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  • How to Pay Insurmountable Medical Bills

    Studies suggest that about one-third of ER visits are for non-emergency matters. An old guideline defines an emergency as a medical condition with such severe symptoms that a person with average knowledge of health and medicine could reasonably believe their health would be in danger without immediate medical attention. Limiting ER usage transfers the burden to consumers to self-diagnose. If the coverage is denied, then the patient can appeal. This policy results in claim denials, up to 1,000 ER denials by one carrier. How to pay insurmountable medical bills in the case of a denied appeal can be confusing but there are options. Prepare: What to Bring to the ER * Complete health insurance information. Bringing your insurance card provides the necessary data. Note, if your policy denied the service due to a missing preauthorization, appeal the decision especially if the service was due to a true emergency situation. * Medication and allergy lists. Bring multiple copies as your family member will have several contact points during the visit. * Medications that will be needed during the first few hours. How to Fight Claim Denials * Really know the times to use the ER. While there are no rules, an ER visit is justified if someone is unconscious, can't breathe, bleeding heavily, has a broken bone, is fainting, or feels unexplained dizziness. If you're uncertain, most insurers staff a 24-hour nurse line to call to receive guidance. * Know your coverage. Most policies offer general guidelines on emergencies under the emergency service benefits of the policy. * Appeal. If you received a claim denial letter, it will contain the deadline for submitting an appeal. There is a resource called Your Guide to the Appeals Process published by the Patient Advocate's Foundation that includes sample appeal letters and facts about appealing. * Complain to your state insurance commissioner. The Consumer's Union has an End Surprise Medical Bills site that lists where to file complaints in each state. * Negotiate. Start with the Healthcare Bluebook to get an idea of pricing. It's a tool you can use to negotiate a lower price. Medical Billing Advocates The majority of medical bills contain errors that are attributed to incorrect insurance decisions, medical billing, and/or coding issues. Medical advocate professionals work on a contingency on the amount saved or bill at an hourly rate. These professionals are the best at: * Reading a muddy medical bill * Identifying billing errors * Negotiating for you Some of the errors detected by these pros include: * Upcoding to a more complicated code which costs more * Unauthorized treatments * Medical errors including decimal point errors * Services the patient did not receive * Cancelled work If you're at a loss about a healthcare bill that appears too high or that you cannot understand, contact your medical provider, insurance plan administrator, or a medical billing advocate for a second opinion. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • What You Should Know About the New Medicare Card

    The new Medicare card comes with a randomly assigned Medicare Beneficiary Identifier (MBI) made up of 11 letters and numbers; and no social security number like on the current card. Some differences in the new cards include: Uppercase letters and numbers The letters B, I, L, O, S and Z will not be used to avoid confusing letters with numbers Positions 2, 5, 8, and 9 will always be letters No embedded logic Each beneficiary will be assigned a unique identifier All 60 million or so Medicare recipients will eventually receive the card in the mail. The mail outs started April of 2018 and will go on for a year. What Do You or the Medicare Recipient Need to Know? You do not have to do anything to get the card. It will be automatically mailed to you. Make sure Medicare has your current address so your card is delivered on time. The card may be in an envelope that resembles junk mail. Once you receive the card, destroy your old card and begin using your new card right away. Do not get worried if your friends have the new card and you don't. It will take some time to mail all of the cards. The new card is paper. You may want to laminate it. Bring the new card to your next healthcare visit. If you forget to bring your new card, your healthcare provider should be able to look up your Medicare identification online. If you have a Medicare Advantage policy, you should still keep and use this plan's card. However, have both cards on hand when you visit your doctor. Beware of Scams (as recommended by the American Association of Retired Persons) Scams relating to the new card are already surfacing. Some Medicare recipients report getting calls from scamsters who tell them that they must pay for the new card and then ask them for their checking account and Medicare card numbers. Don't give out either number!! "Anyone saying they are going to charge you for a card is a scammer," says Paul Stephens, director of policy and advocacy with the Privacy Rights Clearinghouse in San Diego. "In the case of CMS, they will never need you to tell them what your Medicare card number is because they already know it." Identity theft is rising among those 65 and older. The Department of Justice has cited a figure of more than 2.6 million cases of senior identity theft occurring in recent years. Always proceed with extreme caution before releasing any personally identifying information! MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Employers: Why Care About Medical Bill Errors?

    Experts suggest that as many as 80% of medical bills contain errors! Other experience indicates that about 25% to 30% of these bills show significant errors. An Equifax company audit found an average error of $1,300.00 occurred on hospital bills $10,000.00 or more. The source of the errors is from care performed by a medical specialist, complex medical procedures, inpatient work, or care delivered by out-of-network providers. Employees To any employer that self-insures, there is a direct major impact to costs and employee productivity. Employees who notice deductible creep also take on more of the financial burden because of the errors. You can help your employees manage medical insurance errors by educating them to: Become their own best advocate and diligent in reviewing their bills and insurance documentation Look out for red flags like claim rejections, denials or bills that have no matching Explanation of Benefits (EOB) from their insurance company Checking for differences between the carrier's benefits explanation and the provider's patient balance bill Reviewing provider documentation to ensure it accurately reflects the services received In addition to this being a time-consuming process, it can lead to less productivity at work especially for family members with chronic care conditions. Employers Employers can provide employees with services, support, and tools. They can also educate employees with online tutorials, handouts, and seminars. This is to effectively equip employees to advocate for themselves better. Another approach is to offer a medical billing advocacy or advisory service. These services could include: Reviewing bills Identifying medical bill errors Answering employee questions about ICD codes on the services billed Working with healthcare providers to get errors corrected for employee medical bills Negotiating costs for services performed by out-of-network providers When an employer decides to hire a speciality advocate, they need to find an organization with longevity, one that is reputable, and one that can provide data-based statistics on the amount of money the company saved for customers. Some claim assistance professionals specialize with hospital (or facility), laboratory, mental health, ambulance, doctors' or other speciality providers. When advocating directly with a consumer, the healthcare claims advocate may charge an hourly fee or work on contingency. If, however, the medical billing advocate company partners with you, the employer direct, their services may be negotiated as an employee health benefit, assisting employees to better navigate and solve health insurance issues. Once a firm is decided on, the employer needs to make sure the employees know about the services and how and when to contact the billing advocate firm. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • 2018 Medicare Terms and Changes

    Medicare is available for those age 65 and older who are US citizens or legal permanent residents. In addition, either you or your spouse must have worked for 10 years (40 quarters). Some individuals under age 65 can also qualify for Medicare coverage if they have certain disabilities and meet the guidelines. The government provides Medicare Parts A & B. Part A Most people do not pay a premium for Part A that covers inpatient care in hospitals, skilled nursing facility care, home health care and hospice care stays, because when you worked, you paid into the system. There is a deductible of about $1,316.00 and co-insurance after 60 days. Part B This is medical insurance that covers doctors and other health care provider visits, outpatient care, home health care, durable medical equipment, and some preventive services rather than hospital care. The premium is about $134.00 and the deductible is $183.00. Part B is designed for the government to pay about 80% of medical expenses. Part C This is called Medicare Advantage which combines Part A and B and adds additional benefits which might be prescription drug coverage (Part D) and dental or vision coverages. They can be zero premium (you still must pay the Medicare premiums) or have an additional premium based on the benefits. Part D Private insurance companies cover the Medicare Prescription Drug Plan and costs range from about $15.00 to $100.00 per month. They each have a list of approved drugs. Medicare Options and Supplements Because Medicare does not cover all healthcare costs, these policies, known as Medigap, cover some or all the costs not included in Parts A & B. However, these plans do not cover medications and have additional premiums to the Medicare Part A & B. Many people select a combination of these to obtain the most comprehensive coverage they can. For example: Medicare Supplement Plan containing Medicare Part A & B and Part D (to cover prescription drugs) Medicare Advantage Plan (Part C) containing Medicare Part A & B, and most Part C plans include Part D (to cover prescription drugs) Other Medicare Facts You cannot have both: a Medicare Supplement and a Medicare Advantage plan. You can change your Part C or Part D plan every year during the annual enrollment period which for 2018 Medicare ran from October 15 to December 7, 2017. The Part B Premiums for 2018 are: $1340.00/month: less than $85,001 (single)/less than $170,001 (married) $187.50/month: $85,001-$107,000 (single)/$170,001-$214,000 (married) $267.90/month: $107,001-$133,500 (single)/$214,001-$267,000 (married) $348.30/month: $133,501-$160,000 (single)/$267,001-$320,000 (married) $428.60/month: more than $160,000 (single)/more than $320,000 (married) Some individuals who qualify for Medicaid (another government program) may only qualify for QMB (Qualified Medicare Beneficiary) status. This means they receive assistance with Medicare premiums and cost-sharing items such as deductibles, co-insurance or co-pays. With this status, however, there is no coverage for other health costs. Medicare approved providers must NOT bill QMB status persons but state Medicaid may pay for these costs. Also be aware that if Medicare denies a charge as not a covered service, the supplemental insurance will also deny. An example is a person who has an ambulance transport to a physician's office. Medicare denies as not covered and the secondary insurance also denies. The balance is patient responsibility or the patient can appeal with medical records providing medical necessity for the transport. While you might be receiving better coverage than before, the Medicare maze is still something you must pay attention to. Carefully review your bills and Medicare Summary Notices and take action to have a claim decision reconsidered before your appeals deadline expires. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Getting Health Insurance in an Emergency

    This is an attempt to drive people to urgent care centers or doctor's offices which are less expensive and can save the insured money. Exceptions exist for referrals from a physician to the ER for non ER services, non ER services provided to children under age 14, instances when an urgent care clinic is more than 15 miles away and when care is administered on Sundays and major holidays. Necessary ER Visits There is a lot of grey area here but the Affordable Care Act defines an emergency as anything that "a prudent layperson, possessing an average knowledge of medicine and health" would believe to be emergent and in need of immediate attention. That leaves it to the patient to self-diagnose and then decide which is the most prudent place to go. Of course, it does not help that ER staff and doctors often cannot determine if an ER visit is necessary without examining the patient and possibly performing additional tests to rule out a condition. True Emergencies While coughs, sore throats, and headaches are usually not emergencies, the reality is that the Journal of American Medicine discovered that six of the top ten reasons for unnecessary ER visits are also in the top ten symptoms of real emergencies! Before You Head to the ER: Try telemedicine or a virtual doctor's visit. This approach is just beginning to get traction. Many major insurance companies provide this coverage benefit. Choose a retail or "nurse in a box" clinic often located in big box or drug stores. The majority have non-business hour availability. Check out a faith-based program. This is where participant's support each other's medical needs across the country and world by utilizing Medical Cost Sharing Principles. Before an Emergency Happens - Know Your Policy Make sure you know what your insurance policy says about emergency care reimbursement and what defines an emergency. Getting health insurance in an emergency means understanding your coverage. This is more important than ever in a world of rising deductibles, higher co-pays and co-insurance, less coverage and increasing premiums. Do your due diligence before you receive an ER bill and also check the hospital's financial assistance guidelines. While many folks assume this is only for non-insured or low-income situations, there typically is an option for insured to under-insured patients as well. You must meet their guidelines to qualify. Determine your emergency care options prior to one occurring. You do not want to worry about finances when involved in a true emergency. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Why Medical Bills Are a Leading Cause of Bankruptcy

    Often, these little life surprises come when you are at your most vulnerable... such as in emergency situations or when your doctor/facility used out-of-network providers (according to a national study from Johns Hopkins University). For example, you may be treated in an in-network emergency room but that does not mean the doctors treating you are in your network. The opposite can also happen: your physician is in network but you are receiving treatment at an out of network facility. How would you ever know that? 400,000 Doctors Canvassed The study suggests that because you do not select the doctors, you do not know ahead of time if they take your insurance. This shocks those who receive bills for hundreds or even thousands of dollars, months after the treatment, from providers unbeknownst to them! 400,000 doctors were canvassed across the US to rank the difference between the amount Medicare reimburses doctors for treatments and the amount charged to patients covered by other insurance, with no coverage at all or out of network treatment. Medicare fee schedules were used as a baseline because insurance companies use those fees as a beginning point when calculating patient reimbursement out of network. The typical physician charges about 2.5 times the amount Medicare pays. However, the highest markups came from doctors not selected by the patient. What Doctors Charge The typical anesthesiologist, emergency physician, pathologist, neurosurgeon, ambulance, and radiologist charge at least four times the Medicare reimbursement (with anesthesiologists charging six times the amount on average). The lowest markups are used by physicians that people usually see the most. These include general practice doctors, immunologists, dermatologists, psychiatrists, family practitioners and allergists. Their charge up is less than twice the Medicare rates. Regional differences were also noted. For example, doctors in Alaska and Wisconsin markup patient costs at about twice the rate of physicians in Hawaii and Michigan. It is Getting Worse As the healthcare system becomes more complicated, insurance companies may reduce reimbursement rates for contracted physicians (and facilities), which may cause doctors (and facilities) to opt out of the insurance network upon contract expiration. So, the doctor (and facility) who was in your network is now out of network. This means patients are left holding a larger balance. Sadly, medical bills are a leading cause of bankruptcy. As of Spring 2016, 23 states were working towards or already have consumer protections in place. Check your state's Department of Insurance website for additional information. Steps You Can Take The best hedge against an unexpected medical bill balance is prevention and advocating for yourself by taking action before a bill ends up with a collection agency. Research, plan and prepare prior to an emergency situation. For non-emergency care, confirm treatment will be rendered by in network providers. When providing your insurance information, always refer to your plan by its full name. The majority of big insurers have sub plans that may or may not include providers in network. Maintain a communications documentation log. Ask for the names of the providers (or facilities) that will be involved in your care. Check with your insurance and the providers themselves to determine if they are in network vs. covered by your insurance. Check your state's insurance regulation information to determine what consumer protections are in place against unexpected medical bill balances. Your insurance may state you don't owe a balance; however, if a contract does not exist between your insurance and the provider, you may still owe the balance (if no state laws apply). If you find you owe the balance you may be able to negotiate with the provider to reduce the balance. Understand what the procedure's average cost is in your area. If your insurance is through your employer, speak with your human resources department. Verify the provider truly is not in your insurance network. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Ways to Pay Off Medical Bills If You Don't Have Healthcare Coverage

    The impact of health insurance premiums and treatment costs continues to be a major concern for consumers. In addition, a recent industry survey indicated that 77% of consumers struggled using their health insurance in the past year. While we anticipate what's to come on the healthcare landscape, here are some ways to pay off medical bills, reduce and or at least manage your medical costs, with or without insurance. Speak Up: Let your healthcare provider know how medical costs can impact your personal situation. Most providers provide quality care. Sometimes, this could mean extra costs to you. However, if you plainly explain to your doctor your concerns and are seeking ways to keep them in line while effectively treating your condition, s/he can prepare a treatment plan with this in mind. Unnecessary Procedures: Understanding your sensitivity to costs, your physician might eliminate less necessary tests or delay tests, if possible, without compromising your situation. Generic Medications: Costing up to 80% less and just as effective as brand names is a good way to reduce the prices of your prescriptions. There are a number of good resources for this. Online Research: Do your homework before the procedure to compare costs in your area. Use this information as a guideline. Remember, there are many factors in determining why a procedure costs what it does. In addition, contact your own insurance plan or use their cost estimator tool. Right Facilities: Urgent care clinics can cost a fraction of hospitals and emergency rooms when it comes to doing procedures, tests or blood tests. These are good for non-emergency care. Cash Payments: If you can pay cash, ask about cash discounts. It's less work for the administrative offices. Payment Plan: Avoid putting a large medical bill on a credit card. Instead, ask if you can pay using a pay plan. Most providers offer this and in some hardship cases, they might even reduce what you owe. Find out what your doctor's payment options are. Medical Advocates: For complicated cases, a medical or patient advocate offers services including helping to research treatment options, tracking paperwork and negotiating lower rates. You may have to pay a fee but it can help unravel complex paperwork or lower outstanding medical costs. Billing Mistakes: Check your explanation of benefit (EOB) statements to make sure they are correct. Compare them to your actual bill. Industry studies suggest many bills contain errors because of incorrect coding and other reasons. Do not hesitate to call the billing department or your insurance plan's support hotline to get to the bottom of the bill if you suspect it is incorrect or simply want clarification. Understand Your Medical Insurance: Make sure your insurer is still in your market and that your provider and facility remains in-network. Many consumers are shocked when they receive a bill they thought would be covered by their insurance only to find out the provider or the facility was out of network with their plan. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • The Health Insurance Process - When the Patient Gets Stuck

    Studies show that ER costs make up the biggest portion of amounts owed from insured and uninsured patients struggling to pay medical bills! The health insurance process in this case could mean a substantial cost sharing burden for a consumer. In Network or Not? Did you know that about 66% of emergency room doctors are independent contractors who may or may not be in your insurance plan? And in a practice called balance billing, any out-of-network provider or lab can bill you for whatever your insurance does not cover. You might receive bills from several entities, some of which you never even met! What is an out-of-network provider mean? This is a healthcare professional that does not have a contract with an insurance plan. Therefore, the provider does not have to accept the insurance's allowable amount as payment in full. The Ambulance Think about the ambulance too. If the ambulance company that takes you to the ER does not hold a contract with your insurance, you could be on the hook for more than $2,000.00 depending on where you live in relation to the ER and what level of care your receive prior to arriving at the hospital. Plus, if your insurance company concludes that an ER visit wasn't warranted, you might owe even more money. To avoid these nasty surprises, consider the following strategies: Insurance Policy It might sound rudimentary because it is. Ask your insurer what the plan does and does not cover in the event of emergency care. This includes the ER copay, coinsurance, and deductible - in and out-of-network. Many patients are surprised to learn there are different values for out-of-network care. Some plans even have a tiered payment system. Find out which area hospitals are in network with your insurance. Check with the hospital to see which ER doctors are in network in your insurance plan. Find out how your plan defines a medically necessary ambulance ride and what is required to appeal a non-payment decision. EMTs decide which hospital they will take you too but you can request a particular one. Request an in-network doctor when the admission forms are completed. Be aware, however, your insurance may deny the charge if you request a hospital further away and could have been treated at a location nearest you. Out-of-Network Bills If you get a bill for out-of-network charges that you could not prevent because of the emergency, then it's time to get to work. Ask your insurer if they'll cover the costs at the in-network rate. Contact the providers and ask what the insurance has already paid and ask them to settle for that or negotiate for a lower amount. About a quarter of US states have consumer protection laws that restrict providers from balance billing in certain care situations like emergencies. Some laws apply only to certain health plans or certain providers. Contact your state's insurance department for specifics. If all this fails, contact your insurance to determine what must be submitted to file an appeal and time limits for filing. Generally, documentation from the provider(s) will be required. In the case of an out-of-network situation, ask the doctor to provide a letter attesting to a good faith effort was made to utilize a contracted provider and no equitable access to such provider existed. It's not easy blending thoughts of payment with a medical emergency but it is something you can prepare for. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Why Review Your Health Plan's Explanation of Benefits

    Have you ever been surprised that you owe for a medical procedure because maybe you thought your insurance paid the entire amount? In fact, so surprised that you handle it by ignoring the multiple statements, phone calls and the explanation of benefit statement from your health plan (which is where it all begins)? What's on an EOB? Healthcare insurance providers are required by law to send a copy of the EOB to their patients. It can be labeled as a medical claim summary or medical summary notice as well as an explanation of benefits. Usually, in noticeable lettering, it will read: This is not a bill. Some of the information that will be on it includes: The name of the provider What services were provided (blood test, wound treatment, physical therapy, etc.) The amount your provider charged for your treatment The amount that the insurance company will pay, usually referred to as amount allowed (also called allowed charges, negotiated amount or allowed amount) Any co-pay you made The amount you will have to pay after you have met your deductible (coinsurance) The amount of the charges that your insurance company will pay The difference between what the insurance company will pay and what you were charged by your provider, also called not covered, not payable or pending. This is also the amount that you may be billed for. Below are important tips to remember when reviewing these statements: EOB Dos: Keep your EOB and when you receive your bill, compare them. They should match. Respond immediately to requests for information. Review the services you received and the dates they were performed to guard against billing fraud and identity theft. Check the coverage information section so you know exactly treatments that were or should be covered. Scan for double billing which can occur if more than one treatment or provider was used. Ensure your health plan benefits were correctly applied. EOB Don'ts: Ignore the EOB statement because it is not a bill. It is the foundation for the bill and deserves careful scrutiny. Be afraid to question anything that you are uncertain about. Fail to pursue any errors. Most healthcare insurers have numbers you can call to begin any dispute process. Forget to compare the EOB against the bill. Avoid educating yourself on all aspects of your medical life which is with you forever. Many patients ignore the important information contained in this document. Take responsibility for understanding the ins/outs of your health insurance plan or if you do not have one, ask questions upfront to prevent surprises. Understanding the EOB can help keep you out of collections! MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • How to Research Different Insurance Plans

    It's important to understand what kind of health insurance and to research different insurance plans before committing to one. The most common types include: Exclusive Provider Organization (EPO) A Health Maintenance Organization (HMO) Point of Service (POS) A Preferred Provider Organization (PPO) Medicare Medicaid An HMO limits coverage to treatment from doctors under contract to the HMO. Out-of-network care is usually not covered except for an emergency. The EPO is very similar. Users pay less if doctors and hospitals are in the network with a POS plan but referrals are required from the primary care doctor to see a specialist. A PPO is similar to a POS. User pay less with an in-network provider and can use providers outside the network without a referral but will pay more. Medicare and Medicaid are government run programs. Medicare's polices operate the same in all states because policies are set at the federal level. Medicaid is for low-income Americans and it operates differently in each state. There are also different type of catastrophic plans too. Deductibles, Co-pays, Co-insurance and Out-of Network Know your deductible, co-insurance and co-pay structure because this directly relates to what you will pay. Deductibles: Deductibles refer to the amount of money you pay each year before the insurance even kicks in to help pay your medical bills. It may be something like $2,500 for individuals and $5,000 for your family. Co-pays: This is a flat fee paid to your provider on each visit usually after the deductible is met. It may be something like $25.00. Co-insurance: The percentage of charges you will owe to your medical provider after the yearly deductible is met and the insurance has started paying on the claims. This is expressed in a percentage. For example: Your insurance will pay 80% of your doctor's bill while you owe 20%. In-Network vs. Out-of-Network: You might pay more for out-of-network healthcare professionals. This means if you are treated in a facility, group practice or individual healthcare professional who does not hold a contract and or a participating provider with your specific plan, your benefits are reduced or services may not be covered at all. If you will be having surgery or extensive medical treatment, obtain a list of anyone who could be involved in your treatment from the billing office and check with your provider to see if they are covered. If they are not and cannot be switched with another provider, know in advance what they will charge. Be aware as well, your plan may have an in-network AND out-of-network deductible, co-pay, and co-insurance. It is the out-of-network bills that typically result in sticker shock to consumers. Arming yourself with your plan benefits ahead of medical treatment will save you money and frustration. Best practice is to become your own best advocate by initiating expected financial obligation discussions with your healthcare provider. And remember, health insurance in general is complex. Everything differs from plan to plan and even from year to year. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • How to Achieve Healthcare Cost Transparency

    It's no secret that medical billing is complex and specialized. In fact, it has always been interesting at how difficult it appears to be to find out what a medical procedure costs - because there are many factors that contribute to that cost. The internet can provide a range but often, the reality can be quite different because each patient presents different conditions. It seems like it should be as easy as finding out the price of a root canal, a new set of brakes or even a car. But, it's not. Now, though, as the medical landscape changes, we are bearing more of our health care costs than ever. For example, a recent report from the Commonwealth Fund suggested that 21% of adults with healthcare insurance spend 5% or more of their income on out-of-pocket healthcare costs. This means that doctors are increasingly getting asked about how much they charge for a procedure they recommend. Driven by these changes, many providers are working to improve healthcare cost transparency. The Healthcare Financial Management Association (HFMA) even has a task force working on this issue. Who's in the Know? For starters, you can request an estimate from your healthcare provider. Who at your doctor's office is responsible for providing cost information? Is it the billing department, a customer service area, a concierge, coders? Providers need to decide and then make sure those responsible for disseminating cost information have access to relevant data so the figures provided are accurate. According to the HFMA, the objective is to provide timely and meaningful cost information in advance of receiving services. It's Complicated When doing due diligence on prices from multiple sources, which is becoming increasingly common for healthcare services, complications can arise because if only gross estimates are used, they do not take into consideration the allowed amount from insurance plan benefits which can significantly impact the costs. Another reason for the complications is that procedure costs can vary according to patient conditions. Understand too that an estimate is only an estimate. What is black and white are your in/out-of-network individual/family deductibles, co-insurance, and co-pays. It is also recommended to speak with your insurance plan directly to verify any coverage guidelines for your procedure before it occurs. This will help to prevent any surprises your doctor's office may have overlooked. An Ally In the quest for medical cost transparency, under the Affordable Care Act, hospitals are required to list standard charges for items and services and make those lists available to patients. This just a beginning but it has prompted healthcare facilities to begin focusing on transparency which in turn will improve healthcare patient experience. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

  • Coping With Medical Bills From Multiple Providers

    There is an issue that has had a lot of coverage and continues to surface as a major source of frustration and distress for patients and others involved in the medical billing industry. The problem is this: as many hospitals and larger medical health networks are acquiring independent physician practices and clinics, patients are often finding that after the acquisition, they end up paying double or more for the very same doctor visits. Medical bills from multiple providers deserves a lot of attention as you weed out some of the major issues and mistakes that can end up costing you hundreds more dollars for medical care. Where Do Facility Fees Come From? The origin of the facility fee system is that government entitlement programs and insurance companies began to consider these extra costs justified for offices that were part of greater medical networks - the reasoning is that hospitals and medical networks need more money, in order to maintain their larger business operations. However, when a medical business simply takes over a doctor's office and charges double, patients, consumer advocates and even insurance companies argue that no extra value is provided and no extra cost should be assessed, especially for patients who have to pay all of this money out of pocket and can't afford the extra charges. Place of Service Can Mean a Different Policy Not all facilities charge facility fees for a doctor visit. Some hospitals and networks don't charge facilities fees at all for visits to a particular office, and some only charge the facility fee when there is a procedure involved, rather than just a doctor consultation. But some of the hospitals and medical networks charging the highest facility fees for non-procedure visits are finding themselves on the receiving end of some legal challenges from consumers. Consumer Responses Many of those who understand the practice of billing facility fees are arguing that these sorts of expenses wouldn't be justified in any other industry. In many ways, it simply doesn't make sense to charge patients extra simply because of a change in management or an acquisition. Patients are initiating class-action lawsuits against some hospitals, and in some cases, winning. Become proactive in managing future medical bill costs. When you learn that your doctor has merged with a large healthcare network, ask what additional fees may be charged and what services will prompt a facility fee. Or, if this is the first time you will receive treatment from this provider, request a run down of who will be billing you before receiving services. Small steps like these can prepare you mentally and financially. MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at

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