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.
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!
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…)