumer Driven Health Plans". I say High Deductible plans are for those who are willing to do the work- these are not for everyone- if you are the consumer who clips coupons and shops for "Deals" and stays healthy by eating right, excercise, than High Deductible plans are perfect.
Stay Healthy,
Rudy Lehder Rivas, President & CEO
http://www.HSAInside.com
Health Saving Account Specialists
High Deductible Health Insurance Plans for Folks who are good Consumers
Helping consumers look up prices for health care services
Check out a new community website called www.outofpocket.com. This website helps consumers look up prices so they can find the best value for routine health care services. The site relies on consumers to post/share prices they paid for actual visits -- to share with other consumers.
Until the health care industry provides meaningful tools to help consumers make the most out of their health care dollars - it's really up to consumers to search around, ask questions and identify the true price of a specific service ---before visiting a provider.
Regards,
Mona Lori
Founder
www.OutofPocket.com
Let the insurance company
Let the insurance company process your claim first before you pay more than your copay. They will let you know if owe anything and will also more than likely get you discount too.
I can't believe that health
I can't believe that health insurance companies would be that greedy to try to confuse or obfuscate their billing information to get more money out of their policy holders. You have got to be getting something wrong.
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