Transparency?
December 31, 2007 | General
I tend to think that there’s an entire language in the healthcare industry that only a certain few understand. Navigating through hospital bills and healthcare claims can be confusing. We tend to accept at face value what our healthcare facilities and providers charge for services. How much of the medical bill is negotiable? How many even know that negotiating is even an option?
The insurance industry, like any other, is a for profit business. I’m sure we’d like to think that it’s really about the quality of care we receive, but we know better. Whether insured or not, people shouldn’t have to sell their souls to pay for big medical bills. They shouldn’t be forced to beg for donations, acquire credit card debt, sell their home and be bothered by collection agencies. I understand there are advocates for people who need assistance. But if the same people cannot afford to pay their medical bills, how can they afford to pay for an advocate.
I’ve heard so many say that Americans need to take control and responsibility for their healthcare. So I ask you this… to whom must I to turn to for answers? What questions should I be asking? In an age of technology and information, why is the healthcare industry not transparent?
RSS
Comment by Vid B December 31, 2007
Health insurance industry thrives on total control, lack of transparency and complexity.
In any case, whether you are insured or not, you are likely to get huge bills from the hospitals. These hospitals tend to bill at exorbitant rates; generally at 1000 - 2000% more than reasonable rates. If you are ready to spend a few minutes, you can save thousands of dollars. Here is how.
When you get hospital bills, ask for industry standard procedure codes for each and every line item in the bills. They are called CPT (Current Procedural Terminology) codes that are maintained by American Medical Association. They are legally required to provide to the patients. Once you ask this, it is possible that they would not provide; if so, their bills are NOT legally valid.
If they provide CPT codes, go to https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp ; here, you select your state, region and enter the CPT code and you will get the rates for that procedure. This is the rate used by the Government for Medicare reimbursements. You may have to pay slightly more than this amount. Generally doctors call about 60% more than this rate as ‘fantasy rate’. It gives you an idea and you can negotiate for anything between medicare rate and medicare+60%. Will the hospitals agree? You have to understand that anything unreasonable is NOT legally valid and the hospitals know that. So, hospitals can not legally claim more than medicare+60%.
If you need more info, go to http://www.cms.hhs.gov/PhysicianFeeSched/PFSNPAF/list.asp?listpage=2
Remember to make all requests to hospital in writing.
Hope this is helpful for those who receive huge hospital bills.
Bye
BeInformed
Comment by Mona January 2, 2008
As a consumer advocate for health care price transparency, I launched a website to help consumers look-up and compare prices to find the best value for routine health care services. The website, http://www.outofpocket.com, is a platform for collecting and sharing that relies on consumer collaboration. My goal is to increase consumer price awareness, enable consumers make the most of their health care dollars, and encourage more competition and consumer-choice in the industry.
Every consumer is invited to use this free website to look up prices to help make informed decisions before purchasing routine health care services. Prices in the OutofPocket.com directory are collected from several sources including:
Consumer Generated Content: Consumers anonymously post prices they paid for routine health care services, (including MRIs, mammograms, X-rays, lab tests, vaccinations, dental, vision and office visits), along with their personal recommendations on the provider
Providers that Disclose Pricing: Providers are invited to submit prices for their services for inclusion in the directory
Government CMS: Medicare payment data for common medical procedures is loaded in the directory
Please take a minute to visit http://www.outofpocket.com and let me know what you think. I welcome any comments you would like to share on this grassroots price transparency initiative.