By Medical Bill & Claim Resolution (MBCR) | Submitted On October 28, 2012
More and more consumer advocates are sharing with American families new trends in the U.S. health care industry, and there is a growing awareness that the assimilation of individual physician practices into bigger healthcare networks can have an impact on what you pay at your doctor's office. It's a good idea to look closer into how this phenomenon can affect your wallet.
Changing the 'Place of Service': What's in a Name? In many cases, patient interactions that happen in a doctor's office don't change when that office gets bought out by a hospital or other care network. The same doctors are still there, and they operate the same way. What changes, though, is the way that services are billed, first to the health insurer or entitlement program, and then to you.
New reports have found that both government entitlement programs like Medicare and Medicaid, and many private insurers, are simply willing to pay more for services provided by large medical networks than they are for the work of single doctors' offices. Consumers aren't the only ones who see this as a little unfair; doctors who have worked hard to maintain independence can also get pretty bitter about the fact that a reimbursement amount can change based on what kind of medical business is doing the billing. Intuitively, it would seem that this difference in incentive will continue to cause many doctors to sell out their practices to medical networks, maybe even under duress in some cases.
At the Front Desk: Checking Your Patient Financial Responsibility Some of those who counsel individual patients on their rights would recommend simply asking the practice staff what you will have to pay, for example, when a medical business changes hands. But in many cases, this isn't enough because the change isn't always apparent or staff members may inadvertently neglect to advise you. For instance, your doctor's office is now owned by an outpatient hospital campus. Prior to this, you received a bill only for your doctor's fees. After the changeover, however, you also incurred a bill for a facility fee.
While it appears medical and office staff do their best to inform patients of increased or additional fees before and after a place of service changeover, some do not. For example, you ask your doctor's office if your upcoming procedure will be covered under your normal co-pay. Yes, it is. Then, you receive a bill that is up to ten times what you were quoted plus not just one but multiple bills.
To the objective eye, this looks like deceptive pricing, and no other industry would permit this - costs that double or triple in the blink of an eye. Much of the problem, however, has to do with the lack of information available to the public, and the way that third-party payers almost always stand in between the doctor and the patient. It's important you become educated, not just about changing place of service status, but on issues like timely filing, health insurance denials, and all of the other complicated issues that can cause providers to simply push through revised medical bills with big red numbers at the bottom, and your name on the envelope.
MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at www.medicalbillandclaimresolution.com.