We’ve all heard the stories of the emergency room claim that cost $10,000 for a broken thumb, or the person who had to file bankruptcy for huge bills while using their HMO’s out-of-network. These stories have been fueling debate over what should be done with our nation’s health care system. The truth is that these stories happen far more often than most people realize, and many people have misconceptions about how this happens. That’s why it’s important to have the right billing network in place to take advantage of the most favorable, predetermined pricing available.
Let’s take a look at some scenarios where one person is stuck with high medical bills and the other is safe. Let’s say two people go to the emergency room with the same injury, one has adequate health insurance and the other has nothing. The emergency room will know immediately that each patient will be billed separately. Individuals with the right network billing plan will be able to take advantage of a nationwide network, allowing you predetermined pricing for any medical condition. The second will depend on what the emergency room decides to charge. Depending on the medical condition, the payment difference can exceed tens of thousands of dollars. The problem is that you must have access to a participating billing network in order to receive this predetermined billing.
When you look closely at how these billing networks work it becomes clear where you can be exposed, especially on smaller networks. No one knows this better than the self-employed and those who don’t get insurance through work. When an individual buys health insurance on the exchange (Healthcare.gov), the only network options available in Texas are HMOs, or restricted networks. These networks are created to share losses for the insurance company and the medical institution, while hoping to bring in a higher volume of patients to offset claims. Even these smaller types of HMO networks can have large holes in their billing networks. For example, if a person had surgery within their HMO network, they may still be in for an unpleasant surprise when the final bill arrives. Although their surgeon is likely to be covered, both the billing for the anesthesiologist and the surgical equipment rented for the surgery may be outside the HMO network, costing the patient thousands of dollars to pay. You guessed it, not a word of warning, just a bill that health insurance won’t cover well after surgery.
The only way to avoid the small HMO network pricing trap is to take advantage of the much larger billing networks, which can leave you with unexposed pitfalls. Hundreds of thousands of doctors and medical institutions may participate in these large networks, or providers, from coast to coast. Many of these nationwide networks mandate the primary, or leading, billing method for their preferred discount, thereby protecting the patient’s financial interests from any risk of overcharging. In fact, these predetermined pricing modules are so accurate that some insurance companies tailor their coverage to reflect preferred billing, therefore limiting out-of-pocket costs by thousands of dollars. Those who use this service can rest assured knowing that their interests will be protected by moving from the correct billing network to the unrestricted network across the country.
Although these billing network giants are elusive in today’s ACA health insurance environment, they do exist across the country, including in Texas. In fact, I’ve helped dozens of clients take advantage of these unrestricted networks over the past few months at far more reasonable premiums than ACA policies. It is important to consider network billing plans when choosing the right health insurance plan for your family, especially for those who do not qualify for subsidies (federal income credits given to people with limited financial means). To protect your financial interests, it is important to speak with a health insurance professional who has access to these unrestricted billing networks.
Source by Cal J Burgess
