Emergency Room Patients Routinely Overcharged—Greatest Effect on the Uninsured

Emergency Room Patients Routinely Overcharged—Greatest Effect on the Uninsured

A Johns Hopkins study of billing records for more than 12,000 emergency room doctors across the country showed a wide variance in prices. On average, adult patients are charged 340% more than the Medicare rate (amounts Medicare pays each facility for like services, plus the deductible and co-insurance). These rates are lower than in-network health insurance rates—which generally are contracted at 1.6-2.0 times the Medicare allowable rate. The study covered a wide variety of services from CT scans to simple stiches for a small cut.

A very distressing finding of the study was that most hospitals charged minorities and patients that are uninsured substantially higher rates, than commercial insurance and Medicare allowable rates. These huge disparities in emergency room prices poses a serious problem to millions in the U.S.

Surveys of both emergency room physicians and general internal medicine physicians’ charges were analyzed. The resulting service bills’ markup ratios were staggering: Emergency Room doctors had an average markup of 4.4 times Medicare allowable-while the Internists’ charges averaged 2.1 times Medicare allowable; less than half. However, due to a ubiquitous lack of patient-friendly regulation and unfettered and unrestrained greed—some emergency room physicians charged between 1.0-12.6 times what Medicare allows. ($1000-$12,600). This “gap” cannot be attributed solely to the quality of hospital or doctor performance (given the variations within each institution).Besides, who is thinking of that in the ambulance? This disparity cannot be explained by equipment used(a CT machine is a CT machine).Thus, presumably more so than any other hospital department, emergency rooms were guilty for charging up to 12 times more than what Medicare paid for the same services. There is a clear bias, however, toward for-profit hospitals charging more than non-profits.

The population affected most greatly by these practices are more likely to be located in the Southeastern and Midwestern U.S., serving a population of African-Americans and Hispanics that are uninsured. These uninsured patients are often charged FULL CHARGEMASTER rates. It gets worse. Once receiving a bill for services calculated at 12 times Medicare allowable, the billing departments are often aggressive about collecting amounts 8-12 times higher than from most other patients.

Often, the uninsured will receive no discount on their bill. (Several hospitals first seek to have the patient apply for financial assistance—and, if qualified, may receive discounts through that route). Some hospitals are terribly rigid, setting up roadblocks to negotiating reductions to this medical debt. Billing personnel will not even identify their last names. Managers are difficult to identify-generally not listed on the website. A more transparent, interactive approach could go a long way to addressing this problem. Some have a very “quick trigger” as to when to send a patient to collections. The effect that medical debt-particularly debt inflated to 10.0 times the pricing at a comparable facility can have negative life-changing repercussions. The uninsured bear the brunt of such practices –although certainly not alone. Forty-three (43%) percent of the population has medical debt listed on their credit report. Medical debt is the largest driver of individual bankruptcies in the U.S.

 In 2003, the eighty (80) plus hospitals owned by Tenet was the subject of a lawsuit involving this precise topic—that was characterized as “Price-Gouging the Uninsured. To its credit, it softened its policy toward collections against those unable to pay; including discontinuing placing liens on the homes of such patients. Currently, it still offers automatic discounts for the uninsured in certain situations—with payment plans on discounted amounts (although its preference is to do so prior to the patient’s discharge).

The need for state and federal regulation to address hospital rates in order to protect patients becomes more pressing each day. If you have such an experience, write a letter to the hospital Administrator—copy its CEO and the state agency governing hospitals (despite that in some cases, it will not take jurisdiction of billing matters), call your congress person and senators(both state and Federal). Contact NPR and other news organizations. Silence will not result in change. Bringing this to the attention of those with decision-making authority might.

If you think you’ve been overcharged, or otherwise need help with your medical bills and health insurance matters– contact a Board Certified Patient Advocate at Human Health Advocates of Boca Raton, FL. WE ARE HERE TO HELP!

Preparing for an emergency

Preparing for an emergency

Did you know that you can save yourself a lot of time, frustration, and MONEY by being an informed patient? You may be asking yourself “how?” The healthcare system, especially medical billing and health insurance is extremely complex and confusing. However, with a little advance planning, you can reduce or eliminate endless phone calls to medical billing or health insurance representatives that are unwilling or unable to help you resolve your problem. Advance planning is also very likely to help you save money on medical expenses, as well. In a series of blog posts, we will give you many of the tools necessary to help you make informed decisions that ultimately save you money.

Be prepared for an emergency. When you need medical attention quickly, you have to make several decisions at once. Knowing which in-network Hospitals and Urgent Care Centers are closest to your home, workplace, or places you visit most often can save you hundreds, even thousands of dollars.


If possible, start by assessing whether the situation could be handled effectively by an Urgent Care Center, or whether your condition is serious enough to warrant a trip to the emergency room.You could spend a few minutes researching this as part of the planning process. If you are unsure, try calling your primary care physician for help determining which facility you should go to. An Emergency Room visit can cost as much as 10 times that of an Urgent Care Center.


In order to protect yourself from unnecessarily high medical bills, you should know which hospitals and which urgent care centers are in-network with your health insurance plan.

 These simple steps can help you save thousands of dollars:

  1. Locate one or two in-network urgent care centers near your home. Be sure to note the address and hours of each. Remember, some Urgent Care Centers are staffed by MD’s—others not.


  1. Next, locate one or two in-network urgent care centers near your workplace;


  1. Locate one or two in-network hospitals closest to your home. Note the entrance to the Emergency Room.


  1. Finally, locate one or two in-network hospitals near your workplace.Note the entrance to the Emergency Room.


  1. Document the information in a way that you can access it at any time, especially in an emergency.

It’s not always possible to be fully prepared for an emergency. However, knowing which Hospitals and Urgent Care Centers are in-network with your health insurance plan literally can save you thousands of dollars.


Finally, there may be several invoices in connection with an Emergency Room or  Urgent Care Center. Don’t assume that your medical bills or health insurance explanation benefits are correct. Its estimated that 85% of medical bills have erroneous charges or health insurance processing mistakes. If you are having difficulty understanding your medical bills and/or health insurance Explanation of Benefits(“EOB’s”), contact one of our Board-Certified Patient Advocates at Human Health Advocates. We review medical bills and health insurance determinations. We negotiate reductions in medical debt from hospitals and other providers. Get in touch. We can help!

Reduce your out-of-pocket costs by staying In-Network with your health insurance plan

Reduce your out-of-pocket costs by staying In-Network with your health insurance plan

Did you know that you can save yourself a lot of time, frustration, and MONEY by being an
informed patient? You may be asking yourself “how?” The healthcare system, especially the
medical billing and health insurance aspects, are extremely complex and confusing. However, with
a little advance planning, you can reduce or eliminate endless phone calls to representatives that
are unwilling or unable to help you resolve the problem. Advance planning is also very likely to
help you save money on medical expenses. In this series of blog posts, we will give you the
necessary tools to help you make informed decisions and ultimately save you money.

What is a Health Insurance Network and Why Does it Matter?

Every hospital, free-standing facility, and physician has what is called a chargemaster rate. This
rate is typically an inflated amount related to the services that were performed during your visit.
These chargemaster rates are different among the various providers. The chargemaster rate for
an emergency room visit due to the flu might be $1,200 with Hospital A while Hospital B’s rate is
$1,800. Why is this important?

Literally, no one pays the full chargemaster rate. If you are uninsured or underinsured- you are
expected to pay this full rate. However, in most cases, a reduction can be obtained (be on the
lookout for a future blog post to explore this further).

Health Insurance Companies and Providers (hospitals, physicians, facilities, etc.) work together
to negotiate rates for every service, procedure, and supply called “allowed amounts.” This
agreement between a health insurance company and multiple contracted providers is what
creates the NETWORK. Doctors, hospitals, and other providers that do not have a contract with
the insurer are “out-of-network. IF YOU STAY IN-NETWORK amounts billed are radically less
than the chargemaster rate for covered services. Again—that is IF you stay in-network! When
you see a network provider, you are protected by the negotiated rates between the provider and
health insurance company. The provider cannot bill you more than the contracted allowed
amount for services covered by your health insurance plan. This does not apply to non-covered
or exclusionary services.

In some cases, such as having an HMO/EPO plan, out-of-network charges are not paid at all by
the insurance- leaving you with astronomically high medical bills. In other cases, your health
insurance company may make a small payment but, you are left with the remaining balance which can be substantial. Below you will find clear examples of the difference in costs from seeing an in-network vs. out-of-network provider for the same service.


Beth recently received a breast cancer diagnosis. Her primary care physician refers
her to a highly respected oncologist at a local cancer center. Without checking with her
insurance company, Beth schedules an appointment for an initial exam.

Here is an example of difference between the out-of-pocket cost had the oncologist been in-network vs out-of-network:


The Oncologist’s chargemaster rate for Beth’s initial exam: $550.00

The in-network health insurance allowed amount (based on the annual cost-sharing
accumulation): $200.00

The negotiated in-network discount amount: $350.00

The amount you may owe (based on your annual deductible, copay, and out of pocket
maximum): $200.00
**The in-network provider cannot charge you more than the negotiated rate for covered

The out-of-network Oncologist’s chargemaster rate for the initial exam: $550.00

The out-of-network health insurance allowed amount: $100.00

The amount the out-of-network provider may try to collect from you (based on your annual
deductible, copay, and out of pocket maximum): $450.00-$550.00
**The provider is allowed to charge you more than the out-of-network “allowed amount”
as there is no contractual agreement with the health insurer (also known as balance

Beth’s savings by using an in-network provider were $200.00-$300.00


Did you know that using an out-of-network provider is likely the greatest cause of exorbitantly
high medical bills? Providers and patients are not on the same page. Barely a third of doctors
discuss their charges with patients. Unfortunately, it’s the patient’s responsibility to know their
provider’s network status with their health insurance plan. One of the most commonly made
mistakes regarding confirming network status is relying on just the hospital or physician’s office
to provide you with accurate information.

There are many different networks offered by the same health insurer. If you call a provider and
ask, “do you accept Florida Blue?” The answer will almost always be “yes.”** (Florida Blue is the
largest health insurer in Florida)** However, Florida Blue has multiple plans with multiple
networks. Although the doctor or hospital you want to go to might be in-network with the Florida
Blue – Blue Options plan, they may not be in network with your Florida Blue – Blue Select Silver
Plan. A lot of times the physician does not even know which networks they participate in!

In order to verify your provider’s network status, you will need:

• The provider you wish to see’s name, service address, and contact number.

• The NPI (National Provider Identifier) – Contact your provider to request their billing NPI.
Ask if the provider bills the NPI as an individual or as a group. (Organizational healthcare
providers such as hospitals, physician groups, facilities, etc. would submit a claim under
a group NPI).

Once you have the information above, follow this triple-check system to help you avoid
going out-of-network unnecessarily. (Stay tuned for an upcoming blog post regarding
Surprise Medical Bills):

1. Check your health insurance web portal. Every web portal is different based on the
health insurance carrier. Typically, you can search by provider/facility name, specialty,
geographical location, NPI, hospital affiliation and more. If the provider does not
populate in the search results, they are most likely to not be within your plan’s network. If
you are unsure, refer to #2,below.

***NOTE: It is highly recommended that you register for access to your health insurance
web portal, if you haven’t already done so. Most health insurance web portals provide
access to your benefit details, claims submitted by your providers, amounts applied to
deductibles and out-of-pocket maximums, and other valuable resources. TIP-If you
are changing insurance companies, verify how long after separating from the company
you will have access to your information on the internet. Some companies only allow
thirty (30) days—other two (2) years.

2. Call your health insurance company directly at the number on the back of your card.
Give the customer service representative as much information regarding the prospective
provider as possible (name, address, specialty, NPI, etc.).  Ask what the name of your
health insurance network is if you are unsure (see #3).

IMPORTANT: Always ask the customer service representative for a reference number at
the end of the call. Document the representative’s name, date, time,and details of the
call. This information can be extremely helpful if you experience any problems in the
future. For example, your claim could be processed out-of-network when you were
advised the provider was in-network.

3. Verify the network status information you received from your health insurance company
with the provider’s office. Ask for the insurance verification representative at the
provider’s office. Provide them with your Health Insurance Network information and the
details of your call with your health insurance company’s representative. Ask them to
confirm their network status.

4. A provider’s network status may change, sometimes without notice to you. Contracts
between insurers and providers are generally renewed annually (often near the beginning
of the calendar year). Check your established provider’s network status annually to avoid
any surprises.

If you receive conflicting information from either the health insurance company or the
provider’s office, ask to speak with a supervisor to help you clarify the discrepancy. Always
remember to document the name, date, details, and if available, a reference number for
every interaction you have with your health insurance company and providers.

It all boils down to taking a little extra time to verify and confirm your provider’s network
status with your health insurance plan. Ultimately, it is your responsibility to know your
provider’s network status, even in an emergency. Out-of-network, out of luck. Stay in-network, save a buck!

If you are unsure if your medical bills may have been processed out-of-network vs. in-network, or otherwise have trouble with medical billing and health insurance matters, contact one of our Board-Certified Patient Advocates at Human Health Advocates. We can help!

Biggest Flash Points In The Graham-Cassidy Health Care Bill

Biggest Flash Points In The Graham-Cassidy Health Care Bill

From www.npr.org: If Senate Republicans vote to repeal and replace the Affordable Care Act this week, it would affect the health care of pretty much every American.

Here’s a recap of four key flash points in the health overhaul debate with links to NPR coverage over the past six months, and our chart laying out how the Graham-Cassidy bill under consideration in the Senate addresses those issues compared with the Affordable Care Act.

Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.

Medicaid. The federal/state insurance program provides health care for 20 percent of all Americans, including 40 percent of children, half of all births, 60 percent of nursing home expenses and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including California and New York, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.

Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 “essential health benefits,” including maternity care, mental health,Health Advocates hospitalization, prescription drugs, emergency care, and children’s health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and employer-based coverage. But economists say that won’t lower health costs as much as the bills’ backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.

Uncertainty And Market Instability. As far back as April, insurers were worried that they wouldn’t have enough time to set rates for 2018. That fear has only increased. Earlier this month, entrepreneurs said the lack of clarity is interfering with hiring. Enrollment on the federal exchanges opens Nov. 1, though the Trump administration has cut advertising for open enrollment by 90 percent. Some private insurers are stepping up to fill the gap.

The full article is available by clicking here: NPR

Who Wins, Who Loses With Senate Health Care Bill

Who Wins, Who Loses With Senate Health Care Bill

Would you like to have a clearer picture of the tremendous negative effects of the proposed  Republican Health Bill(“Better Care Reconciliation Act”)? Review the following chart and article from NPR for some clearly-presented information. There is nothing BETTER about this than the ACA! This provides LESS CARE than mandated by the ACA! This will cost patients MORE than under the ACA! This will cause more than 20,000,000 people to lose coverage! This is barbaric! Congress has no soul.

PLEASE—WRITE AND CALL YOUR Senators and tell them to VOTE NO!  It’s not too late.  It’s just plain wrong to take away insurance from tens of millions, reduce coverage, and raise costs—all so people that can afford great insurance can pay less taxes. Health care should be a right—available to all—regardless of economics or politics! SPEAK UP NOW! Later might be too late.

CLICK HERE for full NPR article.

This chart illustrates how the plans compare:

People under 26
Can get insurance through a parent’s plan or buy independently. Stays the same. Stays the same.
Adults under 65
Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid. Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020. The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges.Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income. Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline. Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
Coverage cannot be denied or cost more. States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions. Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. If a particular benefit is no longer classified as essential, insurers could impose annual and/or lifetime limits on what they spend on patients for that benefit. And caps on the annual out-of-pocket costs for patients would no longer apply.
People who go to Planned Parenthood
Federal programs reimburse for most Planned Parenthood services. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
The majority of Medicaid dollars go to people with disabilities.
May qualify for Medicare and also Medicaid. Services covered by Medicaid could be cut as federal funding to states declines over time. Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.
People who use mental health services
Covered by all plans under essential health benefits. Could lose coverage in states that get waivers from covering essential health benefits. States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
Thirty-one states and the District of Columbia offer expanded Medicaid coverage. Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion. Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
Pay extra taxes to support ACA. The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion. Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.
Navigating the Medical Billing Process

Navigating the Medical Billing Process

Kenneth Klein, manager of Human Health Advocates, was recently the featured guest on WLRN Public Radio’s popular Topical Currents show. There was an excellent discussion of many aspects of patient advocacy as it relates to medical billing and health insurers. Give a listen.

(3-7-2017) It’s a common assumption that if one has health insurance; the company routinely covers the bulk of medical charges.

Correct? The answer is only a “maybe.”

Today’s Topical Currents looks at the confusing aspects of navigating the medical billing process, with patient advocate Kenneth Klein, Founder/Manager of Human Health Advocates, LLC, in Boca Raton. He provides assistance to patients with medical bill and health insurance related concerns.

Click here to listen to the full interview.


CBS12 Investigates: Cash vs Insurance

CBS12 Investigates: Cash vs Insurance

There are times when it is less expensive to pay cash for medical procedures than submit claims having your doctor/medical provider seek payment from your health insurer.

Health Insurance AdvocateWEST PALM BEACH, Fla. (CBS12) — When you go to the doctor, do you ever think about not using your health insurance?
Some patients are now negotiating the price and paying in cash. They say cutting out insurance is like cutting out the middle man.
As a consumer, when you think about negotiating costs, you probably think about buying a car or a home – not negotiating with your doctor.
But, as we found out, paying out of your pocket instead of going through insurance could save you money.

When James Tow needed to pay for a tonsillectomy, he knew it would be expensive. Instead of just handing over his insurance card and trusting that would be the best price, James asked the doctor’s office if they had a cash price. “If I go through insurance, I’m going to have to pay the insurance price,” said Tow. “Whereas if I do the cash price, I pay less.”

That’s right. For example, if he went through his insurance, the anesthesiologist would have charged $656. James’ insurance would only pay $136, leaving him with an out-of-pocket bill for $520. While just paying cash, the anesthesiologist would only charge $464. So, by paying cash and not going through his insurance, James saved $56.

So why would the doctor’s price vary depending on whether or not a patient has insurance?
We took our question to patient advocate Kenneth Klein. He said one reason doctors charge more for insurance is that it costs them money to file the paperwork, and that can run as much as 20% more. “If they are presented with a situation where they can get cash up front and not do anything else, file any papers, that is great,” added Klein. Klein said there’s nothing in state law that requires you have to use your insurance. “In many situations, it may be disadvantageous to submit this through your insurance,” Klein explained. Although, paying cash isn’t a guarantee that you will always save money.
You will have to decide on a case by case basis. It can vary based on your level of insurance coverage, whether the provider is in or out-of-network and your deductible.

Klein said it pays to treat going to the doctor like any other consumer transaction, and ask, “How much is this going to cost?’ “You are not locked in, and one can always try to negotiate. The worst thing that can happen is the person on the other side says, ‘No’. You are no worse off than you were. In many cases, you may be surprised,” said Klein.

According to Klein, the best places to ask for a cash price are hospitals, imaging centers, sole practitioners, eye doctors, surgical centers and pharmacies.
James said he’s learned from this experience to always ask the doctor for both the cash price and the insurance price and to not assume using insurance is the financially prudent way to go.

“Just paying cash, it seems to me it’s far better,” said Tow. If you decide to negotiate a cash price, get it in writing with the full agreed upon price.
Also, ask for an itemized bill for your records. Klein suggests submitting that bill to your insurance. Some companies may apply it towards your deductible at a reduced rate.


Tips for Your Health Insurance and Medical Bills in 2017 (Part 1)

Tips for Your Health Insurance and Medical Bills in 2017 (Part 1)

by Kenneth Klein, Human Health Advocates

In 2017 brings a new insurance year cycle. There are several things you can do at this time to make your life easier down the road – avoid surprise bills and costs – and ensure that you are maximizing the benefits of your health insurance policy while minimizing the associated costs. For example:

networkcareUse In-Network Providers. Many of us are unaware of the fact that most health insurance policies contain different deductibles and co-pays for in-network providers and out-of-network providers, respectively. The cost of each is drastically different. This is the time to verify that your providers are, in fact, in-network (and, as to ongoing providers, still in-network). Sometimes providers migrate in and out of network based upon their contracts with the insurance companies. I would suggest the following:

• Verify and Document the status of your physicians. Contact each of your physician’s office manager or billing manager and verify that the practice is still in-network for 2017. Make a note of the person with whom you spoke, the date, time, and the substance of the conversation. Also, go to your insurance company website and cross – check by verifying with the tools there. Finally, take the time (yes it will take time but it’s well worth it) to call the customer service number on your health insurance card and get clarification that the provider is in–network. Again, it’s a great practice to take notes – the date, the time, the person with whom you spoke, and the substance of the conversation. Many insurance companies provide a reference number – be sure to ask for one. Each time you schedule an appointment with the provider, and you should “double check” prior to treatment.

Perform the same verification for your pharmacy. Pharmacies also leave and join the insurance company networks. For example, as of January 1, 2017, CVS, which had been – network for Florida Blue will no longer be recognized. Any prescriptions filled there by Florida blue member after that date will surely cost substantially more than those filled at an – network pharmacy.

More valuable tips will follow.

Human Health Advocates wishes each of you a healthy 2017 and beyond.

STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

Health insurance concept. Tag cloud.One of the most common (and most of expensive mistakes) to make when using your health insurance is to use “out-of-network” physicians, labs, hospitals, etc. Whether you are in a PPO or an HMO, your insurance company has providers with whom they have negotiated reduced rates. That’s why the total bill (let’s say for a doctor’s office visit) is $300—but the “allowed amount”—negotiated rate is only $80. If you use this “in-network” doctor, the insurer pays 80% of the $80($64) and you 20% coinsurance share would be only $16.

BUT, if you saw the same type of doctor with the same fee doctor who was NOT part of your insurer’s network (an out-of-network doctor), the insurance company would pay its 80 %( of the SAME) allowable amount-$64.00 and you could be billed $236. BIG DIFFERENCE. You would save $172 merely by staying in-network.

You can typically locate in-network providers on your insurance company’s website. The best practice is to also verify with both the provider and your insurance company verbally (get a reference number of the call), as sometimes a provider leaves a network and the website isn’t updated quickly.

Be informed. Knowledge is Power! Save Money, Avoid Surprises, and Headaches. USE IN-NETWORK HEALTH PROVIDERS!

California Now Requires Timely Updates For Insurers’ Doctor Directories

medical bill helpIt seems that everyone has problems with medical bills and insurance claims. There are many ways way to improve this. Access to information empowers patients. One of the greatest traps insured patients can avoid is incurring sky-high fees by unnecessarily using the services of out-of-network providers. California’s new law has gone a long way in addressing this problem. Florida did so, as well-when it outlawed balance billing ion July 1st and required insurers to maintain current identification of in-network providers on their websites.

Many medical bill problems can be avoided by observing that simple distinction. The claims for a visit to an internist may be $300.00. The in-network internist has a negotiated rate of $90.00—of which you might pay 20% ($18.00). The same internist, were she out-of-network might cost you as much as $228(her $200 fee less the $78 paid by the insurer).An insurance appeal wouldn’t help. But having information posted informing both of the identities of in-network providers and the distinction in costs between using their services and those of out-of-network providers can go far in avoiding medical bill problems.

Please see: