Most consumers’ sign up for health insurance plans without fully understanding the 100+ pages of detail that go over the plan specifics.  In fact, most of us select our health plans based a high-level  outline and never bother to read the fine print details that describe coverage limitations that spells out what’s covered and what’s excluded, identifies lifetime limits/coverage caps , deductible terms--- basically things you need to know so you can understand the out-of-pocket you will be expected to pay.  It’ all very confusing and complicated.  And let’s face it, it’s written in a language that consumers find it practically impossible to understand. 

 

An article in the Wall Street Journal written by Anna Wilde Mathews, The Importance of Deciphering Your Insurance, does an excellent job describing the consequences and complications resulting from not understanding your health policy.  Anna describes how confusing this is to consumers and discusses some specific situations where consumers were stuck with large medical bills because they did not understand their coverage limitations (the fine print) when they purchased their health policy.

 

Some things to look over very carefully when evaluating a health policy:

·         Know your out-of-pocket maximum, which represents the most you should have to pay for care in a given year

·         Pay attention to the terms of your deductible

·         Understand how your plan covers out-of-network providers

·         Check for excluded benefits and coverage caps, including lifetime and annual limits on payouts

·         Know what services are covered and what services are not covered

 

Urgent care centers are an affordable option for patients needing non-critical medical care. At urgent care centers, patients are treated by highly trained staff of physicians, nurses and health care technicians for many non-critical medical problems.  If you haven’t heard of urgent care centers, perhaps you are more familiar with some of the other names they are called:

• Immediate Care
• Convenient Care Clinic
• Express Care Center
• After-hours Facility
• Minor Illness & Injury Center
• On-call Doctor/ Physician
• Quick Care Center
• Now Care Facility
• Prompt Care Clinic

The centers are typically open late nights; require no appointments, accept insurance or cash payment and walk-ins are welcome.  The centers usually guarantee you will receive medical care in less than 30 minutes and their services cost considerably less than visiting an emergency room. 

To find an urgent care center near you, you can use search engines:

• Google - search on urgent care and include your city/state
• Bing - search on urgent care and include your city and state
• Find Urgent Care - a directory to help consumers find centers in their area

If you are a savvy consumer you probably review all the bills you receive before you pay them, to make sure they are accurate. This is a really good habit. Have you ever received a bill that was not yours, or a credit card statement with charges that are not yours, or the wrong discount/sale price taken off your retail purchase, or cell phone charges that you should not have been billed for? This happens to consumers all the time. Human errors, billing errors, software updates – there are lots of reasons these errors occur. Whenever you receive a bill for health care services, utilities, charge card statements, electronic purchases and sometimes even groceries – you should take a minute to review the bill for accuracy. When you purchase an item on sale, or use a coupon, don’t you always look at your receipt to make sure you were charged the right amount? This same "double checking" rule applies to medical services. When you receive a bill (or statement) from a provider or an EOB from your insurer, take a minute to review the information to make sure it is accurate. If you have a health insurance policy that covers screenings, office visits and lab tests, make sure you are not being billed for these services.

You also need to review your health plan coverage very carefully so you know exactly (1) what services (exams and lab tests) are covered at 100%; (2) what services you will be billed for; and (3) what percentage you are expected to pay for these services. Some employer health plans are starting to cover 100% of the full cost of routine exams and preventive services (such as physicals, colonoscopies and mammograms) to help employees stay healthy. This can be a great benefit, but if you’re not careful, you might erroneously get billed for these services. Patients are sometimes billed for preventive screening exams that their health plans cover at 100% because of errors in billing/coding at the doctor’s office. Patients can unknowingly receive care that their health plans don’t consider preventative.

Always review your bills for errors. An article in the Healthy Consumer in last week’s Wall Street Journal discusses why patients may be billed for free exams.

What if consumers could shop for radiology tests (MRI, CT scan, ultrasound, x-ray, mammogram, DEXA, PET, and fluoroscopy), the same way they shop for hotels and airline tickets? 

Radiology tests like MRI and CT scans have become key tools for physicians to help diagnose and monitor disease. It's no surprise that diagnostic imaging has become one of the fastest growing segments of healthcare, consuming billions of dollars per year. In fact we will spend over $20 billion in 2009 just on MRI scans alone.

Many consumers are increasingly forced to burden the costs of these high-tech medical tests through high deductible plans, often paying hundreds of dollars out of pocket for a scan. And uninsured consumers are faced with costs that can easily run into the thousands of dollars. For example, a Lumbar Spine MRI scan performed at a hospital can cost an uninsured consumer $3,000.

Healthcare is still mired in complex and opaque pricing strategies that make it difficult, if not impossible, for uninsured consumers to discover the real costs of Radiology tests and receive the same prices that health insurance companies enjoy. Fortunately there are technology companies, like RemakeHealth, that are building online resources to help healthcare consumers.

RemakeHealth recently launched its Radiology shopping website which lets consumers look up prices for nearly any outpatient Radiology test, find a local certified imaging center and purchase the test with a credit card. Radiology tests featured include X-rays, MRI scans, CT scans, Ultrasounds and more. All the imaging center providers on the website are certified by the American College of Radiology and staffed by American Board of Radiology certified Radiologists.

RemakeHealth acts like a travel agent and has negotiated prices for uninsured consumers in advance. When consumers purchase a test they receive concierge like services which include a personal phone call to set up the appointment and answer any questions about the test.

RemakeHealth is also working to eliminate confusing healthcare pricing schemes. For example a Brain MRI usually has 3 different prices: without dye, with dye, with and without dye. They have simplified this by offering one price and not charging extra for dye injections. Consumers are also often unaware of large price variations that occur between facilities in the same town. RemakeHealth has addressed this by creating one price for each type of test in each of their local service areas.

The company was founded by Dr. Ravi Sohal, who is a Radiologist, and its cofounders are from the Radiology industry as well. The founders have dedicated themselves to helping uninsured consumers make informed decisions by building healthcare shopping tools similar to the ones we all enjoy when looking to buy nearly everything else online.  They have always been amazed that you can shop for an airline ticket and hotel room but not for an X-ray and MRI scan, until now.

 

NeedyMeds is a non-profit organization that provides information about assistance programs that are available to low-income patients and their advocates.  The NeedyMeds website provides access to a wealth of databases of information on clinics and patient assistance programs including:

 

Low-Cost Medicine Programs

 

Patient Assistance Programs provide free or low-cost medicine to low-income people who are uninsured or under-insured.  

 

Additional Assistance Programs (PAPs)

·         Application Assistance is a resource of organizations that will help you find and apply for PAPs for free or a small fee.

·         Disease-Based Assistance programs that help with the costs associated with specific diseases or conditions.

·         Government Programs are state and federal programs that assist low-income residents.

·         Discount Drug Cards provider consumers with discounts on prescription medication.

 

Free/Low Cost Clinics

 

The NeedyMeds database identifies more than 4,000 clinics that are free or low cost with a sliding scale base on income.  To find a clinic in your area, click on a map. 

 

Discount Drug Cards

 

There are many different types of drug discount cards. Some offer significant savings while others are not a good deal. Drug company discount cards offer discounts only for certain medications while others offer a wide range of discounts. You may find it best to use certain cards for some medications and others for other medications.

 

1.       Drug Company Discount Card

2.       State Discount Cards

3.       NeedyMeds Drug Discount Card

 

To learn more about these programs, visit the NeedyMeds website.