Global Courant
We’ve all heard the stories about the emergency room claim costing $10,000 for a broken thumb, or the person who had to file for bankruptcy because of the huge bill while using a network outside of their HMO. These stories have fueled debates about what should be done with our nation’s healthcare system. The truth is that these stories are more common than most people realize, and many have a misconception about how this happens. That’s why it’s crucial to have the right billing network in place to take advantage of the most favorable predetermined prices available.
Let’s look at some scenarios where one person is stuck with a huge medical bill and the other is protected. Suppose two people walk into an emergency room with the same injury, one has adequate health insurance and the other does not. The ER will know immediately that each patient will be billed differently. The person with the right network billing plan can take advantage of a nationwide network, allowing for predetermined pricing for just about any medical condition you can name. The other is at the mercy of what the emergency department decides to charge. Depending on the medical condition, the difference between what is paid out can be in the tens of thousands of dollars. The catch is, in order to receive this predetermined billing, you must have access to the participating billing network.
When you take a closer look at how these billing networks work, it becomes clear where you may be exposed, especially on smaller networks. No one knows this better than the self-employed and those who are not offered insurance through their work. When a person buys health insurance on the stock exchange (Healthcare.gov), the only network options available in Texas are HMO or limited networks. These networks are formed for the insurance company and medical facility to share losses, hoping to attract excess patients to offset the claims. Even this smaller type of HMO networks can have big holes in their billing networks. For example, if a person is undergoing surgery within their HMO network, they may still be in for a nasty surprise when the final bill comes. While their surgeon is likely covered, both the anesthesiologist and the surgical instruments rented for the surgery could fall out of HMO’s billing network, forcing the patient to pay thousands of dollars. You guessed it, not a word of warning, just a bill that health insurance won’t cover properly after surgery.
The only way to avoid a small HMO network price trap is to use much larger billing networks so you can avoid the uncovered pitfalls. Hundreds of thousands of physicians and medical institutions from coast to coast can participate in these larger networks, or providers. Many of these nationwide networks mandate that their preferred discount be the primary, or front-runner, method of billing, protecting the patient’s financial interests from any threat of overpricing. In fact, these predetermined pricing modules are so precise that some insurance companies shape their coverage to reflect preferred billing, cutting out-of-pocket costs by thousands of dollars. Those who use this service can rest easy knowing that their interests are protected in the future by the right billing network with unlimited nationwide networks.
While these billing network giants are elusive in today’s ACA health insurance environment, they exist across the country, including Texas. In fact, in the last few months alone, I’ve helped dozens and dozens of customers take advantage of these unlimited networks, at much more reasonable premiums than ACA policies. It’s important to consider network billing plans when choosing the right health insurance plan for your family, especially for those who don’t qualify for a subsidy (federal income credit for those with limited financial resources). It is extremely important to speak with a health insurance company that has access to these unlimited billing networks to protect your financial interests.
Repricing health insurance claims
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