Balance Billing – Consumer Advocates can help!

What charges are you supposed to pay if you have a PPO, POS. or an HMO type of insurance plan? Deductibles and copays right?

You may be responsible for additional penalties as outlined in the plan if you choose a non participating provider. However, whether you chose the non participating provider, or not, you may be billed for more than your fair share of the bill. That’s because insurance companies routinely deny charges that they feel are unreasonable. Insurers often base their opinions on arbitrary decisions and insufficient or irrelevant data. This practice is referred to as Balance Billing.

Most states prohibit balance billing. These states require the provider to settle their differences with the insurance company and prohibit billing the patient for any more than the deductible and copay. Many consumers do not appeal these denials and pay more than they should . Experienced consumer advocates can help you remove the unfair charges from your bill.

As a patient, if this occurs to you, you might consider the following pre-emptive strike. Forewarned is forearmed and it is far better to play offense, than defense, with these aggressive providers.

• Read and understand your managed care plan contract. Know your duties and responsibilities. Follow the rules.

• Privately inform your medial provider that you are aware of the “contract-medicine” concept.

• Confidently ask the provider to put the invoice in writing, under his personal signature.

• Tell the provider that you will fax the bill to your employer, third-party payer, attorney, IRS, OIG, DOJ and/or insurance commissioner for their opinion of the balance due.

Finally, once the problem has been resolved, politely inform the provider that balance billing is often illegal; and suggest that if your health plan’s compensation is too low, he should enlist in the plan.

To find a qualified advocate please click on this link: ADVOCATE

For more on this issue: Balance-Billing Conundrum

The Public Option

Republicans oppose the public option for many reasons, but in part because it is really necessary if the reform is to work–to bring down costs as well as to expand access.

In the end, am I certain that we will wind up with a public plan in the bill that passes Congress this fall? No.

But any realistic assessment of reform suggests that, ultimately we will require a government plan to rein in run-a-way reimbursements. This is why I am convinced that even if it is not part of this year’s legislation, it will be added sometime in the next three years. As it dawns on legislators—and the public—just how much universal care will cost, Medicare E , which will have lower administrative costs, and the clout to insist on better value for our health care dollars, is a no-brainer.

Finally, it’s quite possible that, this year, Congress will pass the version of the public plan that appears to be gaining votes, one that lets individual states “opt out.” Though I have to wonder . . .. How would a politician explain to his state’s citizens that they are going to have to pay $2,000 more for a family plan because when it comes down to it, their state puts the interests of for-profit insurers ahead of voters?

In the end, when it comes to a subject as important to voters as affordable health care, I suspect they will have more power than the lobbyists. Even the most depraved politician understands that all of the campaign contributions in the world won’t help you if your constituents have decided to “vote the bum out of office.” As I have said in the past, I think that healthcare lobbyists are in for some surprises.

Health Beat: The Public Option: It’s Not About Politics; It’s About the Economics of Reform.

TeamGail – help with medical bills and insurance

Health Beat: Maggie On Lou Dobb’s last night—the Doctor’s “Fix, ” and the Boy in the Balloon

Maggie was on Lou Dobbs last night talking about the fear that Medicare is going to cut reimbursements to doctors, which is unfounded. Read on for more insight. Maggie is once again spot on.

Health Beat: Maggie On Lou Dobb’s last night—the Doctor’s “Fix, ” and the Boy in the Balloon.

Nonprofit Hospitals Need to Earn Their Exemptions

If nonprofit hospitals spend far less money on providing charity care for the poor and uninsured than the value of their federal, state and local tax exemptions, do they deserve those exemptions? What about if they turn away indigent patients or hound them with aggressive collection practices?

More

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PPOGrades: Managed Care Reviews for Health Plans & Underwriters

Unraveling complex PPO provider contracts can be very difficult, often requiring significant experience to interpret them. We understand provider contracts and their cost implications. We have developed a comprehensive program that scrutinizes provider networks. Our PPO program is based upon actuarial standards. It includes an analysis of hospital chargemasters and state regulated transparency data. We inspect provider contracts for inflation clauses. We include a thorough review of hospital billing practices to identify abusive and artificially inflated medical bills. We also analyze the strengths and weaknesses of non participating providers to help underwriters determine the potential for out of network utilization. In addition, we evaluate the PPO’s ability to manage the costs of complex specialty care such as cardiology, oncology, neonatalogy, organ failure and high risk maternity.

We collect and analyze all PPO data in a proprietary database. The results are tabulated and carefully monitored. A final detail report is produced for underwriters. Access to the reports, and our tracking system is available only to subscribers via a password protected website application.

PPOGrades

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