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:
Use 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.
The Florida Legislature passed (signed by Governor Rick Scott) a bill that may be the most consumer-friendly in the country concerning “Balance Billing.“ Yes—FLORIDA.
Balance Billing was previously illegal in Florida for both Medicare and HMO patients but led to financial havoc for thousands of Floridians with PPO coverage. Simply, a patient who went to an in-network hospital’s emergency room. However, many doctors, although affiliated with the hospital, were not “in-network” for these patients.
The treating emergency room doctor (whom the patient had no option in choosing) submits a “full-price bill say $1,200 to the insurance company. It would cover it’s normal negotiated rate- say $300.
As a result of having no way to choose their doctors, thousands of patients were pursued by medical billing companies (many of which were ruthless about pursuing the patient into collections, negative credit reporting, and sometimes lawsuits). This doesn’t mean that all medical bills will not be vigorously pursued. But they will no longer be pursued as the product of balance billing.
That has changed- Thank you Florida Legislature for “doing the right thing.”
Click here to read Florida Statute 627.64194
All health insurance companies require pre-authorization for certain procedures and hospital admissions. Your physician will submit the necessary clinical information to the insurance company (or third-party company, which many insurance companies utilize to review and determine such requests).
Believe it or not there are times when the Explanation of Benefits (“EOB”) that comes from your health insurer can be your friend when paying your medical bills. Sometimes, it may be difficult to understand the EOB-how much the insurance company is paying, how much you’re paying, how much is written off, ow much is applied toward your deductible, and why. This EOB is a very important sort of statement of account between you and your insurer. You may be able to learn a bit about it on your insurer’s website. This might be a good time to contact a health advocate.
Hello To All:
Everyone that goes to their doctor inevitably gets blood drawn to analyze aspects of their health. It is an integral part of the doctor diagnosing the state of your health. One of our clients (and he is not alone in this) thought that the cost for the lab to process the results were included in the doctor’s bill. WRONG! (more…)