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.
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.
WEST 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.
PAID THE CASH PRICE
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.
WHEN TO CONSIDER CASH
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.
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.
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!
It 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.
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