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.

 

If you have major medical bills and need assistance in making sense of these bills, there are a number of bill review services available that will provide you with advice.  Some of these organizations provide assistance before services are provided, others help review medical bills after the services were provided, to determine if you were overcharged.

 

Here are some resources that can help you make sense of your bills.  Keep in mind that some of these organizations offer help -- for a fee.

 

Claims Assistance Professionals

HealthCare mediation LLC

Health Proponent

Health Champion

Hospital Bill Review

ICS Healthcare (Ingenix)

Medical Cost Advocate

INSNet

Patient Advocate Foundation

Patientcare

 

 

To shed some light on health care prices, Anna Wilde Mathews wrote an interesting article in last week’s Wall Street Journal about how much it costs to have a baby.  She researched prices at hospitals in advance and broke down the different expenses she incurred after her baby was delivered.   She certainly takes the mystery out of how much it can cost to deliver a baby as she reviews some of the itemized costs that appeared on her invoice from the hospital.

 

If you are expecting a baby and have the opportunity to research prices in advance, take her advice and do your homework to eliminate the guesswork on how much out of pocket expenses you will be responsible for.  Here are some interesting charges from her report:

 

ITEM	CHARGE
Total delivery charge for three days in the hospital	$ 36,625
Aetna’s negotiated (discounted)  total	$ 17,300
2006 average nationwide negotiated total	$   6,898

 

Miscellaneous items and charges on the hospital bill:

 

ITEM	CHARGE
Epidural anesthetic injection	$    530
Hospital’s resources for providing the epidural	$ 2,152
Anesthesiologist’s fee	$ 1,530
90 minutes in recovery after delivery	$ 2,382

 

Your actual costs will be based on your deductibles, co-pays co-insurance, the new baby’s deductible, out-of-pocket maximum and the specific services provided by the hospital.

 

Thank you Anna for sharing this information with other consumers!  If you have some interesting prices to share with consumers, please add them to the OutofPocket.com directory by clicking here.

 

If you are insured, selecting a health care provider that is not in your network can cost you more out of pocket.  Network providers in your health plan have discounted rates for their services.  Non-network providers do not provide this discount and you’ll end up paying more for their services.  Sometimes the specialist, or provider that came so highly recommended with the highest quality ratings, is not in your network.  How should you approach this to make the most of your health care dollars?  Here are things to consider when deciding to use in-network versus out-of-network providers.

Quality is very important.  You want to find the highest quality provider that offers the best value.

Get cost estimates from the hospital and the physicians, and try to find out if there are any supplemental fees you can avoid.

Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider "reasonable and customary."  This may be a lot less than what the hospital and doctors charge, and you'll be responsible for the difference.  Find out if your insurance company will pay the entire "reasonable and customary" portion, or if you'll be responsible for some of it due to deductibles or co-insurance.

Ask providers if they are willing to accept your insurance company's payment for their services as payment in full, especially if they work in a hospital that's covered by your plan.   Make sure you take care of this before services are provided.

Negotiate with the provider and even offer to pay cash at time of service for special discounts.  Know what payment amount Medicare allows for this service. If you need help finding out this information, send me an email and I will walk you through the steps on how to find this information.  Know what payment amount your health plan allows for an in-network provider for this same service.  Information can be powerful. 

Millions of people every day struggle to contain their health care costs. The National Center for Health Care Statistics reports 43 million people under the age of 65 do not have health insurance.

Consumer driven health care has arrived on the scene to try and generate competition within the health care market. Consumers need to be more aware of the hidden health care costs, and start holding the health care industry accountable.

A key area neglected due to rising health care costs is proper laboratory testing. Does your family have a history of any of the following: heart disease (652,091 deaths / year), cancer (559,312 deaths / year), diabetes (75,119 deaths / year)? Many people may not want to incur the cost going to a doctor for a lab order, and then having to pay for the lab. Many should have a lab test done every 6 months – 1 year. These costs can pile up quickly when paying full price out of pocket. Having your lab tests done at your doctor’s office can be a lot more expensive than having your lab test(s) done at a stand-alone facility, or ordering your lab tests online. Today, consumers will find a number of websites where they can order lab tests online at a discounted price. One of these sites you should definitely check out is PrePaidLab.

As consumer driven health care expands, we now have the ability to take control of our own health care management via the Internet. PrePaidLab is committed to help health care consumers control costs. PrePaidLab offers the ability to browse and order several hundred lab tests through a secure shopping cart. Tests can be ordered with or without a doctor’s order. In most cases receipts can be submitted to an insurance carrier (if applicable) and the cost of the test will be applied towards the deductible.

Consumers should compare prices with cash pay and other Internet based lab sites. PrePaidLab provides deep consumer savings, and a pleasant customer experience. They have a friendly customer service staff that is available to assist you in finding tests, and answering any questions regarding the process.

If you have never ordered lab tests online before, PrePaidLab has outlined the five easy steps to this process:

(1) LOCATED A LAB NEAR YOU. Check to see if there is a PrePaidLab Laboratory center near you. PrePaidLab uses only nationwide CLIA-certified Medical Reference Laboratories with Patient Service Centers close to where you live or work for the blood draw.

(2) SELECT THE LAB TEST YOU NEEED. Go to PrePaidLab and browse the test categories on the left side of the page. There is also a search box on the top left you if you know the test name.

(3) PROVIDE INFORMATION TO ORDER THE TEST. Select your test and fill out the order form and payment information. A HIPAA form is also available which can be used to give PrePaidLab permission to release the results of the lab directly to your physician via fax.

(4) RECEIVE LAB ORDER REGISTRATION. In 48 - 72 hrs you will receive an email from the PrePaidLab secure email system containing the Lab Order Requisition Form. This needs to be printed out and taken to the Laboratory center at your convenience. The requisition tells the Laboratory Technician what test(s) needs to be performed, and shows that you have paid for the lab service.

(5) RECEIVE YOUR LAB RESULTS. 48 - 72 hrs after the lab work is completed; PrePaidLab will send another secure email containing the lab results.

Take control of your health care costs today!