The paper trail from a simple doctor’s visit can be so labyrinthine that some people simply wait for an envelope from a collection agency before cutting a check
“The sequence of events goes something like this: You go to the doctor, pay the $10 or $20 co-pay on your way out, and shove the carbon copy receipt into the bottom of your purse or pocket. Later, you get an envelope with a piece of paper in it that says, “This is not a bill.” It mentions that a bill is coming, but this isn’t it, so you ignore it. Ditto for the second non-bill that says — seemingly– the exact same thing. Then a bill shows up that says that you don’t have to pay it yet because the insurance company might pay some or all of it. Next, the “explanation of benefits” bill that says “this actually is a bill” arrives, and you ignore it, too, because, well, maybe they’re kidding. Once the sixth or seventh envelope arrives, you figure it might be time to pay the bill (or send a “This is not a payment” payment just to be cheeky).
Repeat this cycle for every lab test, radiologist report, dermatological exam, and nurse practitioner appointment, and it’s no wonder you have no idea what you’re shelling out to keep your brood healthy.”
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{ 10 comments }
One way to simplify the process (for everyone) is for the insured to participate in an HRA (Health Reimbursement Arrangement) or HSA (Health Savings Account). These simplified plans have no copays and (generally) have lower premiums.
Essentially the plans are two plans under one umbrella. An insured portion (high deductible) and a loss fund (self funded account for eligible expenses below the deductible).
Visit the doc. Pay your bill as presented. File for reimbursement from your loss fund.
That’s an oversimplified summary but it does eliminate a lot of the confusion and will make life easier on all participants (provider, carrier, insured).
Bob, with the new Health Savings Accounts (as opposed to the older Medical Savings Accounts) do you find there is a place for Health Reimbursement Arrangements anymore?
When would they be appropriate?
The HRA is still valid in the workplace and most employers prefer the HRA over the HSA. The HRA is a tightly administered plan leaving little room for “cheating” by submitting claims that are not legally reimbursable.
Also employers like the forfeiture provisions of the HRA . . . something that does not exist in the HSA. Unused credits in an HRA roll over to be used the next year but are forfeited if the employee leaves for other than retirement.
Under the HSA, once employer monies are deposited into the loss fund the employee can leave (or be fired) and those monies are their to take with them.
The HRA has higher admin costs which can be a negative in a smaller business. Beyond that, the plans are very similar.
No way this solves the problem. These are just a sample of mess-ups from the last year; HSA or HRA would not have done squat to help.
- Group practice, but my insurance is only accepted by one of the docs. That doc isn’t on that day so my son sees another. What is supposed to happen is that it should be submitted to my insurance as in-network since we are a patient of an in-network doc and the group works out the intra-group accounting. Doc #2 submits as out-of-network. I give up after numerous tries to correct and tell group to go pound salt. If they send me to collection, I may sue them.
- Same group states that they are negotiating in-network, but haven’t finalized yet. They decide to drop. Bill everything as out-of-network even though there was an explicit understanding that they planned to stay in-network for at least one doc. They stay in-network for an HMO whose capitation over twelve months equals less than 2 office visits reimbursement in-network for the old insurance. Go figure.
- Private pay rates 200-400% over insurance negotiated rates for speech therapy (this one is actually 2 years old). They say speech therapy is necessary; I offer to pay 125% of negotiated rate. They tell me no dice. I call them names.
- ER visit where there is a separate line item for IV start. Insurance EOB says that charge should be consolidated. I tend to agree. Hospital claims to agree, but bills keep on coming for the difference.
I could also talk about the $1200 charge for moving my son in the NICU from one room to another for the hospital’s convenience. He was in an isolette on wheels. How about the misdirected insurance claim even though I had registration paperwork where a carbon of the correct insurance card is clearly visible? The hospital is in-network so has no recourse according to the insurance company for late submissions, but the hospital doesn’t seem to agree.
The best solution is to let the bills go to collection and then clean up the credit report if necessary. It is easier than dealing with the insurance companies and healthcare billing people.
If you want to let your bills go into collection and affect your credit, that is certainly your prerogative. Calling your provider names is another adult action.
I also think it is a good idea to post anonymously.
Carry on . . .
Bob,
You changed the subject. You said HRA and HSA would solve the problem; it doesnt’ and I gave examples. Also, let me rebut your ad hominem. I have great credit and I pay all my bills that I owe including medical bills, but I won’t waste my time trying clean up someone else’s mess. I also know my rights regarding credit reporting and am willing to sue if the doctor, hospital, or credit reporting agency abuses them. Finally, most medical organizations and their collection agencies don’t even report.
You may well have to deal with court action.
The contracted doc should be covered by other contracted docs; that provision is commonly in the doc’s contract. A complaint to your insurance will often solve the problem. They may put pressure on the cotracted doc, and from there, the covering doc in his group.
The IV start, is the hospital contracted with your insurance? If contracted, it’s either allowed or not, and not to be billed to you….IF they are contracted with the insurance.
I have a HSA, I make sure to get insurance that has a network in my area, to avoid precisely the problem you described.
You can probably fight these agencies for something reasonable like 125% of the typical contracted rate with private insurance if you can find those numbers. It’s just doing it the hard way.
Though actually, I still disagree with you, in the sense that the more HSA’s are out there, the more people become aware of the problem you encountered, the more providers will respond to the concerns.
I know my hopsital is listing prices, in an effort to create price transparency….precisely because of problems like you had.
The real problem usually comes up with the hospitals, as that’s where the big bills are usually run up. Private doctors, the idea is, you find docs contracted with yout insurance.
That the doctors all dropped out of the insurance usually speaks more to the insurance than the doctors. They didn’t sign up for a reason.
I never said it would “solve” the problem, I merely said it is one way of dealing with the issues in the Fool article. The Fool pointed out how some people pay their copay then just assume everything after that is paid. They ignore EOB’s, never bother to match EOB’s with their payment at the doc’s office, etc.
The HSA/HRA eliminates copays and eliminates a lot of bookkeeping for the patient. It is a very streamlined approach to tracking what is and is not paid.
With an HSA/HRA you still have to understand your policy, and know what is in network, what isn’t if you want to maximize your plan.
The problem you (anonymous 3:51AM) cite is one that you have mostly created for yourself. If you want to know what is paid in network, and what isn’t you should check with your carrier, not the provider.
If you don’t understand your plan then you are right. It really doesn’t matter how the plan is structured. The way you handle of it waiting on the provider to turn it over to collections, or sue you will still have the same result.
And to 4:13 anonymous, the docs dont contract with the insurance companies. The health insurance policy is between the carrier and the insured patient, or in the case of an employer plan, with the employer. In many cases the provider will agree to bill the carrier as a courtesy to the patient, but it is still the patient who is responsible for paying the bill.
Bob, I’m on your side. I have a HSA for myself and my practice.
Thing is, I signed something, with at least a few insurance companies, Medicare and Medicaid.
I don’t know if you want to call it a “contract” or whatever, but it is an agreement to seek payment from the insurance company and all that.
The insured should find contracted or participating doctors and participating hospitals, etc., or be prepared to go through these hassles.
Most likely the agreements you signed were with managed care companies (PPO networks). Providers are not direct parties to the health insurance policy but merely assignees for claim purposes.
Any agreements direct with insurance carriers would be with regard to proper handling of those assignments. The contracts to which you refer will usually require timely and proper filing of claims. Since most claims are batch filed electronically the format must agree with the carriers system if your claim is to be considered for adjudication. Your carrier contract would outline all of the details regarding the claims filing process but would not release the insured from responsibility for knowing what is, and is not covered under their policy.
Some carriers such as Blue Cross grow their own PPO networks as opposed to renting them from companies such as Beech Street, PHCS, CCN, etc.
As for Medicare & Medicaid, that is an entirely different system and claims are handled by third party administrators. The taxpayer funded programs have different rules, and severe penalties for misfiling of claims.
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