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No one can argue that health care costs are out of control. Health care reform is being discussed in Washington, but is there anything we can do now about the average $15,000 of medical costs per year per family in the US? Can you take matters into your own hands? A recent article on CBS Moneywatch.com presents some great ideas for taking charge of what you’re charged for health care. You don’t have to pay retail, they argue, if your insurance isn’t meeting your needs or you don’t have insurance. If you properly educate yourself and learn to negotiate, some experts argue you could reduce your medical bills by as much as 80%. So how do you do it?
1. Know the Real Cost – if you have insurance, start with your insurance carrier’s website – most companies let members see their negotiated rates. You can also use sites like Healthcare Blue Book, Vimo, and New Choice Health which provide information on how much local hospitals and doctors charge and how large a discount insurers would receive.
2. Use the Right Words – once you know how things should be priced, it is important to actually visit with the billing staff and be as open and honest as possible. Be clear, confident, and personal. Offer to pay immediately in cash if they agree to a discount.
3. Ask About Outpatient – some procedures may be doable in an outpatient setting rather than an expensive hospital stay. Don’t be afraid to ask if your procedure can be done outpatient.
4. Negotiate Afterwards – even if your bills have been piling up a while, it’s never too late to make an offer. Be aggressive – offer to pay a percentage you can afford right now if they will write off the rest. Often medical offices and hospitals are eager to get the charges off their books. Continue up the chain of command if you don’t get a decent offer to begin with, and document everything you hear in writing as you go.
5. Don’t Pay By Credit Card – if they already have your money, they are less likely to negotiate, and you’ll be stuck paying off your bills and paying the outrageous credit card fees.
6. Ask About Payment Plans – most will be willing to set up one without interest, and if you faithfully make payments for a while, you might be able to negotiate a write-off of the rest of your bill.
7. Call in a Pro – if all else fails, there are people you can turn to for help. Medical Billing Advocates of America has specialists who, for a percentage of the reduction they get you, can help you negotiate lower bills with your doctor. The Access Project offers free information and advice about negotiating, including one on one coaching.
As a medical billing service, we are always willing to work with patients who show good faith, who are honest about what they can and cannot do, and who are willing to work with us to come up with a solution. It is the patients who disappear and ignore their bills entirely that are the problem. There is lots of flexibility, so don’t be afraid to advocate for yourself.
It’s not a new idea. President Clinton proposed the idea in the 1990s and the Congressional Budget Office shot the idea down, saying that the US government has never required its people to purchase anything to be a lawful citizen or penalized them for not purchasing it. Well, the bills proposed last week in the House require Americans to do just that, and some people are up in arms.
The new bill would impose a tax penalty of as much as 2.5% of adjusted gross income for failure to purchase insurance by 2013. The Senate version of the bill scales down the amount somewhat and says it would only be enforced if it could be withdrawn from any refund amount that’s owed to the taxpayer. Those in favor argue that it is no different that the requirement that already exists for people to have liability auto insurance to protect others when they drive. A person without medical insurance could be in an accident and run up huge medical bills which are absorbed by taxpayers and result in higher medical costs to all. The new bills would also require employers to provide coverage for employees or face a fine.
Is it a good idea after all? Is it any different than requiring people to have auto coverage? People still drive cars with insurance and if they don’t get in accident or get pulled over, there is no penalty. But everyone pays taxes (or they should) and everyone without insurance would be penalized. But is that a bad thing? We consider those who drive without insurance to be reckless and dangerous – could we say the same for those without health insurance, especially if they can afford it? What do you think?
According to several recent studies complied by an article from the Robert Wood Johnson Foundation, administrative interactions with health insurance plans cost $31 billion a year, or 7% of all spending for physician and clinical services. Doctors, nurses, and administrative staff are spending increasing amounts of time on administrative tasks such as prior authorization, pharmaceutical formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data. These activities are taking up time physicians could be using to care for their patients and are not providing any benefit to the practices in terms of increased efficiency or cash flow.
The problem, the article contends, is that patients are covered by so many varied insurance plans with different coverages, payment schedules, claim forms, and credentialing requirements that physicians and their staff have to spend an inordinate amount of time dealing with administrative issues associated with all these varied programs. Not only that, but practices often need to hire staff members to deal with the complexities, costing an average of 10% of annual revenue. On particular group office that was studied in California found that even with an electronic medical record system the complexity of dealing with so many different insurance plans was inefficient and costly.
While the multiple payer system still functions, outsourcing your administrative needs is the best way to cut down on costs, decrease time spent in your office on administrative issues, and free up more time to better care for your patients. Perhaps someday things may be simplified with a single payer system, but that in itself will involve new rules, guidelines, and processes that will have to be learned. Will you be ready to transition into any new program that is passed? Can your practice continue to afford the costs in time and money associated with insurance administration? Contact MD Alliance Billing, LLC, and we can discuss with you the advantages of outsourcing your administrative needs.
Lots of talk has been going on about the benefits of electronic medical records, including on this site. But something happened last week that is bound to put fear in the hearts of all physicians and patients everywhere and make us seriously consider the risks of medical records being available online. According to an article on HealthcareITNews. com, last week a site that helps track prescription drug abuse in the state of Virginia was deleted and replaced with this note:
“Attention Virginia! I have your [expletive]! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh 😦 For $10 million, I will gladly send along the password.” (See this page for full note – WARNING – there are lots of nasty expletives in this note).
There is still an ongoing investigation, but it is unclear at this point whether the state of Virginia actually has a backup copy of these records or not or how the hacker was able to get into the system. No news media that I could find has reported whether or not the hacker has been paid. The information he obtained included prescription info but more importantly (and potentially valuable) was the personal info such as name, address, and social security numbers.
So what happens now? As more medical records become digitized and uploaded to networks accessible through the web, will we see more and more of this stuff? How do we ensure that the information is safe? Was it every really safe to begin with? The government and the EMR companies better come up with some answers to the questions before electronic medical records can and/or will be widely adopted.
Members of the Senate Commerce, Science, and Transportation Committee expressed concern in a meeting last Tuesday that certain insurance industry practices were resulting in patients paying more and physicians being reimbursed less for out of network charges. According to an article on MedicalNewsToday.com, one of the main concerns was a database created by Ingenix, a subsidiary of UnitedHealth, used by insurance companies nationwide, that has been responsible for underpaying physicians by as much as 28% below market value. Physicians were then having to either absorb the loss or pass the cost onto their patients. There is also the obvious concern about the conflict of interest in using a database created by an insurance company to determine pay rates for physicians.
Several lawsuits against Ingenix have resulted in a settlement – Ingenix will no longer sell the data to physicians and is contributing to the creation of a new updated database. However, according the article, UnitedHealth has not admitted to any real problem with the database, claiming they failed to see a conflict of interest and that they had operated consistently to high standards. Legislators were not happy with what they viewed to be a lack of admission of wrongdoing and guilt. They said the discussion is far from over, and they passed a bill in the House that will require insurers to explain in clear language coverage limitations and other restrictions to consumers before they purchase the plan.
If you’ve been in the health care industry for long, you know that medical insurance is fraught with complications and difficulties, as well as problems with people taking advantage of the system on both sides. Why does it seem like there is so much dishonesty in medicine? It’s unfair to the physicians who are trying to take care of their patients, and it’s unfair to the patients who are already struggling with rising health care costs. I guess all one has to do is take a look at the current economic crisis to realize that dishonesty and greed are everywhere. Hopefully we are all learning lessons that will result in a better future.
MD Alliance Billing, LLC 