Avatar of Carey Goldberg

by Carey Goldberg

Tools For Estimating Health Costs Getting Better — Or So They Say

May 16, 2012 in health care costs, Insurance Bills

Boy, is this a trend, from plans for Massachusetts health reform to the private sector to health insurers, but if it’s such a trend, how come we still seem to be so nowhere on it??

The excellent amednews.com has a new post titled: Health plans providing detailed cost estimates of doctors visits. It begins:

Health insurers have replaced online tools that showed only rough guesses as to how much a doctor’s visit will cost with new ones that estimate specific dollar amounts for both overall and patient out-of-pocket costs.

During the past year, several health plans have released new versions or made significant updates to their cost estimation tools. The newer tools show not just a negotiated price but also the anticipated cost to a patient based on his or her benefit plan, as well as how much of the deductible is met. The projection is accompanied by a disclaimer noting that the insurer can’t guarantee its accuracy, but insurers say their updated tools are far better than the old versions.

All well and good, but all you Savvy patients out there, has anybody ever actually gotten useful cost info from your health plan in advance?

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Avatar of Sunni Patterson

by Sunni Patterson

Beware of Balance Billing in Hospital Bills

May 12, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills

Balance billing occurs when a healthcare provider bills a patient for some or the entire amount that should have been declared an insurance discount (contractual allowance). The fact that Prime Healthcare Services in California recently settled a suit for $1.2 million and discontinued the practice suggests that this is a problem. In fact, several states have statutes that prohibit balance billing.

How do you tell if you’ve been balanced billed? First, you have to determine if your treatment was performed by an in or out-of-network healthcare professional. Then, you have to check your EOB (Explanation of Benefits).

In- Network

Check an erroneous charge simply by seeing if the bill for the service exceeds the amount on the EOB. If it does, let your insurance company know and let them handle it.

Out-of-Network (OON)

There are two scenarios:

  • If you have an OON benefit, the OON deductible and co-insurance will apply first. The insurance company pays the balance above that like always. However, if the provider billed you for more than the deductible and co-insurance you may be the victim of a scam. Check the EOB. Did insurance pay the provider? If so, report it. It’s a scam and it is wrong.
  • If you do not have an OON benefit and accidentally got treated by the provider, tell them you want to be treated like an uninsured patient. A standard discount will be applied.

When in doubt, check with a medical bill advocate.

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Avatar of Sunni Patterson

by Sunni Patterson

Past Due Medical Bills: When Do I Have to Pay?

May 5, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

Have you received a medical or hospital bill with no clear due date? This can be because of how bills are laid out or because of design issues. Typically, a bill or patient statement will show medical debt as 30, 60, or 90 days past due, providing the kind of urgency that can make you drop a check in the mail. Bills may also be labeled “second notice” or “third notice” to show that the biller has already tried to contact you. But, all of that doesn’t always tell you what you need to know: how long you have to pay before the bill goes to collections. There are several reasons you may choose not to pay your medical debt right away including having a lot of bills or long-term debts to juggle. Prioritizing which ones to pay can take precedent to stay afloat. And, some billing statements require real, actionable steps while medical bills seem to be written in some strange, esoteric language.

Medical Debt Collection: Common Practices

Every medical provider has their own system for handling past due bills. Some are quicker than others to send a past due bill to collections. Many have different billing systems that represent debt in different ways. Some may be explicit about a due date, others will not. In some cases, when patients call, the medical office admits that they don’t even know the exact date when a bill will go to collections. That’s what motivates many experienced consumer advocates and others to recommend “playing it safe” and promptly paying all past due medical bills aged longer than 30 days, which is a common grace period for payments.

Some patients, though, will make active attempts to talk to providers. Those who pick up the phone can often get on payment plans that will make due dates and everything else much clearer, while allowing for deferred payment according to the patient’s finances. Some can even qualify for charity. In many cases, it’s this direct communication which can yield benefits for both parties: you know where you stand and your provider receives data on how and when you are likely to pay a particular bill. It’s a win-win, and that’s why when it comes to vague patient statements, the direct approach is often best. How do you promote open communication with your provider on past due medical bills?

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Avatar of Martha Bebinger

by Martha Bebinger

Price gives OPERATION game real sting

April 30, 2012 in Member Stories

This game scared me as a kid and looking at these prices is kind of scary as an adult. But maybe we would all be better off if we grew up knowing the price of a c-section or knee placement. Thanks Medical Billing and Coding -

Playing Operation: The Costs of Common Surgeries
Via: Medical Billing and Coding Resource

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Avatar of Sunni Patterson

by Sunni Patterson

Overused and Unnecessary Medical Procedures

April 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare, Member Stories

Nine physician specialty societies are each reporting a top five list of commonly used procedures that are often unnecessary. These societies represent 375,000 physicians across the country.

Some of the procedures cited include:

  • Brain scan after fainting (without other relevant symptoms)
  • Antibiotics for sinusitis (while typically resolving itself in two weeks, 80% of patients are prescribed antibiotics. CT scans are also usually unnecessary.)
  • Admission and pre-operative chest X-rays (routine X-rays are not needed.)
  • Colonoscopies (not recommended but once a decade.)
  • Cardiac stress tests (they do not need to be part of a checkup for a healthy adult.)
  • Lower back pain (unless another ailment is suspected, X-rays are not needed in the first six weeks.)

Unwarranted testing can lead to stress, over treatment, higher medical bills, and even unneeded invasive procedures.

In fact, the natural tendency to screen for heart disease prior to having any symptoms, like getting a stress test as a 50th birthday present, hasn’t “panned out,” according to a preventive cardiologist at Northwestern Memorial Hospital.

Study members suggested that patients and doctors have to thoroughly discuss any tests/procedures even if they are suggested by patients because they are not always needed.

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Avatar of Martha Bebinger

by Martha Bebinger

Now at COSTCO, health insurance

April 26, 2012 in health care costs, Insurance Bills, Member Stories

I buy a carload of food at COSTCO every month, so when I heard they were teaming with Aetna to sell health insurance, I had to check out the offer.  I shopped from a zip code in Texas, because COSTCO isn’t selling these plans in Massachusetts.  And they won’t be.  These plans would violate state insurance rules.  One example…Massachusetts caps individual deductibles at $2,000/year.  Should that change?

Here are my top three options (if I lived in one of the states where these COSTCO plan are available):

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Avatar of Martha Bebinger

by Martha Bebinger

If you live near Pasadena, CA…

April 21, 2012 in health care costs, Hospital Bills

check out Huntington Hospital’s procedure pricing tool.  This is an astonishing display of price information. It’s astonishing because posting prices for anything is almost unheard of at hospitals in the US.

If you’re uninsured and you need bariatric surgery, the price is clear and fixed: “$12,000 flat fee $14,075 includes pulmonary and endoscopic workups.”  The hospital is also upfront about the cost of an inpatient psych visit: “Daily per diem rate of $960.00 covers admission to any of the three inpatient psychiatric units (Adult Voluntary, Geriatric, ICU). Daily per diem rate for a private room is $1,260.00.  Professional fees not included. All other hospital services included. This does not include inpatient admission for ECT.”

In another break with tradition, Huntington offers an uninsured “discount.”  Most hospitals charge the uninsured more than the rate paid by insured patients.

I read about Huntington Hospital in the LA Times earlier this week.

On its website, Huntington Memorial Hospital in Pasadena allows people to select several common procedures and get an instant price quote, including an estimate of the patient’s share after plugging in their deductible and coinsurance. But even those numbers exclude the thousands of dollars that physicians, anesthesiologists and other specialists would tack on for most surgeries. Read the rest of this entry →

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Avatar of Sunni Patterson

by Sunni Patterson

25 Million Americans Underinsured Including Middle and Upper Income Families

April 18, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

As current government initiatives wrestle with the issue of millions of uninsured Americans facing potential medical bankruptcy, new studies are revealing that it’s not just the uninsured who are at risk. The issue of underinsured American individuals and families is becoming a major part of today’s healthcare conversation and alerting many more Americans to the dangers that they face, even if they have access to affordable health insurance policies.

Current statistics show a startling trend, where being underinsured is becoming a common way to fall into extreme medical debt and eventual bankruptcy or bad credit situations. Research by the Commonwealth Fund that appeared in recent industry journals shows that America’s underinsured community has doubled in the past four years to over 25 million people. While the highest number of underinsured Americans are in the income range below the poverty level, research shows that middle and upper income families are being affected in larger numbers each year. Research also shows that some individuals with what others would consider healthy annual incomes are still very likely to become underinsured in the immediate future.

In general, being underinsured has to do with the cost of one’s medical bills against that person’s annual income. Read the rest of this entry →

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Avatar of Beth Macy

by Beth Macy

CrossFit injuries in an era of the super-high deductible

April 18, 2012 in Member Stories

Last December, I was high on CrossFit, the boot camp-style exercise regimen that’s a cross between seventh-grade gym and the Marines. My box — aka gym — was run by a former Navy SEAL, and I found his enthusiasm contagious. There were a lot of middle-aged women in the class like me, and together we were getting really good results: pounds and inches dropped. More importantly, my blood sugar numbers were better than they had been in years.

Then I made the bone-headed move of lifting too much weight above my head. The bar literally came down on my head, and I felt an immediate twinge in my right shoulder. Didn’t hurt too bad at first, so I waited it out, hoping it would get better.

Unfortunately, I waited until the new year, when my company’s new policy that no longer features $25 co-pays went into effect. This month, with my shoulder hurting so bad that I can no longer sleep through the night, I went to an orthopedist, who ordered an MRI. I haven’t gotten the bill for the visit with him yet, but he warned  that the MRI would cost as much as $1,000 if I went to a nearby hospital in Salem, Va. He had his assistant call around and get me an appointment for one at an independent imaging center. The cost was about half that of the hospital’s fee — and I had to pay the full amount.

I apologized for being cost-conscious and said I wasn’t used to it. No problem, the doctor said. He’d just moved to our area in Virginia from another state, and he was having to pay $1,400 a month for COBRA before his family’s new insurance kicked in.

I miss CrossFit, as I’ve already put back on most of the pounds I dropped. But mostly I miss my old insurance — the one where I didn’t have to wait till the pain was excruciating before I went to the doc. In the long run, I wonder if an earlier/cheaper visit would have been more cost-efficient after all?

Should I need rotator cuff surgery — I’ll find out tomorrow — at least I’m now well on my way to having my $1,000 deductible paid.

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Avatar of Adrian Gropper MD

by Adrian Gropper MD

Confusopoly – The mystery of medical bills

April 16, 2012 in health care costs, Hospital Bills

Scott Adams introduced “confusopoly” in his book “The Dilbert Future” defining it as “a group of companies with similar products who intentionally confuse customers instead of competing on price”.

Two articles in the past few days have raised this issue. Robert S. Kaplan and Michael E. Porter of Harvard Business School NY Times op-ed “Why Medical Bills are a Mystery” and the LA Times “Healthcare pricing still a struggle for consumers”.

Why am I bringing Dilbert into this? Because the two articles highlight the detachment from patient reality by both hospitals and physician organizations. I doubt most physicians would be similarly detached if asked directly by a patient. The next time you face the confusopoly, consider asking your doctor for help and let’s see who’s side they’re on.

 

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by spendergrass

Great PBS Documentary on Cheaper AND Better Healthcare

April 14, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Member Stories

Just watched ”U.S. Health Care: The Good News” (Episode: The Good News in American Medicine, with T.R. Reid) on PBS.   I was flipping through the channels and it caught my attention.  I watched ”Sicko” when it came out in movie theaters and before I finished my Coke I was convinced that we needed a major overhaul in medical care in the U.S.  It just doesn’t seem humane that people could die because of insurance loopholes or die because they don’t have enough money to pay for their healthcare.

Obviously nothing in life is free. Everything requires energy- which always equates to money in some way or another. Since energy (and money) are finite resources, the only solution seems to be in overhauling the entire system to make it cheaper to get and stay healthy.  And when I saw the part of the show’s title that said ”The Good News in American Medicine”, I had to watch.  Good news.  What is that?

I was very pleased to see there is good news out there. Many communities are doing a lot to overhaul the system and provide care to everyone, regardless of coverage, while bringing the costs way down. It was refreshing to see that people are trying and finding ways to succeed in this area.

I’d recommend watching this show and passing the link along to friends. The more people know about this, the more we have a chance at getting medical care costs down to manageable levels (and be a more humane society). The full video is here:

http://video.pbs.org/video/2198039605/

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Avatar of Carey Goldberg

by Carey Goldberg

More On Prices: In Mass., They’re Very High For In-Home Care

April 11, 2012 in health care costs

I knew the cost of living was higher in Massachusetts, but still found this release comparing prices a bit shocking. It came from a PR newswire, which I think means I can excerpt it generously:

RICHMOND, Va., April 10, 2012 /PRNewswire via COMTEX/ — According to Genworth’s GNW +4.04% 2012 Cost of Care Survey, the cost to receive care in the home through home health aide services in Massachusetts has risen over the past five years.

“Overwhelmingly, Americans prefer to receive long term care in the home and the relatively muted rise in home care costs nationally over the past few years can be viewed as a positive for consumers in Massachusetts,” said Steve Zabel, senior vice president of Long Term Care at Genworth. “Consumer demand for home care services has led to a proliferation of home care services providers and more choice for consumers. This competition has kept home care costs relatively stable, especially when compared to the cost of care in a nursing home or assisted living facility.”

Nationally, the median hourly cost for homemaker services and home health aide services is $18 and $19, respectively. In Massachusetts, by comparison, the median cost for homemaker services is $23 per hour and the median cost for home health aide services is $25 per hour. The median hourly cost for homemaker services in Massachusetts has increased 1.6 percent annually over the past five years, while the hourly cost of home health aide services has increased 2.2 percent over the same period of time.

By comparison, the median annual cost for care in an assisted living facility is $39,600 nationally. The comparable cost in Massachusetts is $55,050. The national yearly cost for assisted living has increased 5.7 percent a year over the past five years, while long term care costs in Massachusetts have increased 1.4 percent a year during the same time period. Nationally, the median annual cost for a private nursing home room rose 4.3 percent annually over the past five years to $81,030, while costs in Massachusetts increased 3.8 percent a year during the comparable time period to $127,750.

SOURCE Genworth Financial

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Avatar of Martha Bebinger

by Martha Bebinger

Health care prices in Massachusetts vary as much as 1000%

April 9, 2012 in health care costs, Medical Care

This article in USA Today caught my eye over the weekend,

“Costs of many preventive medical exams vary as much as 700%.”

That’s a lot, but the gap is even greater in Massachusetts.

This slide, from a deck prepared for the Blue Cross Blue Shield of Massachusetts Foundation, shows a 10 fold or 1000% difference for some procedures. It is not just preventive services as is the report in USA Today. But either way, that’s a huge range, especially if there’s no difference in quality, which is often the case in Massachusetts.

So is the gap between what high and low cost hospitals are paid in Massachusetts greater than anywhere else in the country? Anyone know?

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Avatar of Martha Bebinger

by Martha Bebinger

My first time pushing Medicare’s Blue Button

April 5, 2012 in health care costs, Health Insurance

I’m in Texas visiting my darling sister Elizabeth who is going on 20 years with ALS. GO ELIZABETH! My mom hands me a stack of paper. It’s the latest round of reimbursement roulette. Someone is refusing to pay for something that my sister uses a lot of every day and I need to figure out why.

I grimace but then remember, hey, here’s my chance to check out Medicare’s BLUE BUTTON. My Savvy colleague Adrian Gropper talks about how great this thing is. Let’s find out. (Turns out Adrian wants an enhanced version of the Blue Button more on that below).

The Blue Button, takes any member into their own private Medicare world. You see claims for office visits, hospital stays and supplies. I spent an hour trying to figure out why Medicare wouldn’t pay for the syringes that push food into my sister’s feeding tube and why they won’t send as many absorbent pads as her doctor says she needs.

I didn’t get anywhere when I started the search last Sunday. The claims database is down on weekends. But I was impressed by how much I can find online. My insurer, Blue Cross, has similar feature but it isn’t quite as user friendly. In the end, my mom has to appeal the denial of the syringes and we’re appealing for more pads through Medicaid.

I imagine that some of you wonder why Medicare and Medicaid should pay for these items. It’s a fair question. Read the rest of this entry →

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Avatar of Sunni Patterson

by Sunni Patterson

Upcoming Coding Changes Can Create Confusion

March 31, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

As Americans continue to absorb the healthcare reform and projected modifications, the federal government is updating the way that medical services are coded and billed to consumers. The first mandate is HIPAA 5010, which is an update to the existing HIPAA format and the healthcare information processing systems. 5010 compliance is currently set for July 1, 2012. This will be followed by implementation of an updated coding system, ICD-10, which is to be effective October 1, 2013.

The existing coding system has approximately 13,600 codes while the updated system will have approximately 69,000 codes. The detailed coding system will allow for better analysis and treatment outcomes while providing payers with an initial claim submission that is much easier to understand. However, you may find interpreting your medical bill to be even more confusing as you may see more line item charges.

An example of this was recently reported in a Pennsylvania’s Fox News story. The patient was charged for an office visit and on top of this, she received a separate charge for a “consultation” when the doctor advised her to quit smoking.  Read the rest of this entry →

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by fairhealth

How much do I owe for out-of-network care?

March 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare, Member Stories

Looking at Medicare- vs. “usual and customary”-based reimbursement

By Robin Gelburd

Many Americans with private health insurance have plans that reimburse for out-of-network care. But consumers often don’t realize the wide variation in reimbursement rates among insurers and the implications for their wallets.

At FAIR Health, the independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and out-of-network reimbursement, we have noticed that differences in formulas can make a big difference in reimbursements.  A number of private health plans are now basing out-of-network reimbursement rates on a percentage of Medicare fees – as opposed to the usual, customary and reasonable (UCR) standards that reflect actual provider charges. Read the rest of this entry →

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Avatar of nancy

by nancy

Doc Dude gives in to high tech health care

March 23, 2012 in health care costs, Medical Care

I thought this was hysterical. It’s very on point about consumer perceptions that new technology is always better, and the challenges for providers of dealing with those expectations.  And the last line about the patient satisfaction survey is brilliant!  Costguy, you rock!

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Avatar of Martha Bebinger

by Martha Bebinger

Here’s why we’re paying attention to health care costs

March 23, 2012 in health care costs

If you’re frustrated by how much you’re spending on health care, or how much your company is spending or how much your town is spending or your state then take a deep breath.  It’s going to get a lot worse – soon (click on the image to make it bigger).
This one of 50ish charts in a report out today prepared by Amitabh Chandra at Harvard’s Kennedy School and Josephine Fisher at Amherst College for the Blue Cross Blue Shield Foundation of Massachusetts.

You’ll also see:

- How much more care we use in Massachusetts than do our fellow Americans (54% more for outpatient visits)

- Why we spend more (higher prices)

- How much of our household budget we spend on health care (16%)

- How much more we spend on health care, in total – taking into account higher salaries here and research spending (15%)

- Where we spend most of our money on health care (41% on physician and professional services)

- We spend just under the national average on care in the last two years of life

The data is a bit old, 2009, but all adds up to a useful, informative picture of the health care costs landscape in Massachusetts.

 

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by jalpertsilber

Electrodes at the office – now that’s convenient health care

March 21, 2012 in Medical Care

There’s nothing like convenience—especially when you can get electrodes applied in the office.

I was born with congenital heart disease and every few years, a cardiologist wants a 24-hour monitoring of my heart—done through something called a holter monitor. I’ve had two monitors recently and let me tell you—it’s been the most convenient test I’ve had in years.

Just last week, a nurse visited me here at WBUR and we locked ourselves in the breast-milk pumping room (thankfully with no windows). I stripped off my shirt and within five minutes, she had applied four electrodes to my chest and clipped the monitoring device onto my jeans. Twenty-four hours later, I dropped the electrodes and the device into a FedEx envelope (provided and paid for by the hospital) and sent it off to be read and analyzed. No doctor’s visits, no extra trips to labs, not even a trip to the post office.

I work on a daily show and with our tight deadlines, it can be quite difficult to get away for doctor’s appointments.

But by next week, I should have my results—via email, of course.

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Avatar of Sunni Patterson

by Sunni Patterson

Before the Affordable Health Care Act, Were You Locked Out?

March 17, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare

Locked out of medical care, that is. Who? Individuals with pre-existing conditions. Now, 50,000 of them have healthcare coverage via the Pre-Existing Condition Insurance Plan (PCIP) in their state. This is a temporary high-risk health insurance program that makes healthcare not only available but much more affordable.

For example, a patient named Deborah fell victim to a back injury. It left her unemployed and unable to afford health insurance premiums. However, when she discovered the Michigan PCIP plan, she was able to enroll in it, receive the back surgery she needed and get on the road to recovery.

PCIP makes a difference. It has allowed many Americans to get connected to health insurance and receive the medical care they sorely need. That’s because PCIP enrollees can receive that care immediately.

The Affordable Health Care Act has also helped students up to age 26 receive coverage and assisted seniors by allowing access to more affordable prescription drugs.

You can see how your state administers PCIP by clicking here.

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